Patent Publication Number: US-2023146947-A1

Title: Method of hub communication with surgical instrument systems

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation application claiming priority under 35 U.S.C. §120 to U.S. Pat. Application Serial No. 16/172,328, entitled METHOD OF HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS, filed Oct. 26, 2018, now U.S. Pat. Application Publication No. 2019/0125459, which claims the benefit of U.S. Provisional Pat. Application Serial No. 62/659,900, entitled METHOD OF HUB COMMUNICATION, filed Apr. 19, 2018, the disclosure of which is incorporated by reference herein in its entirety. This application is a continuation application claiming priority under 35 U.S.C. §120 to U.S. Pat. Application Serial No. 16/172,328, entitled METHOD OF HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS, filed Oct. 26, 2018, now U.S. Pat. Application Publication No. 2019/0125459, which also claims the benefit of U.S. Provisional Pat. Application Serial No. 62/665,128, entitled MODULAR SURGICAL INSTRUMENTS, filed May 1, 2018, of U.S. Provisional Pat. Application Serial No. 62/665,129, entitled SURGICAL SUTURING SYSTEMS, filed May 1, 2018, of U.S. Provisional Pat. Application Serial No. 62/665,134, entitled SURGICAL CLIP APPLIER, filed May 1, 2018, of U.S. Provisional Pat. Application Serial No. 62/665,139, entitled SURGICAL INSTRUMENTS COMPRISING CONTROL SYSTEMS, filed May 1, 2018, of U.S. Provisional Pat. Application Serial No. 62/665,177, entitled SURGICAL INSTRUMENTS COMPRISING HANDLE ARRANGEMENTS, filed May 1, 2018, and of U.S. Provisional Pat. Application Serial No. 62/665,192, entitled SURGICAL DISSECTORS, filed May 1, 2018, the disclosures of which are incorporated by reference herein in their entireties. This application is a continuation application claiming priority under 35 U.S.C. §120 to U.S. Pat. Application Serial No. 16/172,328, entitled METHOD OF HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS, filed Oct. 26, 2018, now U.S. Pat. Application Publication No. 2019/0125459, which also claims the benefit of U.S. Provisional Pat. Application Serial No. 62/649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,307, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS, filed Mar. 28, 2018, of U.S. Provisional Pat. Application Serial No. 62/649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES, filed Mar. 28, 2018, and of U.S. Provisional Pat. Application Serial No. 62/649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER, filed Mar. 28, 2018, the disclosures of which are incorporated by reference herein in their entireties. This application is a continuation application claiming priority under 35 U.S.C. §120 to U.S. Pat. Application Serial No. 16/172,328, entitled METHOD OF HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS, filed Oct. 26, 2018, now U.S. Pat. Application Publication No. 2019/0125459, which also claims the benefit of U.S. Provisional Pat. Application Serial No. 62/611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, of U.S. Provisional Pat. Application Serial No. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, and of U.S. Provisional Pat. Application Serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosures of which are incorporated by reference herein in their entireties. This application is a continuation application claiming priority under 35 U.S.C. § 120 to U.S. Pat. Application Serial No. 16/172,328, entitled METHOD OF HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS, filed Oct. 26, 2018, now U.S. Pat. Application Publication No. 2019/0125459, which also claims the benefit of U.S. Provisional Pat. Application Serial No. 62/578,793, entitled SURGICAL INSTRUMENT WITH REMOTE RELEASE, filed Oct. 30, 2017, of U.S. Provisional Pat. Application Serial No. 62/578,804, entitled SURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OF END EFFECTOR MOVEMENT, filed Oct. 30, 2017, of U.S. Provisional Pat. Application Serial No. 62/578,817, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed Oct. 30, 2017, of U.S. Provisional Pat. Application Serial No. 62/578,835, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed Oct. 30, 2017, of U.S. Provisional Pat. Application Serial No. 62/578,844, entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES, filed Oct. 30, 2017, and of U.S. Provisional Pat. Application Serial No. 62/578,855, entitled SURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS, filed Oct. 30, 2017, the disclosures of which are incorporated by reference herein in their entireties. 
    
    
     BACKGROUND 
     The present disclosure relates to various surgical systems. Surgical procedures are typically performed in surgical operating theaters or rooms in a healthcare facility such as, for example, a hospital. A sterile field is typically created around the patient. The sterile field may include the scrubbed team members, who are properly attired, and all furniture and fixtures in the area. Various surgical devices and systems are utilized in performance of a surgical procedure. 
     Furthermore, in the Digital and Information Age, medical systems and facilities are often slower to implement systems or procedures utilizing newer and improved technologies due to patient safety and a general desire for maintaining traditional practices. However, often times medical systems and facilities may lack communication and shared knowledge with other neighboring or similarly situated facilities as a result. To improve patient practices, it would be desirable to find ways to help interconnect medical systems and facilities better. 
     The present disclosure also relates to robotic surgical systems. Robotic surgical systems can include a central control unit, a surgeon’s command console, and a robot having one or more robotic arms. Robotic surgical tools can be releasably mounted to the robotic arm(s). The number and type of robotic surgical tools can depend on the type of surgical procedure. Robotic surgical systems can be used in connection with one or more displays and/or one or more handheld surgical instruments during a surgical procedure. 
     The present invention also relates to surgical systems and, in various arrangements, to grasping instruments that are designed to grasp the tissue of a patient, dissecting instruments configured to manipulate the tissue of a patient, clip appliers configured to clip the tissue of a patient, and suturing instruments configured to suture the tissue of a patient, among others. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various features of the embodiments described herein, together with advantages thereof, may be understood in accordance with the following description taken in conjunction with the accompanying drawings as follows: 
         FIG.  1    is a block diagram of a computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  2    is a surgical system being used to perform a surgical procedure in an operating room, in accordance with at least one aspect of the present disclosure; 
         FIG.  3    is a surgical hub paired with a visualization system, a robotic system, and an intelligent instrument, in accordance with at least one aspect of the present disclosure; 
         FIG.  4    is a partial perspective view of a surgical hub enclosure, and of a combo generator module slidably receivable in a drawer of the surgical hub enclosure, in accordance with at least one aspect of the present disclosure; 
         FIG.  5    is a perspective view of a combo generator module with bipolar, ultrasonic, and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present disclosure; 
         FIG.  6    illustrates individual power bus attachments for a plurality of lateral docking ports of a lateral modular housing configured to receive a plurality of modules, in accordance with at least one aspect of the present disclosure; 
         FIG.  7    illustrates a vertical modular housing configured to receive a plurality of modules, in accordance with at least one aspect of the present disclosure; 
         FIG.  8    illustrates a surgical data network comprising a modular communication hub configured to connect modular devices located in one or more operating theaters of a healthcare facility, or any room in a healthcare facility specially equipped for surgical operations, to the cloud, in accordance with at least one aspect of the present disclosure; 
         FIG.  9    illustrates a computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  10    illustrates a surgical hub comprising a plurality of modules coupled to the modular control tower, in accordance with at least one aspect of the present disclosure; 
         FIG.  11    illustrates one aspect of a Universal Serial Bus (USB) network hub device, in accordance with at least one aspect of the present disclosure; 
         FIG.  12    illustrates a logic diagram of a control system of a surgical instrument or tool, in accordance with at least one aspect of the present disclosure; 
         FIG.  13    illustrates a control circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present disclosure; 
         FIG.  14    illustrates a combinational logic circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present disclosure; 
         FIG.  15    illustrates a sequential logic circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present disclosure; 
         FIG.  16    illustrates a surgical instrument or tool comprising a plurality of motors which can be activated to perform various functions, in accordance with at least one aspect of the present disclosure; 
         FIG.  17    is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described herein, in accordance with at least one aspect of the present disclosure; 
         FIG.  18    illustrates a block diagram of a surgical instrument programmed to control the distal translation of a displacement member, in accordance with at least one aspect of the present disclosure; 
         FIG.  19    is a schematic diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present disclosure; 
         FIG.  20    is a simplified block diagram of a generator configured to provide inductorless tuning, among other benefits, in accordance with at least one aspect of the present disclosure; 
         FIG.  21    illustrates an example of a generator, which is one form of the generator of  FIG.  20   , in accordance with at least one aspect of the present disclosure; 
         FIG.  22    illustrates a combination generator, in accordance with at least one aspect of the present disclosure; 
         FIG.  23    illustrates a method of capturing data from a combination generator and communicating the captured generator data to a cloud-based system, in accordance with at least one aspect of the present disclosure; 
         FIG.  24    illustrates a data packet of combination generator data, in accordance with at least one aspect of the present disclosure; 
         FIG.  25    illustrates an encryption algorithm, in accordance with at least one aspect of the present disclosure; 
         FIG.  26    illustrates another encryption algorithm, in accordance with at least one aspect of the present disclosure; 
         FIG.  27    illustrates yet another encryption algorithm, in accordance with at least one aspect of the present disclosure; 
         FIG.  28    illustrates a high-level representation of a datagram, in accordance with at least one aspect of the present disclosure; 
         FIG.  29    illustrates a more detailed representation of the datagram of  FIG.  28   , in accordance with at least one aspect of the present disclosure; 
         FIG.  30    illustrates another representation of the datagram of  FIG.  28   , in accordance with at least one aspect of the present disclosure; 
         FIG.  31    illustrates a method of identifying surgical data associated with a failure event and communicating the identified surgical data to a cloud-based system on a prioritized basis, in accordance with at least one aspect of the present disclosure; 
         FIG.  32    illustrates yet another representation of the datagram of  FIG.  28   , in accordance with at least one aspect of the present disclosure; 
         FIG.  33    illustrates a partial artificial timeline of a surgical procedure performed in an operating room via a surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  34    illustrates ultrasonic pinging of an operating room wall to determine a distance between a surgical hub and the operating room wall, in accordance with at least one aspect of the present disclosure; 
         FIG.  35    is a logic flow diagram of a process depicting a control program or a logic configuration for surgical hub pairing with surgical devices of a surgical system that are located within the bounds of an operating room, in accordance with at least one aspect of the present disclosure; 
         FIG.  36    is a logic flow diagram of a process depicting a control program or a logic configuration for selectively forming and severing connections between devices of a surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  37    is a logic flow diagram of a process depicting a control program or a logic configuration for selectively reevaluating the bounds of an operating room after detecting a new device, in accordance with at least one aspect of the present disclosure; 
         FIG.  38    is a logic flow diagram of a process depicting a control program or a logic configuration for selectively reevaluating the bounds of an operating room after disconnection of a paired device, in accordance with at least one aspect of the present disclosure; 
         FIG.  39    is a logic flow diagram of a process depicting a control program or a logic configuration for reevaluating the bounds of an operating room by a surgical hub after detecting a change in the position of the surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  40    is a logic flow diagram of a process depicting a control program or a logic configuration for selectively forming connections between devices of a surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  41    is a logic flow diagram of a process depicting a control program or a logic configuration for selectively forming and severing connections between devices of a surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  42    illustrates a surgical hub pairing a first device and a second device of a surgical system in an operating room, in accordance with at least one aspect of the present disclosure; 
         FIG.  43    illustrates a surgical hub unpairing a first device and a second device of a surgical system in an operating room, and pairing the first device with a third device in the operating room, in accordance with at least one aspect of the present disclosure; 
         FIG.  44    is a logic flow diagram of a process depicting a control program or a logic configuration for forming an severing connections between devices of a surgical system in an operating room during a surgical procedure based on progression of the steps of the surgical procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  45    is a logic flow diagram of a process depicting a control program or a logic configuration for overlaying information derived from one or more still frames of a livestream of a remote surgical site onto the livestream, in accordance with at least one aspect of the present disclosure; 
         FIG.  46    is a logic flow diagram of a process depicting a control program or a logic configuration for differentiating among surgical steps of a surgical procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  47    is a logic flow diagram of a process  3230  depicting a control program or a logic configuration for differentiating among surgical steps of a surgical procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  48    is a logic flow diagram of a process  3240  depicting a control program or a logic configuration for identifying a staple cartridge from information derived from one or more still frames of staples deployed from the staple cartridge into tissue, in accordance with at least one aspect of the present disclosure; 
         FIG.  49    is a partial view of a surgical system in an operating room, the surgical system including a surgical hub that has an imaging module in communication with an imaging device at a remote surgical site, in accordance with at least one aspect of the present disclosure; 
         FIG.  50    illustrates a partial view of stapled tissue that received a first staple firing and a second staple firing arranged end-to-end, in accordance with at least one aspect of the present disclosure; 
         FIG.  51    illustrates three rows of staples deployed on one side of a tissue stapled and cut by a surgical stapler, in accordance with at least one aspect of the present disclosure; 
         FIG.  52    illustrates a non-anodized staple and an anodized staple, in accordance with at least one aspect of the present disclosure; 
         FIG.  53    is a logic flow diagram of a process depicting a control program or a logic configuration for coordinating a control arrangement between surgical hubs, in accordance with at least one aspect of the present disclosure; 
         FIG.  54    illustrates an interaction between two surgical hubs in an operating room, in accordance with at least one aspect of the present disclosure; 
         FIG.  55    is a logic flow diagram of a process depicting a control program or a logic configuration for coordinating a control arrangement between surgical hubs, in accordance with at least one aspect of the present disclosure; 
         FIG.  56    illustrates an interaction between two surgical hubs in different operating rooms (“OR1” and “OR3”), in accordance with at least one aspect of the present disclosure; 
         FIG.  57    illustrates a secondary display in an operating room (“OR3”) showing a surgical site in a colorectal procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  58    illustrates a personal interface or tablet in OR1 displaying the surgical site of OR3, in accordance with at least one aspect of the present disclosure; 
         FIG.  59    illustrates an expanded view of the surgical site of OR3 displayed on a primary display of OR1, in accordance with at least one aspect of the present disclosure; 
         FIG.  60    illustrates a personal interface or tablet displaying a layout of OR1 that shows available displays, in accordance with at least one aspect of the present disclosure; 
         FIG.  61    illustrates a recommendation of a transection location of a surgical site of OR3 made by a surgical operator in OR1 via a personal interface or tablet in OR1, in accordance with at least one aspect of the present disclosure; 
         FIG.  62    is a diagram illustrating a technique for interacting with a patient Electronic Medical Record (EMR) database, in accordance with at least one aspect of the present disclosure; 
         FIG.  63    illustrates a process of anonymizing a surgical procedure by substituting an artificial time measure for a real time clock for all information stored internally within the instrument, robot, surgical hub, and/or hospital computer equipment, in accordance with at least one aspect of the present disclosure; 
         FIG.  64    illustrates ultrasonic pinging of an operating room wall to determine a distance between a surgical hub and the operating room wall, in accordance with at least one aspect of the present disclosure; 
         FIG.  65    illustrates a diagram depicting the process of importing patient data stored in an Electronic Medical Record (EMR) database, stripping the patient data, and identifying smart device implications, in accordance with at least one aspect of the present disclosure; 
         FIG.  66    illustrates the application of cloud based analytics to redacted and stripped patient data and independent data pairs, in accordance with at least one aspect of the present disclosure; 
         FIG.  67    is a logic flow diagram of a process depicting a control program or a logic configuration for associating patient data sets from first and second sources of data, in accordance with at least one aspect of the present disclosure; 
         FIG.  68    is a logic flow diagram of a process depicting a control program or a logic configuration for stripping data to extract relevant portions of the data to configure and operate the surgical hub and modules (e.g., instruments) coupled to the surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  69    illustrates a self-describing data packet comprising self-describing data, , in accordance with at least one aspect of the present disclosure; 
         FIG.  70    is a logic flow diagram of a process depicting a control program or a logic configuration for using data packets comprising self-describing data, in accordance with at least one aspect of the present disclosure; 
         FIG.  71    is a logic flow diagram of a process depicting a control program or a logic configuration for using data packets comprising self-describing data, in accordance with at least one aspect of the present disclosure; 
         FIG.  72    is a diagram of a tumor embedded in the right superior posterior lobe of the right lung, in accordance with at least one aspect of the present disclosure; 
         FIG.  73    is a diagram of a lung tumor resection surgical procedure including four separate firings of a surgical stapler to seal and cut bronchial vessels exposed in the fissure leading to and from the upper and lower lobes of the right lung shown in  FIG.  72   , in accordance with at least one aspect of the present disclosure; 
         FIG.  74    is a graphical illustration of a force-to-close (FTC) versus time curve and a force-to-fire (FTF) versus time curve characterizing the first firing of device 002 as shown in  FIG.  72   , in accordance with at least one aspect of the present disclosure; 
         FIG.  75    is a diagram of a staple line visualization laser Doppler to evaluate the integrity of staple line seals by monitoring bleeding of a vessel after a firing of a surgical stapler, in accordance with at least one aspect of the present disclosure; 
         FIG.  76    illustrates a paired data set grouped by surgery, in accordance with at least one aspect of the present disclosure; 
         FIG.  77    is a diagram of the right lung; 
         FIG.  78    is a diagram of the bronchial tree including the trachea and bronchi of the lung; 
         FIG.  79    is a logic flow diagram of a process depicting a control program or a logic configuration for storing paired anonymous data sets grouped by surgery, in accordance with at least one aspect of the present disclosure; 
         FIG.  80    is a logic flow diagram of a process depicting a control program or a logic configuration for determining rate, frequency, and type of data to transfer to a remote cloud-based analytics network, in accordance with at least one aspect of the present disclosure; 
         FIG.  81    illustrates a diagram of a situationally aware surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  82 A  illustrates a logic flow diagram of a process for controlling a modular device according to contextual information derived from received data, in accordance with at least one aspect of the present disclosure; 
         FIG.  82 B  illustrates a logic flow diagram of a process for controlling a second modular device according to contextual information derived from perioperative data received from a first modular device, in accordance with at least one aspect of the present disclosure; 
         FIG.  82 C  illustrates a logic flow diagram of a process for controlling a second modular device according to contextual information derived from perioperative data received from a first modular device and the second modular device, in accordance with at least one aspect of the present disclosure; 
         FIG.  82 D  illustrates a logic flow diagram of a process for controlling a third modular device according to contextual information derived from perioperative data received from a first modular device and a second modular device, in accordance with at least one aspect of the present disclosure; 
         FIG.  83 A  illustrates a diagram of a surgical hub communicably coupled to a particular set of modular devices and an Electronic Medical Record (EMR) database, in accordance with at least one aspect of the present disclosure; 
         FIG.  83 B  illustrates a diagram of a smoke evacuator including pressure sensors, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 A  illustrates a logic flow diagram of a process for determining a procedure type according to smoke evacuator perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 B  illustrates a logic flow diagram of a process for determining a procedure type according to smoke evacuator, insufflator, and medical imaging device perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 C  illustrates a logic flow diagram of a process for determining a procedure type according to medical imaging device perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 D  illustrates a logic flow diagram of a process for determining a procedural step according to insufflator perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 E  illustrates a logic flow diagram of a process for determining a procedural step according to energy generator perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 F  illustrates a logic flow diagram of a process for determining a procedural step according to energy generator perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 G  illustrates a logic flow diagram of a process for determining a procedural step according to stapler perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 H  illustrates a logic flow diagram of a process for determining a patient status according to ventilator, pulse oximeter, blood pressure monitor, and/or EKG monitor perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 I  illustrates a logic flow diagram of a process for determining a patient status according to pulse oximeter, blood pressure monitor, and/or EKG monitor perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  84 J  illustrates a logic flow diagram of a process for determining a patient status according to ventilator perioperative data, in accordance with at least one aspect of the present disclosure; 
         FIG.  85 A  illustrates a scanner coupled to a surgical hub for scanning a patient wristband, in accordance with at least one aspect of the present disclosure; 
         FIG.  85 B  illustrates a scanner coupled to a surgical hub for scanning a list of surgical items, in accordance with at least one aspect of the present disclosure; 
         FIG.  86    illustrates a timeline of an illustrative surgical procedure and the inferences that the surgical hub can make from the data detected at each step in the surgical procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  87 A  illustrates a flow diagram depicting the process of importing patient data stored in an EMR database and deriving inferences therefrom, in accordance with at least one aspect of the present disclosure; 
         FIG.  87 B  illustrates a flow diagram depicting the process of determining control adjustments corresponding to the derived inferences from  FIG.  87 A , in accordance with at least one aspect of the present disclosure; 
         FIG.  88    illustrates a block diagram of a computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  89    illustrates a logic flow diagram of tracking data associated with an operating theater event, in accordance with at least one aspect of the present disclosure; 
         FIG.  90    illustrates a diagram depicting how the data tracked by the surgical hub can be parsed to provide increasingly detailed metrics, in accordance with at least one aspect of the present disclosure; 
         FIG.  91    illustrates a bar graph depicting the number of patients operated on relative to the days of a week for different operating rooms, in accordance with at least one aspect of the present disclosure; 
         FIG.  92    illustrates a bar graph depicting the total downtime between procedures relative to the days of a week for a particular operating room, in accordance with at least one aspect of the present disclosure; 
         FIG.  93    illustrates a bar graph depicting the total downtime per day of the week depicted in  FIG.  92    broken down according to each individual downtime instance, in accordance with at least one aspect of the present disclosure; 
         FIG.  94    illustrates a bar graph depicting the average procedure length relative to the days of a week for a particular operating room, in accordance with at least one aspect of the present disclosure; 
         FIG.  95    illustrates a bar graph depicting procedure length relative to procedure type, in accordance with at least one aspect of the present disclosure; 
         FIG.  96    illustrates a bar graph depicting the average completion time for particular procedural steps for different types of thoracic procedures, in accordance with at least one aspect of the present disclosure; 
         FIG.  97    illustrates a bar graph depicting procedure time relative to procedure types, in accordance with at least one aspect of the present disclosure; 
         FIG.  98    illustrates a bar graph depicting operating room downtime relative to the time of day, in accordance with at least one aspect of the present disclosure; 
         FIG.  99    illustrates a bar graph depicting operating room downtime relative to the day of the week, in accordance with at least one aspect of the present disclosure; 
         FIG.  100    illustrates a pair of pie charts depicting the percentage of time that the operating theater is utilized, in accordance with at least one aspect of the present disclosure; 
         FIG.  101    illustrates a bar graph depicting consumed and unused surgical items relative to procedure type, in accordance with at least one aspect of the present disclosure; 
         FIG.  102    illustrates a logic flow diagram of a process for storing data from the modular devices and patient information database for comparison, in accordance with at least one aspect of the present disclosure; 
         FIG.  103    illustrates a diagram of a distributed computing system, in accordance with at least one aspect of the present disclosure; 
         FIG.  104    illustrates a logic flow diagram of a process for shifting distributed computing resources, in accordance with at least one aspect of the present disclosure; 
         FIG.  105    illustrates a diagram of an imaging system and a surgical instrument bearing a calibration scale, in accordance with at least one aspect of the present disclosure; 
         FIG.  106    illustrates a diagram of a surgical instrument centered on a linear staple transection line using the benefit of centering tools and techniques described in connection with  FIGS.  107 - 119   , in accordance with at least one aspect of the present disclosure; 
         FIGS.  107 - 109    illustrate a process of aligning an anvil trocar of a circular stapler to a staple overlap portion of a linear staple line created by a double-stapling technique, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  107    illustrates an anvil trocar of a circular stapler that is not aligned with a staple overlap portion of a linear staple line created by a double-stapling technique; 
         FIG.  108    illustrates an anvil trocar of a circular stapler that is aligned with the center of the staple overlap portion of the linear staple line created by a double-stapling technique; and 
         FIG.  109    illustrates a centering tool displayed on a surgical hub display showing a staple overlap portion of a linear staple line created by a double-stapling technique to be cut out by a circular stapler, where the anvil trocar is not aligned with the staple overlap portion of the double staple line as shown in  FIG.  107   ; 
         FIGS.  110  and  111    illustrate a before image and an after image of a centering tool, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  110    illustrates an image of a projected cut path of an anvil trocar and circular knife before alignment with the target alignment ring circumscribing the image of the linear staple line over the image of the staple overlap portion presented on a surgical hub display; and 
         FIG.  111    illustrates an image of a projected cut path of an anvil trocar and circular knife after alignment with the target alignment ring circumscribing the image of the linear staple line over the image of the staple overlap portion presented on a surgical hub display; 
         FIGS.  112 - 114    illustrate a process of aligning an anvil trocar of a circular stapler to a center of a linear staple line, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  112    illustrates the anvil trocar out of alignment with the center of the linear staple line; 
         FIG.  113    illustrates the anvil trocar in alignment with the center of the linear staple line; and 
         FIG.  114    illustrates a centering tool displayed on a surgical hub display of a linear staple line, where the anvil trocar is not aligned with the staple overlap portion of the double staple line as shown in  FIG.  112   ; 
         FIG.  115    is an image of a standard reticle field view of a linear staple line transection of a surgical as viewed through a laparoscope displayed on the surgical hub display, in accordance with at least one aspect of the present disclosure; 
         FIG.  116    is an image of a laser-assisted reticle field of view of the surgical site shown in  FIG.  115    before the anvil trocar and circular knife of the circular stapler are aligned to the center of the linear staple line, in accordance with at least one aspect of the present disclosure; 
         FIG.  117    is an image of a laser-assisted reticle field of view of the surgical site shown in  FIG.  116    after the anvil trocar and circular knife of the circular stapler are aligned to the center of the linear staple line, in accordance with at least one aspect of the present disclosure; 
         FIG.  118    illustrates a non-contact inductive sensor implementation of a non-contact sensor to determine an anvil trocar location relative to the center of a staple line transection, in accordance with at least one aspect of the present disclosure; 
         FIGS.  119 A and  119 B  illustrate one aspect of a non-contact capacitive sensor implementation of the non-contact sensor to determine an anvil trocar location relative to the center of a staple line transection, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  119 A  shows the non-contact capacitive sensor without a nearby metal target; and 
         FIG.  119 B  shows the non-contact capacitive sensor near a metal target; 
         FIG.  120    is a logic flow diagram of a process depicting a control program or a logic configuration for aligning a surgical instrument, in accordance with at least one aspect of the present disclosure; 
         FIG.  121    illustrates a primary display of the surgical hub comprising a global and local display, in accordance with at least one aspect of the present disclosure; 
         FIG.  122    illustrates a primary display of the surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  123    illustrates a clamp stabilization sequence over a five second period, in accordance with at least one aspect of the present disclosure; 
         FIG.  124    illustrates a diagram of four separate wide angle view images of a surgical site at four separate times during the procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  125    is a graph of tissue creep clamp stabilization curves for two tissue types, in accordance with at least one aspect of the present disclosure; 
         FIG.  126    is a graph of time dependent proportionate fill of a clamp force stabilization curve, in accordance with at least one aspect of the present disclosure; 
         FIG.  127    is a graph of the role of tissue creep in the clamp force stabilization curve, in accordance with at least one aspect of the present disclosure; 
         FIGS.  128 A and  128 B  illustrate two graphs for determining when the clamped tissue has reached creep stability, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  128 A  illustrates a curve that represents a vector tangent angle dθ as a function of time; and 
         FIG.  128 B  illustrates a curve that represents change in force-to-close (ΔFTC) as a function of time; 
         FIG.  129    illustrates an example of an augmented video image of a pre-operative video image augmented with data identifying displayed elements, in accordance with at least one aspect of the present disclosure; 
         FIG.  130    is a logic flow diagram of a process depicting a control program or a logic configuration to display images, in accordance with at least one aspect of the present disclosure; 
         FIG.  131    illustrates a communication system comprising an intermediate signal combiner positioned in the communication path between an imaging module and a surgical hub display, in accordance with at least one aspect of the present disclosure; 
         FIG.  132    illustrates an independent interactive headset worn by a surgeon to communicate data to the surgical hub, according to one aspect of the present disclosure; 
         FIG.  133    illustrates a method for controlling the usage of a device, in accordance with at least one aspect of the present disclosure, in accordance with at least one aspect of the present disclosure; 
         FIG.  134    illustrates a surgical system that includes a handle having a controller and a motor, an adapter releasably coupled to the handle, and a loading unit releasably coupled to the adapter, in accordance with at least one aspect of the present disclosure; 
         FIG.  135    illustrates a verbal Automated Endoscopic System for Optimal Positioning (AESOP) camera positioning system, in accordance with at least one aspect of the present disclosure; 
         FIG.  136    illustrates a multi-functional surgical control system and switching interface for virtual operating room integration, in accordance with at least one aspect of the present disclosure; 
         FIG.  137    illustrates a diagram of a beam source and combined beam detector system utilized as a device control mechanism in an operating theater, in accordance with at least one aspect of the present disclosure; 
         FIGS.  138 A-E  illustrate various types of sterile field control and data input consoles, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  138 A  illustrates a single zone sterile field control and data input console; 
         FIG.  138 B  illustrates a multi zone sterile field control and data input console; 
         FIG.  138 C  illustrates a tethered sterile field control and data input console; 
         FIG.  138 D  illustrates a battery operated sterile field control and data input console; and 
         FIG.  138 E  illustrates a battery operated sterile field control and data input console; 
         FIGS.  139 A- 139 B  illustrate a sterile field console in use in a sterile field during a surgical procedure, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  139 A  shows the sterile field console positioned in the sterile field near two surgeons engaged in an operation; and 
         FIG.  139 B  shows one of the surgeons tapping the touchscreen of the sterile field console; 
         FIG.  140    illustrates a process for accepting consult feeds from another operating room, in accordance with at least one aspect of the present disclosure; 
         FIG.  141    illustrates a standard technique for estimating vessel path and depth and device trajectory, in accordance with at least one aspect of the present disclosure; 
         FIGS.  142 A- 142 D  illustrate multiple real time views of images of a virtual anatomical detail for dissection, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  142 A  is a perspective view of the virtual anatomical detail; 
         FIG.  142 B  is a side view of the virtual anatomical detail; 
         FIG.  142 C  is a perspective view of the virtual anatomical detail; and 
         FIG.  142 D  is a side view of the virtual anatomical detail; 
         FIGS.  143 A- 143 B  illustrate a touchscreen display that may be used within the sterile field, in accordance with at least one aspect of the present disclosure, where: 
         FIG.  143 A  illustrates an image of a surgical site displayed on a touchscreen display in portrait mode; 
         FIG.  143 B  shows the touchscreen display rotated in landscape mode and the surgeon uses his index finger to scroll the image in the direction of the arrows; 
         FIG.  143 C  shows the surgeon using his index finger and thumb to pinch open the image in the direction of the arrows to zoom in; 
         FIG.  143 D  shows the surgeon using his index finger and thumb to pinch close the image in the direction of the arrows to zoom out; and 
         FIG.  143 E  shows the touchscreen display rotated in two directions indicated by arrows to enable the surgeon to view the image in different orientations; 
         FIG.  144    illustrates a surgical site employing a smart retractor comprising a direct interface control to a surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  145    illustrates a surgical site with a smart flexible sticker display attached to the body of a patient, in accordance with at least one aspect of the present disclosure; 
         FIG.  146    is a logic flow diagram of a process depicting a control program or a logic configuration to communicate from inside a sterile field to a device located outside the sterile field, in accordance with at least one aspect of the present disclosure; 
         FIG.  147    illustrates a system for performing surgery, in accordance with at least one aspect of the present disclosure; 
         FIG.  148    illustrates a second layer of information overlaying a first layer of information, in accordance with at least one aspect of the present disclosure; 
         FIG.  149    depicts a perspective view of a surgeon using a surgical instrument that includes a handle assembly housing and a wireless circuit board during a surgical procedure, with the surgeon wearing a set of safety glasses, in accordance with at least one aspect of the present disclosure; 
         FIG.  150    is a schematic diagram of a feedback control system for controlling a surgical instrument, in accordance with at least one aspect of the present disclosure; 
         FIG.  151    illustrates a feedback controller that includes an on-screen display module and a heads up display (HUD) module, in accordance with at least one aspect of the present disclosure; 
         FIG.  152 A  illustrates a visualization system that may be incorporated into a surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  152 B  illustrates a top plan view of a hand unit of the visualization system of  FIG.  152 A , in accordance with at least one aspect of the present disclosure; 
         FIG.  152 C  illustrates a side plan view of the hand unit depicted in  FIG.  152 A  along with an imaging sensor disposed therein, in accordance with at least one aspect of the present disclosure; 
         FIG.  152 D  illustrates a plurality of an imaging sensors a depicted in  FIG.  152 C , in accordance with at least one aspect of the present disclosure; 
         FIG.  153 A  illustrates a plurality of laser emitters that may be incorporated in the visualization system of  FIG.  152 A , in accordance with at least one aspect of the present disclosure; 
         FIG.  153 B  illustrates illumination of an image sensor having a Bayer pattern of color filters, in accordance with at least one aspect of the present disclosure; 
         FIG.  153 C  illustrates a graphical representation of the operation of a pixel array for a plurality of frames, in accordance with at least one aspect of the present disclosure; 
         FIG.  153 D  illustrates a schematic of an example of an operation sequence of chrominance and luminance frames, in accordance with at least one aspect of the present disclosure; 
         FIG.  153 E  illustrates an example of sensor and emitter patterns, in accordance with at least one aspect of the present disclosure; 
         FIG.  153 F  illustrates a graphical representation of the operation of a pixel array, in accordance with at least one aspect of the present disclosure; 
         FIG.  154    illustrates a schematic of one example of instrumentation for NIR spectroscopy, according to one aspect of the present disclosure; 
         FIG.  155    illustrates schematically one example of instrumentation for determining NIRS based on Fourier transform infrared imaging, in accordance with at least one aspect of the present disclosure; 
         FIGS.  156 A-C  illustrate a change in wavelength of light scattered from moving blood cells, in accordance with at least one aspect of the present disclosure; 
         FIG.  157    illustrates an aspect of instrumentation that may be used to detect a Doppler shift in laser light scattered from portions of a tissue, in accordance with at least one aspect of the present disclosure; 
         FIG.  158    illustrates schematically some optical effects on light impinging on a tissue having subsurface structures, in accordance with at least one aspect of the present disclosure; 
         FIG.  159    illustrates an example of the effects on a Doppler analysis of light impinging on a tissue sample having subsurface structures, in accordance with at least one aspect of the present disclosure; 
         FIGS.  160 A-C  illustrate schematically the detection of moving blood cells at a tissue depth based on a laser Doppler analysis at a variety of laser wavelengths, in accordance with at least one aspect of the present disclosure; 
         FIG.  160 D  illustrates the effect of illuminating a CMOS imaging sensor with a plurality of light wavelengths over time, in accordance with at least one aspect of the present disclosure; 
         FIG.  161    illustrates an example of a use of Doppler imaging to detect the present of subsurface blood vessels, in accordance with at least one aspect of the present disclosure; 
         FIG.  162    illustrates a method to identify a subsurface blood vessel based on a Doppler shift of blue light due to blood cells flowing therethrough, in accordance with at least one aspect of the present disclosure; 
         FIG.  163    illustrates schematically localization of a deep subsurface blood vessel, in accordance with at least one aspect of the present disclosure; 
         FIG.  164    illustrates schematically localization of a shallow subsurface blood vessel, in accordance with at least one aspect of the present disclosure; 
         FIG.  165    illustrates a composite image comprising a surface image and an image of a subsurface blood vessel, in accordance with at least one aspect of the present disclosure; 
         FIG.  166    is a flow chart of a method for determining a depth of a surface feature in a piece of tissue, in accordance with at least one aspect of the present disclosure; 
         FIG.  167    illustrates the effect of the location and characteristics of non-vascular structures on light impinging on a tissue sample, in accordance with at least one aspect of the present disclosure; 
         FIG.  168    schematically depicts one example of components used in a full field OCT device, in accordance with at least one aspect of the present disclosure; 
         FIG.  169    illustrates schematically the effect of tissue anomalies on light reflected from a tissue sample, in accordance with at least one aspect of the present disclosure; 
         FIG.  170    illustrates an image display derived from a combination of tissue visualization modalities, in accordance with at least one aspect of the present disclosure; 
         FIGS.  171 A-C  illustrate several aspects of displays that may be provided to a surgeon for a visual identification of a combination of surface and sub-surface structures of a tissue in a surgical site, in accordance with at least one aspect of the present disclosure; 
         FIG.  172    is a flow chart of a method for providing information related to a characteristic of a tissue to a smart surgical instrument, in accordance with at least one aspect of the present disclosure; 
         FIGS.  173 A and  173 B  illustrate a multi-pixel light sensor receiving by light reflected by a tissue illuminated by sequential exposure to red, green, blue, and infrared light, and red, green, blue, and ultraviolet laser light sources, respectively, in accordance with at least one aspect of the present disclosure; 
         FIGS.  174 A and  174 B  illustrate the distal end of an elongated camera probe having a single light sensor and two light sensors, respectively, in accordance with at least one aspect of the present disclosure; 
         FIG.  174 C  illustrates a perspective view of an example of a monolithic sensor having a plurality of pixel arrays, in accordance with at least one aspect of the present disclosure; 
         FIG.  175    illustrates one example of a pair of fields of view available to two image sensors of an elongated camera probe, in accordance with at least one aspect of the present disclosure; 
         FIGS.  176 A-D  illustrate additional examples of a pair of fields of view available to two image sensors of an elongated camera probe, in accordance with at least one aspect of the present disclosure; 
         FIGS.  177 A-C  illustrate an example of the use of an imaging system incorporating the features disclosed in  FIG.  176 D , in accordance with at least one aspect of the present disclosure; 
         FIGS.  178 A and  178 B  depict another example of the use of a dual imaging system, in accordance with at least one aspect of the present disclosure; 
         FIGS.  179 A-C  illustrate examples of a sequence of surgical steps which may benefit from the use of multi-image analysis at the surgical site, in accordance with at least one aspect of the present disclosure; 
         FIG.  180    is a block diagram of the computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  181    is a block diagram which illustrates the functional architecture of the computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  182    is an example illustration of a tabulation of various resources correlated to particular types of surgical categories, in accordance with at least one aspect of the present disclosure; 
         FIG.  183    provides an example illustration of how data is analyzed by the cloud system to provide a comparison between multiple facilities to compare use of resources, in accordance with at least one aspect of the present disclosure; 
         FIG.  184    illustrates one example of how the cloud system may determine efficacy trends from an aggregated set of data across whole regions, in accordance with at least one aspect of the present disclosure; 
         FIG.  185    provides an example illustration of some types of analysis the cloud system may be configured to perform to provide the predicting modeling, in accordance with at least one aspect of the present disclosure; 
         FIG.  186    provides a graphical illustration of a type of example analysis the cloud system may perform to provide these recommendations, in accordance with at least one aspect of the present disclosure; 
         FIG.  187    provides an illustration of how the cloud system may conduct analysis to identify a statistical correlation to a local issue that is tied to how a device is used in the localized setting, in accordance with at least one aspect of the present disclosure; 
         FIG.  188    provides a graphical illustration of an example of how some devices may satisfy an equivalent use compared to an intended device, and that the cloud system may determine such equivalent use, in accordance with at least one aspect of the present disclosure; 
         FIG.  189    provides various examples of how some data may be used as variables in deciding how a post-operative decision tree may branch out, in accordance with at least one aspect of the present disclosure; 
         FIG.  190    illustrates a block diagram of a computer-implemented interactive surgical system that is configured to adaptively generate control program updates for modular devices, in accordance with at least one aspect of the present disclosure; 
         FIG.  191    illustrates a logic flow diagram of a process for updating the control program of a modular device, in accordance with at least one aspect of the present disclosure; 
         FIG.  192    illustrates a diagram of an illustrative analytics system updating a surgical instrument control program, in accordance with at least one aspect of the present disclosure; 
         FIG.  193    illustrates a diagram of an analytics system pushing an update to a modular device through a surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  194    illustrates a diagram of a computer-implemented interactive surgical system that is configured to adaptively generate control program updates for surgical hubs, in accordance with at least one aspect of the present disclosure; 
         FIG.  195    illustrates a logic flow diagram of a process for updating the control program of a surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  196    illustrates a logic flow diagram of a process for updating the data analysis algorithm of a control program of a surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  197    provides an illustration of example functionality by a cloud medical analytics system for providing improved security and authentication to multiple medical facilities that are interconnected, in accordance with at least one aspect of the present disclosure; 
         FIG.  198    is a flow diagram of the computer-implemented interactive surgical system programmed to use screening criteria to determine critical data and to push requests to a surgical hub to obtain additional data, in accordance with at least one aspect of the present disclosure; 
         FIG.  199    is a flow diagram of an aspect of responding to critical data by the computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  200    is a flow diagram of an aspect of data sorting and prioritization by the computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  201    illustrates an example system for implementing automated inventory control, in accordance with at least one aspect of the present disclosure; 
         FIG.  202    illustrates one example of an institution’s cloud interface through which a proposed surgical procedure may be entered, in accordance with at least one aspect of the present disclosure; 
         FIG.  203    illustrates one example of an institution’s cloud interface through which a cloud-based system provides knowledge regarding the availability and/or usability of inventory items associated with an entered surgical procedure based on system-defined constraints, in accordance with at least one aspect of the present disclosure; 
         FIG.  204    illustrates a surgical tool including modular components wherein the status of each modular component is evaluated based on system-defined constraints, in accordance with at least one aspect of the present disclosure; 
         FIG.  205    is a schematic of a robotic surgical system, in accordance with one aspect of the present disclosure; 
         FIG.  206    is a plan view of a minimally invasive telesurgically-controlled robotic surgical system being used to perform a surgery, in accordance with one aspect of the present disclosure; 
         FIG.  207    is a perspective view of a surgeon’s control console of the surgical system of  FIG.  206   , in accordance with one aspect of the present disclosure; 
         FIG.  208    is a perspective view of an electronics cart of the surgical system of  FIG.  206   , in accordance with one aspect of the present disclosure; 
         FIG.  209    is a diagram of a telesurgically-controlled surgical system, in accordance with one aspect of the present disclosure; 
         FIG.  210    is a partial view of a patient side cart of the surgical system of  FIG.  206   , in accordance with one aspect of the present disclosure; 
         FIG.  211    is a front view of a telesurgically-operated surgery tool for the surgical system of  FIG.  206   , in accordance with one aspect of the present disclosure; 
         FIG.  212    is a control schematic diagram of a telesurgically-controlled surgical system, in accordance with one aspect of the present disclosure; 
         FIG.  213    is an elevation view of a robotic surgical system and various communication paths thereof, in accordance with one aspect of the present disclosure; 
         FIG.  214    is a perspective, exploded view of an interface between a robotic tool and a tool mounting portion of the robotic surgical system of  FIG.  213   ; 
         FIG.  215    is a detail view of the interface of  FIG.  214   , in accordance with one aspect of the present disclosure; 
         FIG.  216    is a perspective view of a bipolar radio frequency (RF) robotic tool having a smoke evacuation pump for use with a robotic surgical system, in accordance with one aspect of the present disclosure; 
         FIG.  217    is a perspective view of the end effector of the bipolar radio frequency robotic tool of  FIG.  216    depicting the end effector clamping and treating tissue, in accordance with one aspect of the present disclosure; 
         FIG.  218    is a plan view of the tool drive interface of the bipolar radio frequency robotic tool of  FIG.  216    with components removed for clarity, in accordance with one aspect of the present disclosure; 
         FIG.  219    is a plan view of an ultrasonic robotic tool having cooling and insufflation features for use with a robotic surgical system, in accordance with one aspect of the present disclosure; 
         FIG.  220    is a flow chart of a control algorithm for a robotic tool for use with a robotic surgical system, in accordance with one aspect of the present disclosure; 
         FIG.  221    is a perspective view of a drive system for a robotic surgical tool, in accordance with one aspect of the present disclosure; 
         FIG.  222    is an exploded perspective view of the drive system of  FIG.  221   , in accordance with at least one aspect of the present disclosure; 
         FIG.  223    is a perspective, partial cross-section view of a proximal housing of the robotic surgical tool of  FIG.  221   , depicting a transmission arrangement within the proximal housing, in accordance with at least one aspect of the present disclosure; 
         FIG.  224    is an exploded perspective view of the transmission arrangement of  FIG.  223   , in accordance with one aspect of the present disclosure; 
         FIG.  225    is an exploded perspective view of the transmission arrangement of  FIG.  223    with various parts removed for clarity, depicting the transmission arrangement in a first configuration in which a first cooperative drive is drivingly coupled to a first output shaft and a second cooperative drive is drivingly coupled to a second output shaft, in accordance with one aspect of the present disclosure; 
         FIG.  226    is an exploded perspective view of the transmission arrangement of  FIG.  223    with various parts removed for clarity, depicting the transmission arrangement in a second configuration in which the first cooperative drive and the second cooperative drive are drivingly coupled to a third output shaft, in accordance with one aspect of the present disclosure; 
         FIG.  227    is an exploded perspective view of the transmission arrangement of  FIG.  223    with various parts removed for clarity, depicting the transmission arrangement in a third configuration in which the first cooperative drive and the second cooperative drive are drivingly coupled to a fourth output shaft, in accordance with one aspect of the present disclosure; 
         FIG.  228    is an exploded, cross-section elevation view of the transmission arrangement of  FIG.  223   , in accordance with at least one aspect of the present disclosure; 
         FIG.  229    is a graphical display of output torque for different surgical functions of the robotic surgical tool of  FIG.  221   , in accordance with at least one aspect of the present disclosure; 
         FIG.  230    is a perspective view of the robotic surgical tool of  FIG.  221    in an unactuated configuration, in accordance with one aspect of the present disclosure; 
         FIG.  231    is a perspective view of the robotic surgical tool of  FIG.  221    in an articulated configuration, in accordance with one aspect of the present disclosure; 
         FIG.  232    is a perspective view of the robotic surgical tool of  FIG.  221    in a rotated configuration, in accordance with one aspect of the present disclosure; 
         FIG.  233    is a perspective view of the robotic surgical tool of  FIG.  221    in a clamped and fired configuration, in accordance with one aspect of the present disclosure; 
         FIG.  234    is a view of robotically-controlled end effectors at a surgical site, in accordance with one aspect of the present disclosure; 
         FIG.  235    is a view of the robotically-controlled end effectors of  FIG.  234   , in accordance with one aspect of the present disclosure; 
         FIG.  236    is a graphical display of force and displacement over time for one of the robotically-controlled end effectors of  FIG.  234   , in accordance with one aspect of the present disclosure; 
         FIG.  237    is a flow chart of a control algorithm for one a surgical tool for use with a robotic surgical system, in accordance with one aspect of the present disclosure; 
         FIG.  238    is an elevation view of a surgical procedure involving a robotic surgical system and a handheld surgical instrument and depicting multiple displays in the surgical theater, in accordance with one aspect of the present disclosure; 
         FIG.  239    is a schematic of a robotic surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  240    is a block diagram of control components for the robotic surgical system of  FIG.  239   , in accordance with at least one aspect of the present disclosure; 
         FIG.  241 A  is an elevation view of an ultrasonic surgical tool positioned out of contact with tissue, in accordance with at least one aspect of the present disclosure; 
         FIG.  241 B  is an elevation view of the ultrasonic surgical tool of  FIG.  241 A  positioned in abutting contact with tissue, in accordance with at least one aspect of the present disclosure; 
         FIG.  242 A  is an elevation view of a monopolar cautery pencil positioned out of contact with tissue, in accordance with at least one aspect of the present disclosure; 
         FIG.  242 B  is an elevation view of the monopolar cautery pencil of  FIG.  242 A  positioned in abutting contact with tissue, in accordance with at least one aspect of the present disclosure; 
         FIG.  243    is a graphical display of continuity and current over time for the ultrasonic surgical tool of  FIGS.  241 A and  241 B , in accordance with at least one aspect of the present disclosure; 
         FIG.  244    illustrates an end effector comprising radio frequency (RF) data sensors located on a jaw member, in accordance with at least one aspect of the present disclosure; 
         FIG.  245    illustrates the sensors shown in  FIG.  244    mounted to or formed integrally with a flexible circuit, in accordance with at least one aspect of the present disclosure; 
         FIG.  246    is a flow chart depicting an automatic activation mode of a surgical instrument, in accordance with at least one aspect of the present disclosure; 
         FIG.  247    is a perspective view of an end effector of a bipolar radio frequency (RF) surgical tool having a smoke evacuation pump for use with a robotic surgical system, depicting the surgical tool clamping and treating tissue, in accordance with at least one aspect of the present disclosure; 
         FIG.  248    is a block diagram of a surgical system comprising a robotic surgical system, a handheld surgical instrument, and a surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  249    is a perspective view of a handle portion of a handheld surgical instrument including a display and further depicting a detail view of the display depicting information from the instrument itself, in accordance with at least one aspect of the present disclosure; 
         FIG.  250    is a perspective view of the handle portion of the handheld surgical instrument of  FIG.  249    depicting the instrument paired with a surgical hub and further including a detail view of the display depicting information from the surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  251    is a schematic of a colon resection procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  252    is a graphical display of force over time for the colon resection procedure displayed on the instrument display in  FIG.  251   , in accordance with at least one aspect of the present disclosure; 
         FIG.  253    is a schematic of a robotic surgical system during a surgical procedure including a plurality of hubs and interactive secondary displays, in accordance with at least one aspect of the present disclosure; 
         FIG.  254    is a detail view of the interactive secondary displays of  FIG.  253   , in accordance with at least one aspect of the present disclosure; 
         FIG.  255    is a block diagram of a robotic surgical system comprising more than one robotic arm, in accordance with at least one aspect of the present disclosure; 
         FIG.  256    is a schematic of a surgical procedure utilizing the robotic surgical system of  FIG.  255   , in accordance with at least one aspect of the present disclosure; 
         FIG.  257    shows graphical representations of forces and positional displacements experienced by the robotic arms of  FIG.  255   , in accordance with at least one aspect of the present disclosure; 
         FIG.  258    is a flow chart depicting an algorithm for controlling the position of the robotic arms of a robotic surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  259    is a flow chart depicting an algorithm for controlling the forces exerted by robotic arms of a robotic surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  260    is a flow chart depicting an algorithm for monitoring the position and forces exerted by robotic arms of a robotic surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  261    is a block diagram of a surgical system comprising a robotic surgical system, a powered handheld surgical instrument, and a surgical hub, in accordance with at least one aspect of the present disclosure; 
         FIG.  262    is a perspective view of a robotic tool and a handheld surgical instrument during a surgical procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  263    is a schematic depicting communication links between surgical hubs and a primary server, in accordance with at least one aspect of the present disclosure; 
         FIG.  264    is a flow chart depicting a queue for external output of data received from the various surgical hubs of  FIG.  263   , in accordance with at least one aspect of the present disclosure; 
         FIG.  265    is a perspective view of a robot arm of a robotic surgical system and schematically depicts additional components of the robotic surgical system, in accordance with one aspect of the present disclosure; 
         FIG.  266    is a perspective view of a robotic arm of a robotic surgical system, and further depicts an operator manually adjusting the position of the robotic arm, in accordance with one aspect of the present disclosure; 
         FIG.  267    is a graphical display of force over time of the robotic arm of  FIG.  266    in a passive power assist mode, in accordance with one aspect of the present disclosure; 
         FIG.  268    is a perspective view of a robotic arm and a secondary interactive display within a sterile field, in accordance with at least one aspect of the present disclosure. 
         FIG.  269    is a graphical display of force over time of the robotic arm of  FIG.  268   , in accordance with one aspect of the present disclosure; 
         FIG.  270    is a perspective view of a robotic arm and a robotic hub of a robotic surgical system, in accordance with at least one aspect of the present disclosure; 
         FIG.  271    is a detail view of an end effector of a linear stapler attached to the robotic arm of  FIG.  270   , depicting the end effector positioned relative to a targeted tissue region during a surgical procedure, in accordance with at least one aspect of the present disclosure; 
         FIG.  272    is a graphical display of distance and force-to-close over time for the linear stapler of  FIG.  271   , in accordance with one aspect of the present disclosure; 
         FIG.  273    is a schematic depicting a robotic surgical system having a plurality of sensing systems, in accordance with one aspect of the present disclosure; 
         FIG.  273 A  is a detail view of a trocar of  FIG.  273   , in accordance with at least one aspect of the present disclosure; 
         FIG.  274    is a flowchart depicting a robotic surgical system utilizing a plurality of independent sensing systems, in accordance with one aspect of the present disclosure; 
         FIG.  275    is a perspective view of a surgical suturing instrument comprising a handle, a shaft, and an end effector; 
         FIG.  276    is a partial plan view of the surgical suturing instrument of  FIG.  275   ; 
         FIG.  277    is a partial plan view of the surgical suturing instrument of  FIG.  275   , wherein the end effector is in an articulated state; 
         FIG.  278    is a partial perspective view of the surgical suturing instrument of  FIG.  275   ; 
         FIG.  279    is a partial perspective view of the surgical suturing instrument of  FIG.  275   , wherein the end effector is in an articulated and rotated state; 
         FIG.  280    is a schematic of a needle sensing system and a circuit diagram of a needle sensing circuit of the needle sensing system, wherein a needle of the needle sensing system is in a home position; 
         FIG.  281    is a schematic of the needle sensing system of  FIG.  280    and a circuit diagram of the needle sensing circuit of  FIG.  280   , wherein the needle is in a first partially fired position; 
         FIG.  282    is a schematic of the needle sensing system of  FIG.  280    and a circuit diagram of the needle sensing circuit of  FIG.  280   , wherein the needle is in a second partially fired position; 
         FIG.  283    is a logic diagram of a process depicting a control program for controlling a surgical suturing instrument; 
         FIG.  284    is a plan view of a suturing device cartridge comprising an adaptive needle driving system; 
         FIG.  285    is a graph of a first aspect of an adaptive needle driving system; 
         FIG.  286    is a graph of a second aspect of the adaptive needle driving system of  FIG.  285   ; 
         FIG.  287    is a graph of a third aspect of the adaptive needle driving system of  FIG.  285   ; 
         FIG.  288    is a plan view of a collapsible suturing device comprising a shaft and a needle driving system, wherein the needle driving system comprises a movable needle guide, and wherein the movable needle guide is in an expanded position; 
         FIG.  289    is a plan view of the suturing device of  FIG.  288   , wherein the movable needle guide is in a collapsed position; 
         FIG.  290    is a plan view of the suturing device of  FIG.  288   , wherein the movable needle guide is in a partially expanded position; 
         FIG.  291    is a plan view of a collapsible suturing device comprising a shaft and an end effector configured to be articulated relative to the shaft, wherein the end effector comprises a needle driving system comprising a movable needle guide; 
         FIG.  292    is a plan view of a collapsible suturing device comprising a needle driving system comprising a movable needle guide and an intermediate feed wheel; 
         FIG.  293    is a cross-sectional view of an end effector of a suturing device comprising a body portion, a needle track defined within the body portion, and a suturing needle, wherein the suturing needle is in a parked position; 
         FIG.  294    is a cross-sectional view of the end effector of  FIG.  293   , wherein the suturing needle is in a ready-to-fire position; 
         FIG.  295    is a cross-sectional view of the end effector of  FIG.  293   , wherein the suturing needle is in a partially-fired position; 
         FIG.  296    is a diagram illustrating a relationship between stress and strain of a component of an end effector and corresponding identifiable events during the use of the end effector; 
         FIG.  297    is a partial perspective view of a surgical instrument system comprising an actuation interface and a modular shaft to be actuated with the actuation interface, wherein the surgical instrument system is shown in a partially attached configuration; 
         FIG.  298    is a graph illustrating a sensed torque of the surgical instrument system of  FIG.  297    and a sensed current of a motor of the surgical instrument system of  FIG.  297   ; 
         FIG.  299    is a partial perspective view of a surgical grasper and a mono-polar bridge instrument; 
         FIG.  300    is a graph illustrating a reactive algorithm of the surgical grasper of  FIG.  299   ; 
         FIG.  301    is a logic diagram of a process depicting a control program for controlling a surgical instrument; 
         FIG.  302    is a partial perspective view of a surgical suturing instrument; and 
         FIG.  303    is a graph depicting sensed parameters of the surgical suturing instrument of  FIG.  302    and also depicting an algorithm for the surgical suturing instrument to react to the sensed parameters. 
         FIG.  304    is a logic diagram of a process depicting a control program for controlling a surgical suturing instrument; 
         FIG.  305    is a perspective view of an end effector assembly comprising a suture cartridge; 
         FIG.  306    is a partial perspective view of the end effector assembly of  FIG.  305   ; 
         FIG.  307    is a partial cross-sectional view of an end effector assembly comprising a needle sensing system; 
         FIG.  308    is a partial perspective view of an end effector assembly comprising a needle sensing system; 
         FIG.  309    is a partial perspective view of an end effector assembly comprising a needle sensing system; 
         FIG.  310    is a partial perspective view of an end effector assembly comprising a needle sensing system; 
         FIG.  311    is a partial perspective view of an end effector assembly comprising a needle sensing system; 
         FIG.  312    is a perspective view of a helical suturing needle for use with a surgical suturing instrument; 
         FIG.  313    is an elevational view of the helical suturing needle of  FIG.  312   ; 
         FIG.  314    is a logic flow diagram of a process depicting a control program for controlling a surgical instrument; 
         FIG.  315    is a perspective view of a surgical suturing instrument handle comprising a motor; 
         FIG.  316    is a partial cross-sectional view of the surgical suturing instrument handle of  FIG.  315   ; 
         FIG.  317    is an exploded view of a suturing cartridge for use with a surgical suturing system; 
         FIG.  318    is a partial cross-sectional view of a surgical instrument including a jaw assembly capable of grasping and dissection in accordance with at least one embodiment; 
         FIG.  319    is a graph depicting the force, speed, and orientation of the jaw assembly of  FIG.  318    in accordance with at least one embodiment; 
         FIG.  320    is a partial perspective view of bipolar forceps being used to cut tissue; 
         FIG.  321    is a perspective view of the bipolar forceps of  FIG.  320   ; 
         FIG.  322    is a graph depicting the force and speed of the jaws of the bipolar forceps of  FIG.  320    in accordance with at least one embodiment; 
         FIG.  323    is another graph depicting the operation of the bipolar forceps of  FIG.  320    in accordance with at least one embodiment; and 
         FIG.  324    is a schematic of a control system for use with any of the surgical instruments disclosed herein. 
     
    
    
     Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner. 
     DETAILED DESCRIPTION 
     Applicant of the present application owns the following U.S. Patent Applications that were filed on Aug. 24, 2018 which are each herein incorporated by reference in their respective entireties:
     U.S. Pat. Application Serial No. 16/112,129, entitled SURGICAL SUTURING INSTRUMENT CONFIGURED TO MANIPULATE TISSUE USING MECHANICAL AND ELECTRICAL POWER, now U.S. Pat. Application Publication No. 2019/0125431;   U.S. Pat. Application Serial No. 16/112,155, entitled SURGICAL SUTURING INSTRUMENT COMPRISING A CAPTURE WIDTH WHICH IS LARGER THAN TROCAR DIAMETER, now U.S. Pat. Application Publication No. 2019/0125335;   U.S. Pat. Application Serial No. 16/112,168, entitled SURGICAL SUTURING INSTRUMENT COMPRISING A NON-CIRCULAR NEEDLE, now U.S. Pat. Application Publication No. 2019/0125336;   U.S. Pat. Application Serial No. 16/112,180, entitled ELECTRICAL POWER OUTPUT CONTROL BASED ON MECHANICAL FORCES, now U.S. Pat. Application Publication No. 2019/0125432;   U.S. Pat. Application Serial No. 16/112,193, entitled REACTIVE ALGORITHM FOR SURGICAL SYSTEM, now U.S. Pat. No. 10,932,806;   U.S. Pat. Application Serial No. 16/112,099, entitled SURGICAL INSTRUMENT COMPRISING AN ADAPTIVE ELECTRICAL SYSTEM, now U.S. Pat. Application Publication No. 2019/0125378;   U.S. Pat. Application Serial No. 16/112,112, entitled CONTROL SYSTEM ARRANGEMENTS FOR A MODULAR SURGICAL INSTRUMENT, now U.S. Pat. Application Publication No. 2019/0125320;   U.S. Pat. Application Serial No. 16/112,119, entitled ADAPTIVE CONTROL PROGRAMS FOR A SURGICAL SYSTEM COMPRISING MORE THAN ONE TYPE OF CARTRIDGE, now U.S. Pat. Application Publication No. 2019/0125338;   U.S. Pat. Application Serial No. 16/112,097, entitled SURGICAL INSTRUMENT SYSTEMS COMPRISING BATTERY ARRANGEMENTS, now U.S. Pat. Application Publication No. 2019/0125377;   U.S. Pat. Application Serial No. 16/112,109, entitled SURGICAL INSTRUMENT SYSTEMS COMPRISING HANDLE ARRANGEMENTS, now U.S. Pat. Application Publication No. 2019/0125388;   U.S. Pat. Application Serial No. 16/112,114, entitled SURGICAL INSTRUMENT SYSTEMS COMPRISING FEEDBACK MECHANISMS, now U.S. Pat. No. 10,980,560;   U.S. Pat. Application Serial No. 16/112,117, entitled SURGICAL INSTRUMENT SYSTEMS COMPRISING LOCKOUT MECHANISMS, now U.S. Pat. Application Publication No. 2019/0125476;   U.S. Pat. Application Serial No. 16/112,095, entitled SURGICAL INSTRUMENTS COMPRISING A LOCKABLE END EFFECTOR SOCKET, now U.S. Pat. No. 11,291,465;   U.S. Pat. Application Serial No. 16/112,121, entitled SURGICAL INSTRUMENTS COMPRISING A SHIFTING MECHANISM, now U.S. Pat. No. 11,026,712;   U.S. Pat. Application Serial No. 16/112,151, entitled SURGICAL INSTRUMENTS COMPRISING A SYSTEM FOR ARTICULATION AND ROTATION COMPENSATION, now U.S. Pat. No. 10,772,651;   U.S. Pat. Application Serial No. 16/112,154, entitled SURGICAL INSTRUMENTS COMPRISING A BIASED SHIFTING MECHANISM, now U.S. Pat. No. 11,207,090;   U.S. Pat. Application Serial No. 16/112,226, entitled SURGICAL INSTRUMENTS COMPRISING AN ARTICULATION DRIVE THAT PROVIDES FOR HIGH ARTICULATION ANGLES, now U.S. Pat. No. 11,129,636;   U.S. Pat. Application Serial No. 16/112,062, entitled SURGICAL DISSECTORS AND MANUFACTURING TECHNIQUES, now U.S. Pat. No. 10,959,744;   U.S. Pat. Application Serial No. 16/112,098, entitled SURGICAL DISSECTORS CONFIGURED TO APPLY MECHANICAL AND ELECTRICAL ENERGY, now U.S. Pat. Application Publication No. 2019/0125430;   U.S. Pat. Application Serial No. 16/112,237, entitled SURGICAL CLIP APPLIER CONFIGURED TO STORE CLIPS IN A STORED STATE, now U.S. Pat. No. 11,026,713;   U.S. Pat. Application Serial No. 16/112,245, entitled SURGICAL CLIP APPLIER COMPRISING AN EMPTY CLIP CARTRIDGE LOCKOUT, now U.S. Pat. No. 11,051,836;   U.S. Pat. Application Serial No. 16/112,249, entitled SURGICAL CLIP APPLIER COMPRISING AN AUTOMATIC CLIP FEEDING SYSTEM, now U.S. Pat. No. 11,109,878;   U.S. Pat. Application Serial No. 16/112,253, entitled SURGICAL CLIP APPLIER COMPRISING ADAPTIVE FIRING CONTROL, now U.S. Pat. No. 11,103,268; and   U.S. Pat. Application Serial No. 16/112,257, entitled SURGICAL CLIP APPLIER COMPRISING ADAPTIVE CONTROL IN RESPONSE TO A STRAIN GAUGE CIRCUIT, now U.S. Pat. No. 11,071,560.   

     Applicant of the present application owns the following U.S. Pat. Applications that were filed on May 1, 2018 and which are each herein incorporated by reference in their respective entireties:
     U.S. Pat. Application Serial No. 62/665,129, entitled SURGICAL SUTURING SYSTEMS;   U.S. Provisional Pat. Application Serial No. 62/665,139, entitled SURGICAL INSTRUMENTS COMPRISING CONTROL SYSTEMS;   U.S. Pat. Application Serial No. 62/665,177, entitled SURGICAL INSTRUMENTS COMPRISING HANDLE ARRANGEMENTS;   U.S. Pat. Application Serial No. 62/665,128, entitled MODULAR SURGICAL INSTRUMENTS;   U.S. Pat. Application Serial No. 62/665,192, entitled SURGICAL DISSECTORS; and   U.S. Pat. Application Serial No. 62/665,134, entitled SURGICAL CLIP APPLIER.   

     Applicant of the present application owns the following U.S. Pat. Applications that were filed on Feb. 28, 2018 and which are each herein incorporated by reference in their respective entireties:
     U.S. Pat. Application Serial No. 15/908,021, entitled SURGICAL INSTRUMENT WITH REMOTE RELEASE;   U.S. Pat. Application Serial No. 15/908,012, entitled SURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OF END EFFECTOR MOVEMENT;   U.S. Pat. Application Serial No. 15/908,040, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS;   U.S. Pat. Application Serial No. 15/908,057, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS;   U.S. Pat. Application Serial No. 15/908,058, entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES; and   U.S. Pat. Application Serial No. 15/908,143, entitled SURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS.   

     Applicant of the present application owns the following U.S. Pat. Applications that were filed on Oct. 30, 2017 and which are each herein incorporated by reference in their respective entireties:
     U.S. Provisional Pat. Application Serial No. 62/578,793, entitled SURGICAL INSTRUMENT WITH REMOTE RELEASE;   U.S. Provisional Pat. Application Serial No. 62/578,804, entitled SURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OF END EFFECTOR MOVEMENT;   U.S. Provisional Pat. Application Serial No. 62/578,817, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS;   U.S. Provisional Pat. Application Serial No. 62/578,835, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS;   U.S. Provisional Pat. Application Serial No. 62/578,844, entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES; and   U.S. Provisional Pat. Application Serial No. 62/578,855, entitled SURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS.   

     Applicant of the present application owns the following U.S. Provisional Pat. Applications, filed on Dec. 28, 2017, the disclosure of each of which is herein incorporated by reference in its entirety:
     U.S. Provisional Pat. Application Serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM;   U.S. Provisional Pat. Application Serial No. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and   U.S. Provisional Pat. Application Serial No. 62/611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.   

     Applicant of the present application owns the following U.S. Provisional Pat. Applications, filed on Mar. 28, 2018, each of which is herein incorporated by reference in its entirety:
     U.S. Provisional Pat. Application Serial No. 62/649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;   U.S. Provisional Pat. Application Serial No. 62/649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;   U.S. Provisional Pat. Application Serial No. 62/649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS;   U.S. Provisional Pat. Application Serial No. 62/649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;   U.S. Provisional Pat. Application Serial No. 62/649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;   U.S. Provisional Pat. Application Serial No. 62/649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;   U.S. Provisional Pat. Application Serial No. 62/649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;   U.S. Provisional Pat. Application Serial No. 62/649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;   U.S. Provisional Pat. Application Serial No. 62/649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;   U.S. Provisional Pat. Application Serial No. 62/649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;   U.S. Provisional Pat. Application Serial No. 62/649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;   U.S. Provisional Pat. Application Serial No. 62/649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;   U.S. Provisional Pat. Application Serial No. 62/649,307, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and   U.S. Provisional Pat. Application Serial No. 62/649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.   

     Applicant of the present application owns the following U.S. Pat. Applications, filed on Mar. 29, 2018, each of which is herein incorporated by reference in its entirety:
     U.S. Pat. Application Serial No. 15/940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;   U.S. Pat. Application Serial No. 15/940,648, entitled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES;   U.S. Pat. Application Serial No. 15/940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES;   U.S. Pat. Application Serial No. 15/940,666, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS;   U.S. Pat. Application Serial No. 15/940,670, entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS;   U.S. Pat. Application Serial No. 15/940,677, entitled SURGICAL HUB CONTROL ARRANGEMENTS;   U.S. Pat. Application Serial No. 15/940,632, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;   U.S. Pat. Application Serial No. 15/940,640, entitled COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS;   U.S. Pat. Application Serial No. 15/940,645, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;   U.S. Pat. Application Serial No. 15/940,649, entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME;   U.S. Pat. Application Serial No. 15/940,654, entitled SURGICAL HUB SITUATIONAL AWARENESS;   U.S. Pat. Application Serial No. 15/940,663, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING;   U.S. Pat. Application Serial No. 15/940,668, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA;   U.S. Pat. Application Serial No. 15/940,671, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;   U.S. Pat. Application Serial No. 15/940,686, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE;   U.S. Pat. Application Serial No. 15/940,700, entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS;   U.S. Pat. Application Serial No. 15/940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;   U.S. Pat. Application Serial No. 15/940,704, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;   U.S. Pat. Application Serial No. 15/940,722, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY; and   U.S. Pat. Application Serial No. 15/940,742, entitled DUAL CMOS ARRAY IMAGING.   

     Applicant of the present application owns the following U.S. Pat. Applications, filed on Mar. 29, 2018, each of which is herein incorporated by reference in its entirety:
     U.S. Pat. Application Serial No. 15/940,636, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;   U.S. Pat. Application Serial No. 15/940,653, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;   U.S. Pat. Application Serial No. 15/940,660, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;   U.S. Pat. Application Serial No. 15/940,679, entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET;   U.S. Pat. Application Serial No. 15/940,694, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION;   U.S. Pat. Application Serial No. 15/940,634, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;   U.S. Pat. Application Serial No. 15/940,706, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; and   U.S. Pat. Application Serial No. 15/940,675, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES.   

     Applicant of the present application owns the following U.S. Pat. Applications, filed on Mar. 29, 2018, each of which is herein incorporated by reference in its entirety:
     U.S. Pat. Application Serial No. 15/940,627, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;   U.S. Pat. Application Serial No. 15/940,637, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;   U.S. Pat. Application Serial No. 15/940,642, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;   U.S. Pat. Application Serial No. 15/940,676, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;   U.S. Pat. Application Serial No. 15/940,680, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;   U.S. Pat. Application Serial No. 15/940,683, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;   U.S. Pat. Application Serial No. 15/940,690, entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and   U.S. Pat. Application Serial No. 15/940,711, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.   

     Applicant of the present application owns the following U.S. Provisional Pat. Applications, filed on Mar. 30, 2018, each of which is herein incorporated by reference in its entirety:
     U.S. Provisional Pat. Application Serial No. 62/650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;   U.S. Provisional Pat. Application Serial No. 62/650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS;   U.S. Provisional Pat. Application Serial No. 62/650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and   U.S. Provisional Pat. Application Serial No. 62/650,898, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS.   

     Applicant of the present application owns the following U.S. Provisional Pat. Application, filed on Apr. 19, 2018, which is herein incorporated by reference in its entirety:
     U.S. Provisional Pat. Application Serial No. 62/659,900, entitled METHOD OF HUB COMMUNICATION.   

     Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. Well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. The reader will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and illustrative. Variations and changes thereto may be made without departing from the scope of the claims. 
     The terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has” and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a surgical system, device, or apparatus that “comprises,” “has,” “includes”, or “contains” one or more elements possesses those one or more elements, but is not limited to possessing only those one or more elements. Likewise, an element of a system, device, or apparatus that “comprises,” “has,” “includes”, or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. 
     The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” refers to the portion closest to the clinician and the term “distal” refers to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute. 
     Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily appreciate that the various methods and devices disclosed herein can be used in numerous surgical procedures and applications including, for example, in connection with open surgical procedures. As the present Detailed Description proceeds, the reader will further appreciate that the various instruments disclosed herein can be inserted into a body in any way, such as through a natural orifice, through an incision or puncture hole formed in tissue, etc. The working portions or end effector portions of the instruments can be inserted directly into a patient’s body or can be inserted through an access device that has a working channel through which the end effector and elongate shaft of a surgical instrument can be advanced. 
     Before explaining various aspects of surgical devices and generators in detail, it should be noted that the illustrative examples are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative examples may be implemented or incorporated in other aspects, variations and modifications, and may be practiced or carried out in various ways. Further, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative examples for the convenience of the reader and are not for the purpose of limitation thereof. Also, it will be appreciated that one or more of the following-described aspects, expressions of aspects, and/or examples, can be combined with any one or more of the other following-described aspects, expressions of aspects and/or examples. 
     Aspects of the present disclosure are presented for a comprehensive digital medical system capable of spanning multiple medical facilities and configured to provide integrated and comprehensive improved medical care to a vast number of patients. The comprehensive digital medical system includes a cloud-based medical analytics system that is configured to interconnect to multiple surgical hubs located across many different medical facilities. The surgical hubs are configured to interconnect with one or more surgical devices that are used to conduct medical procedures on patients. The surgical hubs provide a wide array of functionality to improve the outcomes of medical procedures. The data generated by the various surgical devices and medical hubs about the patient and the medical procedure may be transmitted to the cloud-based medical analytics system. This data may then be aggregated with similar data gathered from many other surgical hubs and surgical devices located at other medical facilities. Various patterns and correlations may be found through the cloud-based analytics system analyzing the collected data. Improvements in the techniques used to generate the data may be generated as a result, and these improvements may then be disseminated to the various surgical hubs and surgical devices. Due to the interconnectedness of all of the aforementioned components, improvements in medical procedures and practices may be found that otherwise may not be found if the many components were not so interconnected. Various examples of structures and functions of these various components will be described in more detail in the following description. 
     Referring to  FIG.  1   , a computer-implemented interactive surgical system  100  includes one or more surgical systems  102  and a cloud-based system (e.g., the cloud  104  that may include a remote server  113  coupled to a storage device  105 ). Each surgical system  102  includes at least one surgical hub  106  in communication with the cloud  104  that may include a remote server  113 . In one example, as illustrated in  FIG.  1   , the surgical system  102  includes a visualization system  108 , a robotic system  110 , and a handheld intelligent surgical instrument  112 , which are configured to communicate with one another and/or the hub  106 . In some aspects, a surgical system  102  may include an M number of hubs  106 , an N number of visualization systems  108 , an O number of robotic systems  110 , and a P number of handheld intelligent surgical instruments  112 , where M, N, O, and P are integers greater than or equal to one. 
       FIG.  3    depicts an example of a surgical system  102  being used to perform a surgical procedure on a patient who is lying down on an operating table  114  in a surgical operating room  116 . A robotic system  110  is used in the surgical procedure as a part of the surgical system  102 . The robotic system  110  includes a surgeon’s console  118 , a patient side cart  120  (surgical robot), and a surgical robotic hub  122 . The patient side cart  120  can manipulate at least one removably coupled surgical tool  117  through a minimally invasive incision in the body of the patient while the surgeon views the surgical site through the surgeon’s console  118 . An image of the surgical site can be obtained by a medical imaging device  124 , which can be manipulated by the patient side cart  120  to orient the imaging device  124 . The robotic hub  122  can be used to process the images of the surgical site for subsequent display to the surgeon through the surgeon’s console  118 . 
     Other types of robotic systems can be readily adapted for use with the surgical system  102 . Various examples of robotic systems and surgical tools that are suitable for use with the present disclosure are described in U.S. Provisional Pat. Application Serial No. 62/611,339, titled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. 
     Various examples of cloud-based analytics that are performed by the cloud  104 , and are suitable for use with the present disclosure, are described in U.S. Provisional Pat. Application Serial No. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. 
     In various aspects, the imaging device  124  includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, Charge-Coupled Device (CCD) sensors and Complementary Metal-Oxide Semiconductor (CMOS) sensors. 
     The optical components of the imaging device  124  may include one or more illumination sources and/or one or more lenses. The one or more illumination sources may be directed to illuminate portions of the surgical field. The one or more image sensors may receive light reflected or refracted from the surgical field, including light reflected or refracted from tissue and/or surgical instruments. 
     The one or more illumination sources may be configured to radiate electromagnetic energy in the visible spectrum as well as the invisible spectrum. The visible spectrum, sometimes referred to as the optical spectrum or luminous spectrum, is that portion of the electromagnetic spectrum that is visible to (i.e., can be detected by) the human eye and may be referred to as visible light or simply light. A typical human eye will respond to wavelengths in air that are from about 380 nm to about 750 nm. 
     The invisible spectrum (i.e., the non-luminous spectrum) is that portion of the electromagnetic spectrum that lies below and above the visible spectrum (i.e., wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the red visible spectrum, and they become invisible infrared (IR), microwave, and radio electromagnetic radiation. Wavelengths less than about 380 nm are shorter than the violet spectrum, and they become invisible ultraviolet, x-ray, and gamma ray electromagnetic radiation. 
     In various aspects, the imaging device  124  is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present disclosure include, but not limited to, an arthroscope, angioscope, bronchoscope, choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope, sigmoidoscope, thoracoscope, and ureteroscope. 
     In one aspect, the imaging device employs multi-spectrum monitoring to discriminate topography and underlying structures. A multi-spectral image is one that captures image data within specific wavelength ranges across the electromagnetic spectrum. The wavelengths may be separated by filters or by the use of instruments that are sensitive to particular wavelengths, including light from frequencies beyond the visible light range, e.g., IR and ultraviolet. Spectral imaging can allow extraction of additional information the human eye fails to capture with its receptors for red, green, and blue. The use of multi-spectral imaging is described in greater detail under the heading “Advanced Imaging Acquisition Module” in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. Multi-spectrum monitoring can be a useful tool in relocating a surgical field after a surgical task is completed to perform one or more of the previously described tests on the treated tissue. 
     It is axiomatic that strict sterilization of the operating room and surgical equipment is required during any surgery. The strict hygiene and sterilization conditions required in a “surgical theater,” i.e., an operating or treatment room, necessitate the highest possible sterility of all medical devices and equipment. Part of that sterilization process is the need to sterilize anything that comes in contact with the patient or penetrates the sterile field, including the imaging device  124  and its attachments and components. It will be appreciated that the sterile field may be considered a specified area, such as within a tray or on a sterile towel, that is considered free of microorganisms, or the sterile field may be considered an area, immediately around a patient, who has been prepared for a surgical procedure. The sterile field may include the scrubbed team members, who are properly attired, and all furniture and fixtures in the area. 
     In various aspects, the visualization system  108  includes one or more imaging sensors, one or more image-processing units, one or more storage arrays, and one or more displays that are strategically arranged with respect to the sterile field, as illustrated in  FIG.  2   . In one aspect, the visualization system  108  includes an interface for HL7, PACS, and EMR. Various components of the visualization system  108  are described under the heading “Advanced Imaging Acquisition Module” in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. 
     As illustrated in  FIG.  2   , a primary display  119  is positioned in the sterile field to be visible to an operator at the operating table  114 . In addition, a visualization tower  111  is positioned outside the sterile field. The visualization tower  111  includes a first non-sterile display  107  and a second non-sterile display  109 , which face away from each other. The visualization system  108 , guided by the hub  106 , is configured to utilize the displays  107 ,  109 , and  119  to coordinate information flow to operators inside and outside the sterile field. For example, the hub  106  may cause the visualization system  108  to display a snapshot of a surgical site, as recorded by an imaging device  124 , on a non-sterile display  107  or  109 , while maintaining a live feed of the surgical site on the primary display  119 . The snapshot on the non-sterile display  107  or  109  can permit a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example. 
     In one aspect, the hub  106  is also configured to route a diagnostic input or feedback entered by a non-sterile operator at the visualization tower  111  to the primary display  119  within the sterile field, where it can be viewed by a sterile operator at the operating table. In one example, the input can be in the form of a modification to the snapshot displayed on the non-sterile display  107  or  109 , which can be routed to the primary display  119  by the hub  106 . 
     Referring to  FIG.  2   , a surgical instrument  112  is being used in the surgical procedure as part of the surgical system  102 . The hub  106  is also configured to coordinate information flow to a display of the surgical instrument  112 . For example, in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. A diagnostic input or feedback entered by a non-sterile operator at the visualization tower  111  can be routed by the hub  106  to the surgical instrument display  115  within the sterile field, where it can be viewed by the operator of the surgical instrument  112 . Example surgical instruments that are suitable for use with the surgical system  102  are described under the heading “Surgical Instrument Hardware” and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety, for example. 
     Referring now to  FIG.  3   , a hub  106  is depicted in communication with a visualization system  108 , a robotic system  110 , and a handheld intelligent surgical instrument  112 . The hub  106  includes a hub display  135 , an imaging module  138 , a generator module  140 , a communication module  130 , a processor module  132 , and a storage array  134 . In certain aspects, as illustrated in  FIG.  3   , the hub  106  further includes a smoke evacuation module  126  and/or a suction/irrigation module  128 . 
     During a surgical procedure, energy application to tissue, for sealing and/or cutting, is generally associated with smoke evacuation, suction of excess fluid, and/or irrigation of the tissue. Fluid, power, and/or data lines from different sources are often entangled during the surgical procedure. Valuable time can be lost addressing this issue during a surgical procedure. Detangling the lines may necessitate disconnecting the lines from their respective modules, which may require resetting the modules. The hub modular enclosure 136 offers a unified environment for managing the power, data, and fluid lines, which reduces the frequency of entanglement between such lines. 
     Aspects of the present disclosure present a surgical hub for use in a surgical procedure that involves energy application to tissue at a surgical site. The surgical hub includes a hub enclosure and a combo generator module slidably receivable in a docking station of the hub enclosure. The docking station includes data and power contacts. The combo generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a monopolar RF energy generator component that are housed in a single unit. In one aspect, the combo generator module also includes a smoke evacuation component, at least one energy delivery cable for connecting the combo generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid, and/or particulates generated by the application of therapeutic energy to the tissue, and a fluid line extending from the remote surgical site to the smoke evacuation component. 
     In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module slidably received in the hub enclosure. In one aspect, the hub enclosure comprises a fluid interface. 
     Certain surgical procedures may require the application of more than one energy type to the tissue. One energy type may be more beneficial for cutting the tissue, while another different energy type may be more beneficial for sealing the tissue. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution where a hub modular enclosure  136  is configured to accommodate different generators, and facilitate an interactive communication therebetween. One of the advantages of the hub modular enclosure  136  is enabling the quick removal and/or replacement of various modules. 
     Aspects of the present disclosure present a modular surgical enclosure for use in a surgical procedure that involves energy application to tissue. The modular surgical enclosure includes a first energy-generator module, configured to generate a first energy for application to the tissue, and a first docking station comprising a first docking port that includes first data and power contacts, wherein the first energy-generator module is slidably movable into an electrical engagement with the power and data contacts and wherein the first energy-generator module is slidably movable out of the electrical engagement with the first power and data contacts, 
     Further to the above, the modular surgical enclosure also includes a second energy-generator module configured to generate a second energy, different than the first energy, for application to the tissue, and a second docking station comprising a second docking port that includes second data and power contacts, wherein the second energy-generator module is slidably movable into an electrical engagement with the power and data contacts, and wherein the second energy-generator module is slidably movable out of the electrical engagement with the second power and data contacts. 
     In addition, the modular surgical enclosure also includes a communication bus between the first docking port and the second docking port, configured to facilitate communication between the first energy-generator module and the second energy-generator module. 
     Referring to  FIGS.  3 - 7   , aspects of the present disclosure are presented for a hub modular enclosure  136  that allows the modular integration of a generator module  140 , a smoke evacuation module  126 , and a suction/irrigation module  128 . The hub modular enclosure  136  further facilitates interactive communication between the modules  140 ,  126 ,  128 . As illustrated in  FIG.  5   , the generator module  140  can be a generator module with integrated monopolar, bipolar, and ultrasonic components supported in a single housing unit  139  slidably insertable into the hub modular enclosure  136 . As illustrated in  FIG.  5   , the generator module  140  can be configured to connect to a monopolar device  146 , a bipolar device  147 , and an ultrasonic device  148 . Alternatively, the generator module  140  may comprise a series of monopolar, bipolar, and/or ultrasonic generator modules that interact through the hub modular enclosure  136 . The hub modular enclosure  136  can be configured to facilitate the insertion of multiple generators and interactive communication between the generators docked into the hub modular enclosure  136  so that the generators would act as a single generator. 
     In one aspect, the hub modular enclosure  136  comprises a modular power and communication backplane  149  with external and wireless communication headers to enable the removable attachment of the modules  140 ,  126 ,  128  and interactive communication therebetween. 
     In one aspect, the hub modular enclosure  136  includes docking stations, or drawers,  151 , herein also referred to as drawers, which are configured to slidably receive the modules  140 ,  126 ,  128 .  FIG.  4    illustrates a partial perspective view of a surgical hub enclosure  136 , and a combo generator module  145  slidably receivable in a docking station  151  of the surgical hub enclosure  136 . A docking port  152  with power and data contacts on a rear side of the combo generator module  145  is configured to engage a corresponding docking port  150  with power and data contacts of a corresponding docking station  151  of the hub modular enclosure  136  as the combo generator module  145  is slid into position within the corresponding docking station  151  of the hub module enclosure  136 . In one aspect, the combo generator module  145  includes a bipolar, ultrasonic, and monopolar module and a smoke evacuation module integrated together into a single housing unit  139 , as illustrated in  FIG.  5   . 
     In various aspects, the smoke evacuation module  126  includes a fluid line  154  that conveys captured/collected smoke and/or fluid away from a surgical site and to, for example, the smoke evacuation module  126 . Vacuum suction originating from the smoke evacuation module  126  can draw the smoke into an opening of a utility conduit at the surgical site. The utility conduit, coupled to the fluid line, can be in the form of a flexible tube terminating at the smoke evacuation module  126 . The utility conduit and the fluid line define a fluid path extending toward the smoke evacuation module  126  that is received in the hub enclosure  136 . 
     In various aspects, the suction/irrigation module  128  is coupled to a surgical tool comprising an aspiration fluid line and a suction fluid line. In one example, the aspiration and suction fluid lines are in the form of flexible tubes extending from the surgical site toward the suction/irrigation module  128 . One or more drive systems can be configured to cause irrigation and aspiration of fluids to and from the surgical site. 
     In one aspect, the surgical tool includes a shaft having an end effector at a distal end thereof and at least one energy treatment associated with the end effector, an aspiration tube, and an irrigation tube. The aspiration tube can have an inlet port at a distal end thereof and the aspiration tube extends through the shaft. Similarly, an irrigation tube can extend through the shaft and can have an inlet port in proximity to the energy deliver implement. The energy deliver implement is configured to deliver ultrasonic and/or RF energy to the surgical site and is coupled to the generator module  140  by a cable extending initially through the shaft. 
     The irrigation tube can be in fluid communication with a fluid source, and the aspiration tube can be in fluid communication with a vacuum source. The fluid source and/or the vacuum source can be housed in the suction/irrigation module  128 . In one example, the fluid source and/or the vacuum source can be housed in the hub enclosure  136  separately from the suction/irrigation module  128 . In such example, a fluid interface can be configured to connect the suction/irrigation module  128  to the fluid source and/or the vacuum source. 
     In one aspect, the modules  140 ,  126 ,  128  and/or their corresponding docking stations on the hub modular enclosure  136  may include alignment features that are configured to align the docking ports of the modules into engagement with their counterparts in the docking stations of the hub modular enclosure  136 . For example, as illustrated in  FIG.  4   , the combo generator module  145  includes side brackets  155  that are configured to slidably engage with corresponding brackets  156  of the corresponding docking station  151  of the hub modular enclosure  136 . The brackets cooperate to guide the docking port contacts of the combo generator module  145  into an electrical engagement with the docking port contacts of the hub modular enclosure  136 . 
     In some aspects, the drawers  151  of the hub modular enclosure  136  are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers  151 . For example, the side brackets  155  and/or  156  can be larger or smaller depending on the size of the module. In other aspects, the drawers  151  are different in size and are each designed to accommodate a particular module. 
     Furthermore, the contacts of a particular module can be keyed for engagement with the contacts of a particular drawer to avoid inserting a module into a drawer with mismatching contacts. 
     As illustrated in  FIG.  4   , the docking port  150  of one drawer  151  can be coupled to the docking port  150  of another drawer  151  through a communications link  157  to facilitate an interactive communication between the modules housed in the hub modular enclosure  136 . The docking ports  150  of the hub modular enclosure  136  may alternatively, or additionally, facilitate a wireless interactive communication between the modules housed in the hub modular enclosure  136 . Any suitable wireless communication can be employed, such as for example Air Titan-Bluetooth. 
       FIG.  6    illustrates individual power bus attachments for a plurality of lateral docking ports of a lateral modular housing  160  configured to receive a plurality of modules of a surgical hub  206 . The lateral modular housing  160  is configured to laterally receive and interconnect the modules  161 . The modules  161  are slidably inserted into docking stations  162  of lateral modular housing  160 , which includes a backplane for interconnecting the modules  161 . As illustrated in  FIG.  6   , the modules  161  are arranged laterally in the lateral modular housing  160 . Alternatively, the modules  161  may be arranged vertically in a lateral modular housing. 
       FIG.  7    illustrates a vertical modular housing  164  configured to receive a plurality of modules  165  of the surgical hub  106 . The modules  165  are slidably inserted into docking stations, or drawers,  167  of vertical modular housing  164 , which includes a backplane for interconnecting the modules  165 . Although the drawers  167  of the vertical modular housing  164  are arranged vertically, in certain instances, a vertical modular housing  164  may include drawers that are arranged laterally. Furthermore, the modules  165  may interact with one another through the docking ports of the vertical modular housing  164 . In the example of  FIG.  7   , a display  177  is provided for displaying data relevant to the operation of the modules  165 . In addition, the vertical modular housing  164  includes a master module  178  housing a plurality of sub-modules that are slidably received in the master module  178 . 
     In various aspects, the imaging module  138  comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular housing that can be assembled with a light source module and a camera module. The housing can be a disposable housing. In at least one example, the disposable housing is removably coupled to a reusable controller, a light source module, and a camera module. The light source module and/or the camera module can be selectively chosen depending on the type of surgical procedure. In one aspect, the camera module comprises a CCD sensor. In another aspect, the camera module comprises a CMOS sensor. In another aspect, the camera module is configured for scanned beam imaging. Likewise, the light source module can be configured to deliver a white light or a different light, depending on the surgical procedure. 
     During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or a different light source can be inefficient. Temporarily losing sight of the surgical field may lead to undesirable consequences. The module imaging device of the present disclosure is configured to permit the replacement of a light source module or a camera module midstream during a surgical procedure, without having to remove the imaging device from the surgical field. 
     In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. A first channel is configured to slidably receive the camera module, which can be configured for a snap-fit engagement with the first channel. A second channel is configured to slidably receive the light source module, which can be configured for a snap-fit engagement with the second channel. In another example, the camera module and/or the light source module can be rotated into a final position within their respective channels. A threaded engagement can be employed in lieu of the snap-fit engagement. 
     In various examples, multiple imaging devices are placed at different positions in the surgical field to provide multiple views. The imaging module  138  can be configured to switch between the imaging devices to provide an optimal view. In various aspects, the imaging module  138  can be configured to integrate the images from the different imaging device. 
     Various image processors and imaging devices suitable for use with the present disclosure are described in U.S. Pat. No. 7,995,045, titled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, which issued on Aug. 9, 2011, which is herein incorporated by reference in its entirety. In addition, U.S. Pat. No. 7,982,776, titled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, which issued on Jul. 19, 2011, which is herein incorporated by reference in its entirety, describes various systems for removing motion artifacts from image data. Such systems can be integrated with the imaging module 138. Furthermore, U.S. Pat. Application Publication No. 2011/0306840, titled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS, which published on Dec. 15, 2011, and U.S. Pat. Application Publication No. 2014/0243597, titled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, which published on Aug. 28, 2014, each of which is herein incorporated by reference in its entirety. 
       FIG.  8    illustrates a surgical data network  201  comprising a modular communication hub  203  configured to connect modular devices located in one or more operating theaters of a healthcare facility, or any room in a healthcare facility specially equipped for surgical operations, to a cloud-based system (e.g., the cloud  204  that may include a remote server  213  coupled to a storage device  205 ). In one aspect, the modular communication hub  203  comprises a network hub  207  and/or a network switch  209  in communication with a network router. The modular communication hub  203  also can be coupled to a local computer system  210  to provide local computer processing and data manipulation. The surgical data network  201  may be configured as passive, intelligent, or switching. A passive surgical data network serves as a conduit for the data, enabling it to go from one device (or segment) to another and to the cloud computing resources. An intelligent surgical data network includes additional features to enable the traffic passing through the surgical data network to be monitored and to configure each port in the network hub  207  or network switch  209 . An intelligent surgical data network may be referred to as a manageable hub or switch. A switching hub reads the destination address of each packet and then forwards the packet to the correct port. 
     Modular devices  1   a - 1   n  located in the operating theater may be coupled to the modular communication hub  203 . The network hub  207  and/or the network switch  209  may be coupled to a network router  211  to connect the devices  1   a - 1   n  to the cloud  204  or the local computer system  210 . Data associated with the devices  1   a - 1   n  may be transferred to cloud-based computers via the router for remote data processing and manipulation. Data associated with the devices  1   a - 1   n  may also be transferred to the local computer system  210  for local data processing and manipulation. Modular devices  2   a - 2   m  located in the same operating theater also may be coupled to a network switch  209 . The network switch  209  may be coupled to the network hub  207  and/or the network router  211  to connect to the devices  2   a - 2   m  to the cloud  204 . Data associated with the devices  2   a - 2   n  may be transferred to the cloud  204  via the network router  211  for data processing and manipulation. Data associated with the devices  2   a - 2   m  may also be transferred to the local computer system  210  for local data processing and manipulation. 
     It will be appreciated that the surgical data network  201  may be expanded by interconnecting multiple network hubs  207  and/or multiple network switches  209  with multiple network routers  211 . The modular communication hub  203  may be contained in a modular control tower configured to receive multiple devices  1   a - 1   n / 2   a - 2   m . The local computer system  210  also may be contained in a modular control tower. The modular communication hub  203  is connected to a display  212  to display images obtained by some of the devices  1   a - 1   n / 2   a - 2   m , for example during surgical procedures. In various aspects, the devices  1   a - 1   n / 2   a - 2   m  may include, for example, various modules such as an imaging module  138  coupled to an endoscope, a generator module  140  coupled to an energy-based surgical device, a smoke evacuation module  126 , a suction/irrigation module  128 , a communication module  130 , a processor module  132 , a storage array  134 , a surgical device coupled to a display, and/or a non-contact sensor module, among other modular devices that may be connected to the modular communication hub  203  of the surgical data network  201 . 
     In one aspect, the surgical data network  201  may comprise a combination of network hub(s), network switch(es), and network router(s) connecting the devices  1   a - 1   n / 2   a - 2   m  to the cloud. Any one of or all of the devices  1   a - 1   n / 2   a - 2   m  coupled to the network hub or network switch may collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be appreciated that cloud computing relies on sharing computing resources rather than having local servers or personal devices to handle software applications. The word “cloud” may be used as a metaphor for “the Internet,” although the term is not limited as such. Accordingly, the term “cloud computing” may be used herein to refer to “a type of Internet-based computing,” where different services—such as servers, storage, and applications—are delivered to the modular communication hub  203  and/or computer system  210  located in the surgical theater (e.g., a fixed, mobile, temporary, or field operating room or space) and to devices connected to the modular communication hub  203  and/or computer system  210  through the Internet. The cloud infrastructure may be maintained by a cloud service provider. In this context, the cloud service provider may be the entity that coordinates the usage and control of the devices  1   a - 1   n / 2   a - 2   m  located in one or more operating theaters. The cloud computing services can perform a large number of calculations based on the data gathered by smart surgical instruments, robots, and other computerized devices located in the operating theater. The hub hardware enables multiple devices or connections to be connected to a computer that communicates with the cloud computing resources and storage. 
     Applying cloud computer data processing techniques on the data collected by the devices  1   a - 1   n / 2   a - 2   m , the surgical data network provides improved surgical outcomes, reduced costs, and improved patient satisfaction. At least some of the devices  1   a - 1   n / 2   a - 2   m  may be employed to view tissue states to assess leaks or perfusion of sealed tissue after a tissue sealing and cutting procedure. At least some of the devices  1   a - 1   n / 2   a - 2   m  may be employed to identify pathology, such as the effects of diseases, using the cloud-based computing to examine data including images of samples of body tissue for diagnostic purposes. This includes localization and margin confirmation of tissue and phenotypes. At least some of the devices  1   a - 1   n / 2   a - 2   m  may be employed to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. The data gathered by the devices  1   a - 1   n / 2   a - 2   m , including image data, may be transferred to the cloud  204  or the local computer system  210  or both for data processing and manipulation including image processing and manipulation. The data may be analyzed to improve surgical procedure outcomes by determining if further treatment, such as the application of endoscopic intervention, emerging technologies, a targeted radiation, targeted intervention, and precise robotics to tissue-specific sites and conditions, may be pursued. Such data analysis may further employ outcome analytics processing, and using standardized approaches may provide beneficial feedback to either confirm surgical treatments and the behavior of the surgeon or suggest modifications to surgical treatments and the behavior of the surgeon. 
     In one implementation, the operating theater devices  1   a - 1   n  may be connected to the modular communication hub  203  over a wired channel or a wireless channel depending on the configuration of the devices  1   a - 1   n  to a network hub. The network hub  207  may be implemented, in one aspect, as a local network broadcast device that works on the physical layer of the Open System Interconnection (OSI) model. The network hub provides connectivity to the devices  1   a - 1   n  located in the same operating theater network. The network hub  207  collects data in the form of packets and sends them to the router in half duplex mode. The network hub  207  does not store any media access control/Internet Protocol (MAC/IP) to transfer the device data. Only one of the devices  1   a - 1   n  can send data at a time through the network hub  207 . The network hub  207  has no routing tables or intelligence regarding where to send information and broadcasts all network data across each connection and to a remote server  213  ( FIG.  9   ) over the cloud  204 . The network hub  207  can detect basic network errors such as collisions, but having all information broadcast to multiple ports can be a security risk and cause bottlenecks. 
     In another implementation, the operating theater devices  2   a - 2   m  may be connected to a network switch  209  over a wired channel or a wireless channel. The network switch  209  works in the data link layer of the OSI model. The network switch  209  is a multicast device for connecting the devices  2   a - 2   m  located in the same operating theater to the network. The network switch  209  sends data in the form of frames to the network router  211  and works in full duplex mode. Multiple devices  2   a - 2   m  can send data at the same time through the network switch  209 . The network switch  209  stores and uses MAC addresses of the devices  2   a - 2   m  to transfer data. 
     The network hub  207  and/or the network switch  209  are coupled to the network router  211  for connection to the cloud  204 . The network router  211  works in the network layer of the OSI model. The network router  211  creates a route for transmitting data packets received from the network hub  207  and/or network switch  211  to cloud-based computer resources for further processing and manipulation of the data collected by any one of or all the devices  1   a - 1   n / 2   a - 2   m . The network router  211  may be employed to connect two or more different networks located in different locations, such as, for example, different operating theaters of the same healthcare facility or different networks located in different operating theaters of different healthcare facilities. The network router  211  sends data in the form of packets to the cloud  204  and works in full duplex mode. Multiple devices can send data at the same time. The network router  211  uses IP addresses to transfer data. 
     In one example, the network hub  207  may be implemented as a USB hub, which allows multiple USB devices to be connected to a host computer. The USB hub may expand a single USB port into several tiers so that there are more ports available to connect devices to the host system computer. The network hub  207  may include wired or wireless capabilities to receive information over a wired channel or a wireless channel. In one aspect, a wireless USB short-range, high-bandwidth wireless radio communication protocol may be employed for communication between the devices  1   a - 1   n  and devices  2   a - 2   m  located in the operating theater. 
     In other examples, the operating theater devices  1   a - 1   n / 2   a - 2   m  may communicate to the modular communication hub  203  via Bluetooth wireless technology standard for exchanging data over short distances (using short-wavelength UHF radio waves in the ISM band from 2.4 to 2.485 GHz) from fixed and mobile devices and building personal area networks (PANs). In other aspects, the operating theater devices  1   a - 1   n / 2   a - 2   m  may communicate to the modular communication hub  203  via a number of wireless or wired communication standards or protocols, including but not limited to Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module may include a plurality of communication modules. For instance, a first communication module may be dedicated to shorter-range wireless communications such as Wi-Fi and Bluetooth, and a second communication module may be dedicated to longer-range wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, and others. 
     The modular communication hub  203  may serve as a central connection for one or all of the operating theater devices  1   a - 1   n / 2   a - 2   m  and handles a data type known as frames. Frames carry the data generated by the devices  1   a - 1   n / 2   a - 2   m . When a frame is received by the modular communication hub  203 , it is amplified and transmitted to the network router  211 , which transfers the data to the cloud computing resources by using a number of wireless or wired communication standards or protocols, as described herein. 
     The modular communication hub  203  can be used as a standalone device or be connected to compatible network hubs and network switches to form a larger network. The modular communication hub  203  is generally easy to install, configure, and maintain, making it a good option for networking the operating theater devices  1   a - 1   n / 2   a - 2   m . 
       FIG.  9    illustrates a computer-implemented interactive surgical system  200 . The computer-implemented interactive surgical system  200  is similar in many respects to the computer-implemented interactive surgical system  100 . For example, the computer-implemented interactive surgical system  200  includes one or more surgical systems  202 , which are similar in many respects to the surgical systems  102 . Each surgical system  202  includes at least one surgical hub  206  in communication with a cloud  204  that may include a remote server  213 . In one aspect, the computer-implemented interactive surgical system  200  comprises a modular control tower  236  connected to multiple operating theater devices such as, for example, intelligent surgical instruments, robots, and other computerized devices located in the operating theater. As shown in  FIG.  10   , the modular control tower  236  comprises a modular communication hub  203  coupled to a computer system  210 . As illustrated in the example of  FIG.  9   , the modular control tower  236  is coupled to an imaging module  238  that is coupled to an endoscope  239 , a generator module  240  that is coupled to an energy device  241 , a smoke evacuator module  226 , a suction/irrigation module  228 , a communication module  230 , a processor module  232 , a storage array  234 , a smart device/instrument  235  optionally coupled to a display  237 , and a non-contact sensor module  242 . The operating theater devices are coupled to cloud computing resources and data storage via the modular control tower  236 . A robot hub  222  also may be connected to the modular control tower  236  and to the cloud computing resources. The devices/instruments  235 , visualization systems  208 , among others, may be coupled to the modular control tower  236  via wired or wireless communication standards or protocols, as described herein. The modular control tower  236  may be coupled to a hub display  215  (e.g., monitor, screen) to display and overlay images received from the imaging module, device/instrument display, and/or other visualization systems  208 . The hub display also may display data received from devices connected to the modular control tower in conjunction with images and overlaid images. 
       FIG.  10    illustrates a surgical hub  206  comprising a plurality of modules coupled to the modular control tower  236 . The modular control tower  236  comprises a modular communication hub  203 , e.g., a network connectivity device, and a computer system  210  to provide local processing, visualization, and imaging, for example. As shown in  FIG.  10   , the modular communication hub  203  may be connected in a tiered configuration to expand the number of modules (e.g., devices) that may be connected to the modular communication hub  203  and transfer data associated with the modules to the computer system  210 , cloud computing resources, or both. As shown in  FIG.  10   , each of the network hubs/switches in the modular communication hub  203  includes three downstream ports and one upstream port. The upstream network hub/switch is connected to a processor to provide a communication connection to the cloud computing resources and a local display  217 . Communication to the cloud  204  may be made either through a wired or a wireless communication channel. 
     The surgical hub  206  employs a non-contact sensor module  242  to measure the dimensions of the operating theater and generate a map of the surgical theater using either ultrasonic or laser-type non-contact measurement devices. An ultrasound-based non-contact sensor module scans the operating theater by transmitting a burst of ultrasound and receiving the echo when it bounces off the perimeter walls of an operating theater as described under the heading “Surgical Hub Spatial Awareness Within an Operating Room” in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, which is herein incorporated by reference in its entirety, in which the sensor module is configured to determine the size of the operating theater and to adjust Bluetooth-pairing distance limits. A laser-based non-contact sensor module scans the operating theater by transmitting laser light pulses, receiving laser light pulses that bounce off the perimeter walls of the operating theater, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating theater and to adjust Bluetooth pairing distance limits, for example. 
     The computer system  210  comprises a processor  244  and a network interface  245 . The processor  244  is coupled to a communication module  247 , storage  248 , memory  249 , non-volatile memory  250 , and input/output interface  251  via a system bus. The system bus can be any of several types of bus structure(s) including the memory bus or memory controller, a peripheral bus or external bus, and/or a local bus using any variety of available bus architectures including, but not limited to, 9-bit bus, Industrial Standard Architecture (ISA), Micro-Charmel Architecture (MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESA Local Bus (VLB), Peripheral Component Interconnect (PCI), USB, Advanced Graphics Port (AGP), Personal Computer Memory Card International Association bus (PCMCIA), Small Computer Systems Interface (SCSI), or any other proprietary bus. 
     The processor  244  may be any single-core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the processor may be an LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas Instruments, for example, comprising an on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with StellarisWare® software, a 2 KB electrically erasable programmable read-only memory (EEPROM), and/or one or more pulse width modulation (PWM) modules, one or more quadrature encoder inputs (QEI) analogs, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, details of which are available for the product datasheet. 
     In one aspect, the processor  244  may comprise a safety controller comprising two controller-based families such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options. 
     The system memory includes volatile memory and non-volatile memory. The basic input/output system (BIOS), containing the basic routines to transfer information between elements within the computer system, such as during start-up, is stored in non-volatile memory. For example, the non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random-access memory (RAM), which acts as external cache memory. Moreover, RAM is available in many forms such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct Rambus RAM (DRRAM). 
     The computer system  210  also includes removable/non-removable, volatile/non-volatile computer storage media, such as for example disk storage. The disk storage includes, but is not limited to, devices like a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card, or memory stick. In addition, the disk storage can include storage media separately or in combination with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM device (CD-ROM), compact disc recordable drive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or a digital versatile disc ROM drive (DVD-ROM). To facilitate the connection of the disk storage devices to the system bus, a removable or non-removable interface may be employed. 
     It is to be appreciated that the computer system  210  includes software that acts as an intermediary between users and the basic computer resources described in a suitable operating environment. Such software includes an operating system. The operating system, which can be stored on the disk storage, acts to control and allocate resources of the computer system. System applications take advantage of the management of resources by the operating system through program modules and program data stored either in the system memory or on the disk storage. It is to be appreciated that various components described herein can be implemented with various operating systems or combinations of operating systems. 
     A user enters commands or information into the computer system  210  through input device(s) coupled to the I/O interface  251 . The input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, touch pad, keyboard, microphone, joystick, game pad, satellite dish, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor through the system bus via interface port(s). The interface port(s) include, for example, a serial port, a parallel port, a game port, and a USB. The output device(s) use some of the same types of ports as input device(s). Thus, for example, a USB port may be used to provide input to the computer system and to output information from the computer system to an output device. An output adapter is provided to illustrate that there are some output devices like monitors, displays, speakers, and printers, among other output devices that require special adapters. The output adapters include, by way of illustration and not limitation, video and sound cards that provide a means of connection between the output device and the system bus. It should be noted that other devices and/or systems of devices, such as remote computer(s), provide both input and output capabilities. 
     The computer system  210  can operate in a networked environment using logical connections to one or more remote computers, such as cloud computer(s), or local computers. The remote cloud computer(s) can be a personal computer, server, router, network PC, workstation, microprocessor-based appliance, peer device, or other common network node, and the like, and typically includes many or all of the elements described relative to the computer system. For purposes of brevity, only a memory storage device is illustrated with the remote computer(s). The remote computer(s) is logically connected to the computer system through a network interface and then physically connected via a communication connection. The network interface encompasses communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE 802.5 and the like. WAN technologies include, but are not limited to, point-to-point links, circuit-switching networks like Integrated Services Digital Networks (ISDN) and variations thereon, packet-switching networks, and Digital Subscriber Lines (DSL). 
     In various aspects, the computer system  210  of  FIG.  10   , the imaging module  238  and/or visualization system  208 , and/or the processor module  232  of  FIGS.  9 - 10   , may comprise an image processor, image-processing engine, media processor, or any specialized digital signal processor (DSP) used for the processing of digital images. The image processor may employ parallel computing with single instruction, multiple data (SIMD) or multiple instruction, multiple data (MIMD) technologies to increase speed and efficiency. The digital image-processing engine can perform a range of tasks. The image processor may be a system on a chip with multicore processor architecture. 
     The communication connection(s) refers to the hardware/software employed to connect the network interface to the bus. While the communication connection is shown for illustrative clarity inside the computer system, it can also be external to the computer system  210 . The hardware/software necessary for connection to the network interface includes, for illustrative purposes only, internal and external technologies such as modems, including regular telephone-grade modems, cable modems, and DSL modems, ISDN adapters, and Ethernet cards. 
       FIG.  11    illustrates a functional block diagram of one aspect of a USB network hub  300  device, according to one aspect of the present disclosure. In the illustrated aspect, the USB network hub device  300  employs a TUSB2036 integrated circuit hub by Texas Instruments. The USB network hub  300  is a CMOS device that provides an upstream USB transceiver port  302  and up to three downstream USB transceiver ports  304 ,  306 ,  308  in compliance with the USB 2.0 specification. The upstream USB transceiver port  302  is a differential root data port comprising a differential data minus (DM0) input paired with a differential data plus (DP0) input. The three downstream USB transceiver ports  304 ,  306 ,  308  are differential data ports where each port includes differential data plus (DP 1 -DP 3 ) outputs paired with differential data minus (DM 1 -DM 3 ) outputs. 
     The USB network hub  300  device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compliant USB transceivers are integrated into the circuit for the upstream USB transceiver port  302  and all downstream USB transceiver ports  304 ,  306 ,  308 . The downstream USB transceiver ports  304 ,  306 ,  308  support both full-speed and low-speed devices by automatically setting the slew rate according to the speed of the device attached to the ports. The USB network hub  300  device may be configured either in bus-powered or self-powered mode and includes a hub power logic  312  to manage power. 
     The USB network hub  300  device includes a serial interface engine  310  (SIE). The SIE  310  is the front end of the USB network hub  300  hardware and handles most of the protocol described in chapter 8 of the USB specification. The SIE  310  typically comprehends signaling up to the transaction level. The functions that it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection/generation, clock/data separation, non-return-to-zero invert (NRZI) data encoding/decoding and bit-stuffing, CRC generation and checking (token and data), packet ID (PID) generation and checking/decoding, and/or serial-parallel/parallel-serial conversion. The  310  receives a clock input  314  and is coupled to a suspend/resume logic and frame timer  316  circuit and a hub repeater circuit  318  to control communication between the upstream USB transceiver port  302  and the downstream USB transceiver ports  304 ,  306 ,  308  through port logic circuits  320 ,  322 ,  324 . The SIE  310  is coupled to a command decoder  326  via interface logic to control commands from a serial EEPROM via a serial EEPROM interface  330 . 
     In various aspects, the USB network hub  300  can connect  127  functions configured in up to six logical layers (tiers) to a single computer. Further, the USB network hub  300  can connect to all peripherals using a standardized four-wire cable that provides both communication and power distribution. The power configurations are bus-powered and self-powered modes. The USB network hub  300  may be configured to support four modes of power management: a bus-powered hub, with either individual-port power management or ganged-port power management, and the self-powered hub, with either individual-port power management or ganged-port power management. In one aspect, using a USB cable, the USB network hub  300 , the upstream USB transceiver port  302  is plugged into a USB host controller, and the downstream USB transceiver ports  304 ,  306 ,  308  are exposed for connecting USB compatible devices, and so forth. 
     Surgical Instrument Hardware 
       FIG.  12    illustrates a logic diagram of a control system  470  of a surgical instrument or tool in accordance with one or more aspects of the present disclosure. The system  470  comprises a control circuit. The control circuit includes a microcontroller  461  comprising a processor  462  and a memory  468 . One or more of sensors  472 ,  474 ,  476 , for example, provide real-time feedback to the processor  462 . A motor  482 , driven by a motor driver  492 , operably couples a longitudinally movable displacement member to drive the I-beam knife element. A tracking system  480  is configured to determine the position of the longitudinally movable displacement member. The position information is provided to the processor  462 , which can be programmed or configured to determine the position of the longitudinally movable drive member as well as the position of a firing member, firing bar, and I-beam knife element. Additional motors may be provided at the tool driver interface to control I-beam firing, closure tube travel, shaft rotation, and articulation. A display  473  displays a variety of operating conditions of the instruments and may include touch screen functionality for data input. Information displayed on the display  473  may be overlaid with images acquired via endoscopic imaging modules. 
     In one aspect, the microcontroller  461  may be any single-core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the main microcontroller  461  may be an LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas Instruments, for example, comprising an on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle SRAM, and internal ROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, and/or one or more 12-bit ADCs with 12 analog input channels, details of which are available for the product datasheet. 
     In one aspect, the microcontroller  461  may comprise a safety controller comprising two controller-based families such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options. 
     The microcontroller  461  may be programmed to perform various functions such as precise control over the speed and position of the knife and articulation systems. In one aspect, the microcontroller  461  includes a processor  462  and a memory  468 . The electric motor  482  may be a brushed direct current (DC) motor with a gearbox and mechanical links to an articulation or knife system. In one aspect, a motor driver  492  may be an A3941 available from Allegro Microsystems, Inc. Other motor drivers may be readily substituted for use in the tracking system  480  comprising an absolute positioning system. A detailed description of an absolute positioning system is described in U.S. Pat. Application Publication No. 2017/0296213, titled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, which published on Oct. 19, 2017, which is herein incorporated by reference in its entirety. 
     The microcontroller  461  may be programmed to provide precise control over the speed and position of displacement members and articulation systems. The microcontroller  461  may be configured to compute a response in the software of the microcontroller  461 . The computed response is compared to a measured response of the actual system to obtain an “observed” response, which is used for actual feedback decisions. The observed response is a favorable, tuned value that balances the smooth, continuous nature of the simulated response with the measured response, which can detect outside influences on the system. 
     In one aspect, the motor  482  may be controlled by the motor driver  492  and can be employed by the firing system of the surgical instrument or tool. In various forms, the motor  482  may be a brushed DC driving motor having a maximum rotational speed of approximately 25,000 RPM. In other arrangements, the motor  482  may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor driver  492  may comprise an H-bridge driver comprising field-effect transistors (FETs), for example. The motor  482  can be powered by a power assembly releasably mounted to the handle assembly or tool housing for supplying control power to the surgical instrument or tool. The power assembly may comprise a battery which may include a number of battery cells connected in series that can be used as the power source to power the surgical instrument or tool. In certain circumstances, the battery cells of the power assembly may be replaceable and/or rechargeable. In at least one example, the battery cells can be lithium-ion batteries which can be couplable to and separable from the power assembly. 
     The motor driver  492  may be an A3941 available from Allegro Microsystems, Inc. The A3941  492  is a full-bridge controller for use with external N-channel power metal-oxide semiconductor field-effect transistors (MOSFETs) specifically designed for inductive loads, such as brush DC motors. The driver  492  comprises a unique charge pump regulator that provides full (&gt;10 V) gate drive for battery voltages down to 7 V and allows the A3941 to operate with a reduced gate drive, down to 5.5 V. A bootstrap capacitor may be employed to provide the above battery supply voltage required for N-channel MOSFETs. An internal charge pump for the high-side drive allows DC (100% duty cycle) operation. The full bridge can be driven in fast or slow decay modes using diode or synchronous rectification. In the slow decay mode, current recirculation can be through the high-side or the lowside FETs. The power FETs are protected from shoot-through by resistor-adjustable dead time. Integrated diagnostics provide indications of undervoltage, overtemperature, and power bridge faults and can be configured to protect the power MOSFETs under most short circuit conditions. Other motor drivers may be readily substituted for use in the tracking system  480  comprising an absolute positioning system. 
     The tracking system  480  comprises a controlled motor drive circuit arrangement comprising a position sensor  472  according to one aspect of this disclosure. The position sensor  472  for an absolute positioning system provides a unique position signal corresponding to the location of a displacement member. In one aspect, the displacement member represents a longitudinally movable drive member comprising a rack of drive teeth for meshing engagement with a corresponding drive gear of a gear reducer assembly. In other aspects, the displacement member represents the firing member, which could be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents a firing bar or the I-beam, each of which can be adapted and configured to include a rack of drive teeth. Accordingly, as used herein, the term displacement member is used generically to refer to any movable member of the surgical instrument or tool such as the drive member, the firing member, the firing bar, the I-beam, or any element that can be displaced. In one aspect, the longitudinally movable drive member is coupled to the firing member, the firing bar, and the I-beam. Accordingly, the absolute positioning system can, in effect, track the linear displacement of the I-beam by tracking the linear displacement of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to any position sensor  472  suitable for measuring linear displacement. Thus, the longitudinally movable drive member, the firing member, the firing bar, or the I-beam, or combinations thereof, may be coupled to any suitable linear displacement sensor. Linear displacement sensors may include contact or non-contact displacement sensors. Linear displacement sensors may comprise linear variable differential transformers (LVDT), differential variable reluctance transducers (DVRT), a slide potentiometer, a magnetic sensing system comprising a movable magnet and a series of linearly arranged Hall effect sensors, a magnetic sensing system comprising a fixed magnet and a series of movable, linearly arranged Hall effect sensors, an optical sensing system comprising a movable light source and a series of linearly arranged photo diodes or photo detectors, an optical sensing system comprising a fixed light source and a series of movable linearly, arranged photo diodes or photo detectors, or any combination thereof. 
     The electric motor  482  can include a rotatable shaft that operably interfaces with a gear assembly that is mounted in meshing engagement with a set, or rack, of drive teeth on the displacement member. A sensor element may be operably coupled to a gear assembly such that a single revolution of the position sensor  472  element corresponds to some linear longitudinal translation of the displacement member. An arrangement of gearing and sensors can be connected to the linear actuator, via a rack and pinion arrangement, or a rotary actuator, via a spur gear or other connection. A power source supplies power to the absolute positioning system and an output indicator may display the output of the absolute positioning system. The displacement member represents the longitudinally movable drive member comprising a rack of drive teeth formed thereon for meshing engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member, firing bar, I-beam, or combinations thereof. 
     A single revolution of the sensor element associated with the position sensor  472  is equivalent to a longitudinal linear displacement  d   1  of the of the displacement member, where d1 is the longitudinal linear distance that the displacement member moves from point “a” to point “b” after a single revolution of the sensor element coupled to the displacement member. The sensor arrangement may be connected via a gear reduction that results in the position sensor  472  completing one or more revolutions for the full stroke of the displacement member. The position sensor  472  may complete multiple revolutions for the full stroke of the displacement member. 
     A series of switches, where n is an integer greater than one, may be employed alone or in combination with a gear reduction to provide a unique position signal for more than one revolution of the position sensor  472 . The state of the switches are fed back to the microcontroller  461  that applies logic to determine a unique position signal corresponding to the longitudinal linear displacement  d   1  +  d   2  + ... dn of the displacement member. The output of the position sensor  472  is provided to the microcontroller  461 . The position sensor  472  of the sensor arrangement may comprise a magnetic sensor, an analog rotary sensor like a potentiometer, or an array of analog Hall-effect elements, which output a unique combination of position signals or values. 
     The position sensor  472  may comprise any number of magnetic sensing elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors encompass many aspects of physics and electronics. The technologies used for magnetic field sensing include search coil, fluxgate, optically pumped, nuclear precession, SQUID, Hall-effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive/piezoelectric composites, magnetodiode, magnetotransistor, fiber-optic, magneto-optic, and microelectromechanical systems-based magnetic sensors, among others. 
     In one aspect, the position sensor  472  for the tracking system  480  comprising an absolute positioning system comprises a magnetic rotary absolute positioning system. The position sensor  472  may be implemented as an AS5055EQFT single-chip magnetic rotary position sensor available from Austria Microsystems, AG. The position sensor  472  is interfaced with the microcontroller  461  to provide an absolute positioning system. The position sensor  472  is a low-voltage and low-power component and includes four Hall-effect elements in an area of the position sensor  472  that is located above a magnet. A high-resolution ADC and a smart power management controller are also provided on the chip. A coordinate rotation digital computer (CORDIC) processor, also known as the digit-by-digit method and Volder’s algorithm, is provided to implement a simple and efficient algorithm to calculate hyperbolic and trigonometric functions that require only addition, subtraction, bitshift, and table lookup operations. The angle position, alarm bits, and magnetic field information are transmitted over a standard serial communication interface, such as a serial peripheral interface (SPI) interface, to the microcontroller  461 . The position sensor  472  provides 12 or 14 bits of resolution. The position sensor  472  may be an AS5055 chip provided in a small QFN 16-pin 4x4x0.85 mm package. 
     The tracking system  480  comprising an absolute positioning system may comprise and/or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power source converts the signal from the feedback controller into a physical input to the system: in this case the voltage. Other examples include a PWM of the voltage, current, and force. Other sensor(s) may be provided to measure physical parameters of the physical system in addition to the position measured by the position sensor  472 . In some aspects, the other sensor(s) can include sensor arrangements such as those described in U.S. Pat. No. 9,345,481, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which issued on May 24, 2016, which is herein incorporated by reference in its entirety; U.S. Pat. Application Publication No. 2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which published on Sep. 18, 2014, which is herein incorporated by reference in its entirety; and U.S. Pat. Application Serial No. 15/628,175, titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is herein incorporated by reference in its entirety. In a digital signal processing system, an absolute positioning system is coupled to a digital data acquisition system where the output of the absolute positioning system will have a finite resolution and sampling frequency. The absolute positioning system may comprise a compare-and-combine circuit to combine a computed response with a measured response using algorithms, such as a weighted average and a theoretical control loop, that drive the computed response towards the measured response. The computed response of the physical system takes into account properties like mass, inertial, viscous friction, inductance resistance, etc., to predict what the states and outputs of the physical system will be by knowing the input. 
     The absolute positioning system provides an absolute position of the displacement member upon power-up of the instrument, without retracting or advancing the displacement member to a reset (zero or home) position as may be required with conventional rotary encoders that merely count the number of steps forwards or backwards that the motor  482  has taken to infer the position of a device actuator, drive bar, knife, or the like. 
     A sensor  474 , such as, for example, a strain gauge or a micro-strain gauge, is configured to measure one or more parameters of the end effector, such as, for example, the amplitude of the strain exerted on the anvil during a clamping operation, which can be indicative of the closure forces applied to the anvil. The measured strain is converted to a digital signal and provided to the processor  462 . Alternatively, or in addition to the sensor  474 , a sensor  476 , such as, for example, a load sensor, can measure the closure force applied by the closure drive system to the anvil. The sensor  476 , such as, for example, a load sensor, can measure the firing force applied to an I-beam in a firing stroke of the surgical instrument or tool. The I-beam is configured to engage a wedge sled, which is configured to upwardly cam staple drivers to force out staples into deforming contact with an anvil. The I-beam also includes a sharpened cutting edge that can be used to sever tissue as the I-beam is advanced distally by the firing bar. Alternatively, a current sensor  478  can be employed to measure the current drawn by the motor  482 . The force required to advance the firing member can correspond to the current drawn by the motor  482 , for example. The measured force is converted to a digital signal and provided to the processor  462 . 
     In one form, the strain gauge sensor  474  can be used to measure the force applied to the tissue by the end effector. A strain gauge can be coupled to the end effector to measure the force on the tissue being treated by the end effector. A system for measuring forces applied to the tissue grasped by the end effector comprises a strain gauge sensor  474 , such as, for example, a micro-strain gauge, that is configured to measure one or more parameters of the end effector, for example. In one aspect, the strain gauge sensor  474  can measure the amplitude or magnitude of the strain exerted on a jaw member of an end effector during a clamping operation, which can be indicative of the tissue compression. The measured strain is converted to a digital signal and provided to a processor  462  of the microcontroller  461 . A load sensor  476  can measure the force used to operate the knife element, for example, to cut the tissue captured between the anvil and the staple cartridge. A magnetic field sensor can be employed to measure the thickness of the captured tissue. The measurement of the magnetic field sensor also may be converted to a digital signal and provided to the processor  462 . 
     The measurements of the tissue compression, the tissue thickness, and/or the force required to close the end effector on the tissue, as respectively measured by the sensors  474 ,  476 , can be used by the microcontroller  461  to characterize the selected position of the firing member and/or the corresponding value of the speed of the firing member. In one instance, a memory  468  may store a technique, an equation, and/or a lookup table which can be employed by the microcontroller  461  in the assessment. 
     The control system  470  of the surgical instrument or tool also may comprise wired or wireless communication circuits to communicate with the modular communication hub as shown in  FIGS.  8 - 11   . 
       FIG.  13    illustrates a control circuit  500  configured to control aspects of the surgical instrument or tool according to one aspect of this disclosure. The control circuit  500  can be configured to implement various processes described herein. The control circuit  500  may comprise a microcontroller comprising one or more processors  502  (e.g., microprocessor, microcontroller) coupled to at least one memory circuit  504 . The memory circuit  504  stores machine-executable instructions that, when executed by the processor  502 , cause the processor  502  to execute machine instructions to implement various processes described herein. The processor  502  may be any one of a number of single-core or multicore processors known in the art. The memory circuit  504  may comprise volatile and non-volatile storage media. The processor  502  may include an instruction processing unit  506  and an arithmetic unit  508 . The instruction processing unit may be configured to receive instructions from the memory circuit  504  of this disclosure. 
       FIG.  14    illustrates a combinational logic circuit  510  configured to control aspects of the surgical instrument or tool according to one aspect of this disclosure. The combinational logic circuit  510  can be configured to implement various processes described herein. The combinational logic circuit  510  may comprise a finite state machine comprising a combinational logic  512  configured to receive data associated with the surgical instrument or tool at an input  514 , process the data by the combinational logic  512 , and provide an output  516 . 
       FIG.  15    illustrates a sequential logic circuit  520  configured to control aspects of the surgical instrument or tool according to one aspect of this disclosure. The sequential logic circuit  520  or the combinational logic  522  can be configured to implement various processes described herein. The sequential logic circuit  520  may comprise a finite state machine. The sequential logic circuit  520  may comprise a combinational logic  522 , at least one memory circuit  524 , and a clock  529 , for example. The at least one memory circuit  524  can store a current state of the finite state machine. In certain instances, the sequential logic circuit  520  may be synchronous or asynchronous. The combinational logic  522  is configured to receive data associated with the surgical instrument or tool from an input  526 , process the data by the combinational logic  522 , and provide an output  528 . In other aspects, the circuit may comprise a combination of a processor (e.g., processor  502 ,  FIG.  13   ) and a finite state machine to implement various processes herein. In other aspects, the finite state machine may comprise a combination of a combinational logic circuit (e.g., combinational logic circuit  510 ,  FIG.  14   ) and the sequential logic circuit  520 . 
       FIG.  16    illustrates a surgical instrument or tool comprising a plurality of motors which can be activated to perform various functions. In certain instances, a first motor can be activated to perform a first function, a second motor can be activated to perform a second function, a third motor can be activated to perform a third function, a fourth motor can be activated to perform a fourth function, and so on. In certain instances, the plurality of motors of robotic surgical instrument  600  can be individually activated to cause firing, closure, and/or articulation motions in the end effector. The firing, closure, and/or articulation motions can be transmitted to the end effector through a shaft assembly, for example. 
     In certain instances, the surgical instrument system or tool may include a firing motor  602 . The firing motor  602  may be operably coupled to a firing motor drive assembly  604  which can be configured to transmit firing motions, generated by the motor  602  to the end effector, in particular to displace the I-beam element. In certain instances, the firing motions generated by the motor  602  may cause the staples to be deployed from the staple cartridge into tissue captured by the end effector and/or the cutting edge of the I-beam element to be advanced to cut the captured tissue, for example. The I-beam element may be retracted by reversing the direction of the motor  602 . 
     In certain instances, the surgical instrument or tool may include a closure motor  603 . The closure motor  603  may be operably coupled to a closure motor drive assembly  605  which can be configured to transmit closure motions, generated by the motor  603  to the end effector, in particular to displace a closure tube to close the anvil and compress tissue between the anvil and the staple cartridge. The closure motions may cause the end effector to transition from an open configuration to an approximated configuration to capture tissue, for example. The end effector may be transitioned to an open position by reversing the direction of the motor  603 . 
     In certain instances, the surgical instrument or tool may include one or more articulation motors  606   a ,  606   b , for example. The motors  606   a ,  606   b  may be operably coupled to respective articulation motor drive assemblies  608   a ,  608   b , which can be configured to transmit articulation motions generated by the motors  606   a ,  606   b  to the end effector. In certain instances, the articulation motions may cause the end effector to articulate relative to the shaft, for example. 
     As described above, the surgical instrument or tool may include a plurality of motors which may be configured to perform various independent functions. In certain instances, the plurality of motors of the surgical instrument or tool can be individually or separately activated to perform one or more functions while the other motors remain inactive. For example, the articulation motors  606   a ,  606   b  can be activated to cause the end effector to be articulated while the firing motor  602  remains inactive. Alternatively, the firing motor  602  can be activated to fire the plurality of staples, and/or to advance the cutting edge, while the articulation motor  606  remains inactive. Furthermore, the closure motor  603  may be activated simultaneously with the firing motor  602  to cause the closure tube and the I-beam element to advance distally as described in more detail hereinbelow. 
     In certain instances, the surgical instrument or tool may include a common control module  610  which can be employed with a plurality of motors of the surgical instrument or tool. In certain instances, the common control module  610  may accommodate one of the plurality of motors at a time. For example, the common control module  610  can be couplable to and separable from the plurality of motors of the robotic surgical instrument individually. In certain instances, a plurality of the motors of the surgical instrument or tool may share one or more common control modules such as the common control module  610 . In certain instances, a plurality of motors of the surgical instrument or tool can be individually and selectively engaged with the common control module  610 . In certain instances, the common control module  610  can be selectively switched from interfacing with one of a plurality of motors of the surgical instrument or tool to interfacing with another one of the plurality of motors of the surgical instrument or tool. 
     In at least one example, the common control module  610  can be selectively switched between operable engagement with the articulation motors  606   a ,  606   b  and operable engagement with either the firing motor  602  or the closure motor  603 . In at least one example, as illustrated in  FIG.  16   , a switch  614  can be moved or transitioned between a plurality of positions and/or states. In a first position  616 , the switch  614  may electrically couple the common control module  610  to the firing motor  602 ; in a second position  617 , the switch  614  may electrically couple the common control module  610  to the closure motor  603 ; in a third position  618   a , the switch  614  may electrically couple the common control module  610  to the first articulation motor  606   a ; and in a fourth position  618   b , the switch  614  may electrically couple the common control module  610  to the second articulation motor  606   b , for example. In certain instances, separate common control modules  610  can be electrically coupled to the firing motor  602 , the closure motor  603 , and the articulations motor  606   a ,  606   b  at the same time. In certain instances, the switch  614  may be a mechanical switch, an electromechanical switch, a solid-state switch, or any suitable switching mechanism. 
     Each of the motors  602 ,  603 ,  606   a ,  606   b  may comprise a torque sensor to measure the output torque on the shaft of the motor. The force on an end effector may be sensed in any conventional manner, such as by force sensors on the outer sides of the jaws or by a torque sensor for the motor actuating the jaws. 
     In various instances, as illustrated in  FIG.  16   , the common control module  610  may comprise a motor driver  626  which may comprise one or more H-Bridge FETs. The motor driver  626  may modulate the power transmitted from a power source  628  to a motor coupled to the common control module  610  based on input from a microcontroller  620  (the “controller”), for example. In certain instances, the microcontroller  620  can be employed to determine the current drawn by the motor, for example, while the motor is coupled to the common control module  610 , as described above. 
     In certain instances, the microcontroller  620  may include a microprocessor  622  (the “processor”) and one or more non-transitory computer-readable mediums or memory units  624  (the “memory”). In certain instances, the memory  624  may store various program instructions, which when executed may cause the processor  622  to perform a plurality of functions and/or calculations described herein. In certain instances, one or more of the memory units  624  may be coupled to the processor  622 , for example. 
     In certain instances, the power source  628  can be employed to supply power to the microcontroller  620 , for example. In certain instances, the power source  628  may comprise a battery (or “battery pack” or “power pack”), such as a lithium-ion battery, for example. In certain instances, the battery pack may be configured to be releasably mounted to a handle for supplying power to the surgical instrument  600 . A number of battery cells connected in series may be used as the power source  628 . In certain instances, the power source  628  may be replaceable and/or rechargeable, for example. 
     In various instances, the processor  622  may control the motor driver  626  to control the position, direction of rotation, and/or velocity of a motor that is coupled to the common control module  610 . In certain instances, the processor  622  can signal the motor driver  626  to stop and/or disable a motor that is coupled to the common control module  610 . It should be understood that the term “processor” as used herein includes any suitable microprocessor, microcontroller, or other basic computing device that incorporates the functions of a computer’s central processing unit (CPU) on an integrated circuit or, at most, a few integrated circuits. The processor is a multipurpose, programmable device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. It is an example of sequential digital logic, as it has internal memory. Processors operate on numbers and symbols represented in the binary numeral system. 
     In one instance, the processor  622  may be any single-core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In certain instances, the microcontroller  620  may be an LM 4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F Processor Core comprising an on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle SRAM, an internal ROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, one or more 12-bit ADCs with 12 analog input channels, among other features that are readily available for the product datasheet. Other microcontrollers may be readily substituted for use with the module  4410 . Accordingly, the present disclosure should not be limited in this context. 
     In certain instances, the memory  624  may include program instructions for controlling each of the motors of the surgical instrument  600  that are couplable to the common control module  610 . For example, the memory  624  may include program instructions for controlling the firing motor  602 , the closure motor  603 , and the articulation motors  606   a ,  606   b . Such program instructions may cause the processor  622  to control the firing, closure, and articulation functions in accordance with inputs from algorithms or control programs of the surgical instrument or tool. 
     In certain instances, one or more mechanisms and/or sensors such as, for example, sensors  630  can be employed to alert the processor  622  to the program instructions that should be used in a particular setting. For example, the sensors  630  may alert the processor  622  to use the program instructions associated with firing, closing, and articulating the end effector. In certain instances, the sensors  630  may comprise position sensors which can be employed to sense the position of the switch  614 , for example. Accordingly, the processor  622  may use the program instructions associated with firing the I-beam of the end effector upon detecting, through the sensors  630  for example, that the switch  614  is in the first position  616 ; the processor  622  may use the program instructions associated with closing the anvil upon detecting, through the sensors  630  for example, that the switch  614  is in the second position  617 ; and the processor  622  may use the program instructions associated with articulating the end effector upon detecting, through the sensors  630  for example, that the switch  614  is in the third or fourth position  618   a ,  618   b . 
       FIG.  17    is a schematic diagram of a robotic surgical instrument  700  configured to operate a surgical tool described herein according to one aspect of this disclosure. The robotic surgical instrument  700  may be programmed or configured to control distal/proximal translation of a displacement member, distal/proximal displacement of a closure tube, shaft rotation, and articulation, either with single or multiple articulation drive links. In one aspect, the surgical instrument  700  may be programmed or configured to individually control a firing member, a closure member, a shaft member, and/or one or more articulation members. The surgical instrument  700  comprises a control circuit  710  configured to control motor-driven firing members, closure members, shaft members, and/or one or more articulation members. 
     In one aspect, the robotic surgical instrument  700  comprises a control circuit  710  configured to control an anvil  716  and an I-beam  714  (including a sharp cutting edge) portion of an end effector  702 , a removable staple cartridge  718 , a shaft  740 , and one or more articulation members  742   a ,  742   b  via a plurality of motors  704   a - 704   e . A position sensor  734  may be configured to provide position feedback of the I-beam  714  to the control circuit  710 . Other sensors  738  may be configured to provide feedback to the control circuit  710 . A timer/counter  731  provides timing and counting information to the control circuit  710 . An energy source  712  may be provided to operate the motors  704   a - 704 e, and a current sensor  736  provides motor current feedback to the control circuit  710 . The motors  704   a - 704   e  can be operated individually by the control circuit  710  in an open-loop or closed-loop feedback control. 
     In one aspect, the control circuit  710  may comprise one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer/counter  731  provides an output signal, such as the elapsed time or a digital count, to the control circuit  710  to correlate the position of the I-beam  714  as determined by the position sensor  734  with the output of the timer/counter  731  such that the control circuit  710  can determine the position of the I-beam  714  at a specific time (t) relative to a starting position or the time (t) when the I-beam  714  is at a specific position relative to a starting position. The timer/counter  731  may be configured to measure elapsed time, count external events, or time external events. 
     In one aspect, the control circuit  710  may be programmed to control functions of the end effector  702  based on one or more tissue conditions. The control circuit  710  may be programmed to sense tissue conditions, such as thickness, either directly or indirectly, as described herein. The control circuit  710  may be programmed to select a firing control program or closure control program based on tissue conditions. A firing control program may describe the distal motion of the displacement member. Different firing control programs may be selected to better treat different tissue conditions. For example, when thicker tissue is present, the control circuit  710  may be programmed to translate the displacement member at a lower velocity and/or with lower power. When thinner tissue is present, the control circuit  710  may be programmed to translate the displacement member at a higher velocity and/or with higher power. A closure control program may control the closure force applied to the tissue by the anvil  716 . Other control programs control the rotation of the shaft  740  and the articulation members  742   a ,  742   b . 
     In one aspect, the control circuit  710  may generate motor set point signals. The motor set point signals may be provided to various motor controllers  708   a - 708   e . The motor controllers  708   a - 708   e  may comprise one or more circuits configured to provide motor drive signals to the motors  704   a - 704   e  to drive the motors  704   a - 704   e  as described herein. In some examples, the motors  704   a - 704   e  may be brushed DC electric motors. For example, the velocity of the motors  704   a - 704   e  may be proportional to the respective motor drive signals. In some examples, the motors  704   a - 704   e  may be brushless DC electric motors, and the respective motor drive signals may comprise a PWM signal provided to one or more stator windings of the motors  704   a - 704   e . Also, in some examples, the motor controllers  708   a - 708   e  may be omitted and the control circuit  710  may generate the motor drive signals directly. 
     In one aspect, the control circuit  710  may initially operate each of the motors  704   a - 704   e  in an open-loop configuration for a first open-loop portion of a stroke of the displacement member. Based on the response of the robotic surgical instrument  700  during the open-loop portion of the stroke, the control circuit  710  may select a firing control program in a closed-loop configuration. The response of the instrument may include a translation distance of the displacement member during the open-loop portion, a time elapsed during the open-loop portion, the energy provided to one of the motors  704   a - 704   e  during the open-loop portion, a sum of pulse widths of a motor drive signal, etc. After the open-loop portion, the control circuit  710  may implement the selected firing control program for a second portion of the displacement member stroke. For example, during a closed-loop portion of the stroke, the control circuit  710  may modulate one of the motors  704   a - 704   e  based on translation data describing a position of the displacement member in a closed-loop manner to translate the displacement member at a constant velocity. 
     In one aspect, the motors  704   a - 704   e  may receive power from an energy source  712 . The energy source  712  may be a DC power supply driven by a main alternating current power source, a battery, a super capacitor, or any other suitable energy source. The motors  704   a - 704   e  may be mechanically coupled to individual movable mechanical elements such as the I-beam  714 , anvil  716 , shaft  740 , articulation  742   a , and articulation  742   b  via respective transmissions  706   a - 706   e . The transmissions  706   a - 706   e  may include one or more gears or other linkage components to couple the motors  704   a - 704   e  to movable mechanical elements. A position sensor  734  may sense a position of the I-beam  714 . The position sensor  734  may be or include any type of sensor that is capable of generating position data that indicate a position of the I-beam  714 . In some examples, the position sensor  734  may include an encoder configured to provide a series of pulses to the control circuit  710  as the I-beam  714  translates distally and proximally. The control circuit  710  may track the pulses to determine the position of the I-beam  714 . Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals indicating motion of the I-beam  714 . Also, in some examples, the position sensor  734  may be omitted. Where any of the motors  704   a - 704   e  is a stepper motor, the control circuit  710  may track the position of the I-beam  714  by aggregating the number and direction of steps that the motor  704  has been instructed to execute. The position sensor  734  may be located in the end effector  702  or at any other portion of the instrument. The outputs of each of the motors  704   a - 704   e  include a torque sensor  744   a - 744   e  to sense force and have an encoder to sense rotation of the drive shaft. 
     In one aspect, the control circuit  710  is configured to drive a firing member such as the I-beam  714  portion of the end effector  702 . The control circuit  710  provides a motor set point to a motor control  708   a , which provides a drive signal to the motor  704   a . The output shaft of the motor  704   a  is coupled to a torque sensor  744   a . The torque sensor  744   a  is coupled to a transmission  706   a  which is coupled to the I-beam  714 . The transmission  706   a  comprises movable mechanical elements such as rotating elements and a firing member to control the movement of the I-beam  714  distally and proximally along a longitudinal axis of the end effector  702 . In one aspect, the motor  704   a  may be coupled to the knife gear assembly, which includes a knife gear reduction set that includes a first knife drive gear and a second knife drive gear. A torque sensor  744   a  provides a firing force feedback signal to the control circuit  710 . The firing force signal represents the force required to fire or displace the I-beam  714 . A position sensor  734  may be configured to provide the position of the I-beam  714  along the firing stroke or the position of the firing member as a feedback signal to the control circuit  710 . The end effector  702  may include additional sensors  738  configured to provide feedback signals to the control circuit  710 . When ready to use, the control circuit  710  may provide a firing signal to the motor control  708   a . In response to the firing signal, the motor  704   a  may drive the firing member distally along the longitudinal axis of the end effector  702  from a proximal stroke start position to a stroke end position distal to the stroke start position. As the firing member translates distally, an I-beam  714 , with a cutting element positioned at a distal end, advances distally to cut tissue located between the staple cartridge  718  and the anvil  716 . 
     In one aspect, the control circuit  710  is configured to drive a closure member such as the anvil  716  portion of the end effector  702 . The control circuit  710  provides a motor set point to a motor control  708   b , which provides a drive signal to the motor  704   b . The output shaft of the motor  704   b  is coupled to a torque sensor  744   b . The torque sensor  744   b  is coupled to a transmission  706   b  which is coupled to the anvil  716 . The transmission  706   b  comprises movable mechanical elements such as rotating elements and a closure member to control the movement of the anvil  716  from the open and closed positions. In one aspect, the motor  704   b  is coupled to a closure gear assembly, which includes a closure reduction gear set that is supported in meshing engagement with the closure spur gear. The torque sensor  744   b  provides a closure force feedback signal to the control circuit  710 . The closure force feedback signal represents the closure force applied to the anvil  716 . The position sensor  734  may be configured to provide the position of the closure member as a feedback signal to the control circuit  710 . Additional sensors  738  in the end effector  702  may provide the closure force feedback signal to the control circuit  710 . The pivotable anvil  716  is positioned opposite the staple cartridge  718 . When ready to use, the control circuit  710  may provide a closure signal to the motor control  708   b . In response to the closure signal, the motor  704   b  advances a closure member to grasp tissue between the anvil  716  and the staple cartridge  718 . 
     In one aspect, the control circuit  710  is configured to rotate a shaft member such as the shaft  740  to rotate the end effector  702 . The control circuit  710  provides a motor set point to a motor control  708   c , which provides a drive signal to the motor  704   c . The output shaft of the motor  704   c  is coupled to a torque sensor  744   c . The torque sensor  744   c  is coupled to a transmission  706   c  which is coupled to the shaft  740 . The transmission  706   c  comprises movable mechanical elements such as rotating elements to control the rotation of the shaft  740  clockwise or counterclockwise up to and over 360°. In one aspect, the motor  704   c  is coupled to the rotational transmission assembly, which includes a tube gear segment that is formed on (or attached to) the proximal end of the proximal closure tube for operable engagement by a rotational gear assembly that is operably supported on the tool mounting plate. The torque sensor  744   c  provides a rotation force feedback signal to the control circuit  710 . The rotation force feedback signal represents the rotation force applied to the shaft  740 . The position sensor  734  may be configured to provide the position of the closure member as a feedback signal to the control circuit  710 . Additional sensors  738  such as a shaft encoder may provide the rotational position of the shaft  740  to the control circuit  710 . 
     In one aspect, the control circuit  710  is configured to articulate the end effector  702 . The control circuit  710  provides a motor set point to a motor control  708   d , which provides a drive signal to the motor  704   d . The output shaft of the motor  704   d  is coupled to a torque sensor  744   d . The torque sensor  744   d  is coupled to a transmission  706   d  which is coupled to an articulation member  742   a . The transmission  706   d  comprises movable mechanical elements such as articulation elements to control the articulation of the end effector  702  ±65°. In one aspect, the motor  704   d  is coupled to an articulation nut, which is rotatably journaled on the proximal end portion of the distal spine portion and is rotatably driven thereon by an articulation gear assembly. The torque sensor  744   d  provides an articulation force feedback signal to the control circuit  710 . The articulation force feedback signal represents the articulation force applied to the end effector  702 . Sensors  738 , such as an articulation encoder, may provide the articulation position of the end effector  702  to the control circuit  710 . 
     In another aspect, the articulation function of the robotic surgical system  700  may comprise two articulation members, or links,  742   a ,  742   b . These articulation members  742   a ,  742   b  are driven by separate disks on the robot interface (the rack) which are driven by the two motors  708   d ,  708   e . When the separate firing motor  704   a  is provided, each of articulation links  742   a ,  742   b  can be antagonistically driven with respect to the other link in order to provide a resistive holding motion and a load to the head when it is not moving and to provide an articulation motion as the head is articulated. The articulation members  742   a ,  742   b  attach to the head at a fixed radius as the head is rotated. Accordingly, the mechanical advantage of the push-and-pull link changes as the head is rotated. This change in the mechanical advantage may be more pronounced with other articulation link drive systems. 
     In one aspect, the one or more motors  704   a - 704   e  may comprise a brushed DC motor with a gearbox and mechanical links to a firing member, closure member, or articulation member. Another example includes electric motors  704   a - 704   e  that operate the movable mechanical elements such as the displacement member, articulation links, closure tube, and shaft. An outside influence is an unmeasured, unpredictable influence of things like tissue, surrounding bodies, and friction on the physical system. Such outside influence can be referred to as drag, which acts in opposition to one of electric motors  704   a - 704   e . The outside influence, such as drag, may cause the operation of the physical system to deviate from a desired operation of the physical system. 
     In one aspect, the position sensor  734  may be implemented as an absolute positioning system. In one aspect, the position sensor  734  may comprise a magnetic rotary absolute positioning system implemented as an AS5055EQFT single-chip magnetic rotary position sensor available from Austria Microsystems, AG. The position sensor  734  may interface with the control circuit  710  to provide an absolute positioning system. The position may include multiple Hall-effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit-by-digit method and Volder’s algorithm, that is provided to implement a simple and efficient algorithm to calculate hyperbolic and trigonometric functions that require only addition, subtraction, bitshift, and table lookup operations. 
     In one aspect, the control circuit  710  may be in communication with one or more sensors  738 . The sensors  738  may be positioned on the end effector  702  and adapted to operate with the robotic surgical instrument  700  to measure the various derived parameters such as the gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensors  738  may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor for measuring one or more parameters of the end effector  702 . The sensors  738  may include one or more sensors. The sensors  738  may be located on the staple cartridge  718  deck to determine tissue location using segmented electrodes. The torque sensors  744   a - 744   e  may be configured to sense force such as firing force, closure force, and/or articulation force, among others. Accordingly, the control circuit  710  can sense (1) the closure load experienced by the distal closure tube and its position, (2) the firing member at the rack and its position, (3) what portion of the staple cartridge  718  has tissue on it, and (4) the load and position on both articulation rods. 
     In one aspect, the one or more sensors  738  may comprise a strain gauge, such as a micro-strain gauge, configured to measure the magnitude of the strain in the anvil  716  during a clamped condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensors  738  may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil  716  and the staple cartridge  718 . The sensors  738  may be configured to detect impedance of a tissue section located between the anvil  716  and the staple cartridge  718  that is indicative of the thickness and/or fullness of tissue located therebetween. 
     In one aspect, the sensors  738  may be implemented as one or more limit switches, electromechanical devices, solid-state switches, Hall-effect devices, magneto-resistive (MR) devices, giant magneto-resistive (GMR) devices, magnetometers, among others. In other implementations, the sensors  738  may be implemented as solid-state switches that operate under the influence of light, such as optical sensors, IR sensors, ultraviolet sensors, among others. Still, the switches may be solid-state devices such as transistors (e.g., FET, junction FET, MOSFET, bipolar, and the like). In other implementations, the sensors  738  may include electrical conductorless switches, ultrasonic switches, accelerometers, and inertial sensors, among others. 
     In one aspect, the sensors  738  may be configured to measure forces exerted on the anvil  716  by the closure drive system. For example, one or more sensors  738  can be at an interaction point between the closure tube and the anvil  716  to detect the closure forces applied by the closure tube to the anvil  716 . The forces exerted on the anvil  716  can be representative of the tissue compression experienced by the tissue section captured between the anvil  716  and the staple cartridge  718 . The one or more sensors  738  can be positioned at various interaction points along the closure drive system to detect the closure forces applied to the anvil  716  by the closure drive system. The one or more sensors  738  may be sampled in real time during a clamping operation by the processor of the control circuit  710 . The control circuit  710  receives real-time sample measurements to provide and analyze time-based information and assess, in real time, closure forces applied to the anvil  716 . 
     In one aspect, a current sensor  736  can be employed to measure the current drawn by each of the motors  704   a - 704   e . The force required to advance any of the movable mechanical elements such as the I-beam  714  corresponds to the current drawn by one of the motors  704   a - 704   e . The force is converted to a digital signal and provided to the control circuit  710 . The control circuit  710  can be configured to simulate the response of the actual system of the instrument in the software of the controller. A displacement member can be actuated to move an I-beam  714  in the end effector  702  at or near a target velocity. The robotic surgical instrument  700  can include a feedback controller, which can be one of any feedback controllers, including, but not limited to a PID, a state feedback, a linear-quadratic (LQR), and/or an adaptive controller, for example. The robotic surgical instrument  700  can include a power source to convert the signal from the feedback controller into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example. Additional details are disclosed in U.S. Pat. Application Serial No. 15/636,829, titled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed Jun. 29, 2017, which is herein incorporated by reference in its entirety. 
       FIG.  18    illustrates a block diagram of a surgical instrument  750  programmed to control the distal translation of a displacement member according to one aspect of this disclosure. In one aspect, the surgical instrument  750  is programmed to control the distal translation of a displacement member such as the I-beam  764 . The surgical instrument  750  comprises an end effector  752  that may comprise an anvil  766 , an I-beam  764  (including a sharp cutting edge), and a removable staple cartridge  768 . 
     The position, movement, displacement, and/or translation of a linear displacement member, such as the I-beam  764 , can be measured by an absolute positioning system, sensor arrangement, and position sensor  784 . Because the I-beam  764  is coupled to a longitudinally movable drive member, the position of the I-beam  764  can be determined by measuring the position of the longitudinally movable drive member employing the position sensor  784 . Accordingly, in the following description, the position, displacement, and/or translation of the I-beam  764  can be achieved by the position sensor  784  as described herein. A control circuit  760  may be programmed to control the translation of the displacement member, such as the I-beam  764 . The control circuit  760 , in some examples, may comprise one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the processor or processors to control the displacement member, e.g., the I-beam  764 , in the manner described. In one aspect, a timer/counter  781  provides an output signal, such as the elapsed time or a digital count, to the control circuit  760  to correlate the position of the I-beam  764  as determined by the position sensor  784  with the output of the timer/counter  781  such that the control circuit  760  can determine the position of the I-beam  764  at a specific time (t) relative to a starting position. The timer/counter  781  may be configured to measure elapsed time, count external events, or time external events. 
     The control circuit  760  may generate a motor set point signal  772 . The motor set point signal  772  may be provided to a motor controller  758 . The motor controller  758  may comprise one or more circuits configured to provide a motor drive signal  774  to the motor  754  to drive the motor  754  as described herein. In some examples, the motor  754  may be a brushed DC electric motor. For example, the velocity of the motor  754  may be proportional to the motor drive signal  774 . In some examples, the motor  754  may be a brushless DC electric motor and the motor drive signal  774  may comprise a PWM signal provided to one or more stator windings of the motor  754 . Also, in some examples, the motor controller  758  may be omitted, and the control circuit  760  may generate the motor drive signal  774  directly. 
     The motor  754  may receive power from an energy source  762 . The energy source  762  may be or include a battery, a super capacitor, or any other suitable energy source. The motor  754  may be mechanically coupled to the I-beam  764  via a transmission  756 . The transmission  756  may include one or more gears or other linkage components to couple the motor  754  to the I-beam  764 . A position sensor  784  may sense a position of the I-beam  764 . The position sensor  784  may be or include any type of sensor that is capable of generating position data that indicate a position of the I-beam  764 . In some examples, the position sensor  784  may include an encoder configured to provide a series of pulses to the control circuit  760  as the I-beam  764  translates distally and proximally. The control circuit  760  may track the pulses to determine the position of the I-beam  764 . Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals indicating motion of the I-beam  764 . Also, in some examples, the position sensor  784  may be omitted. Where the motor  754  is a stepper motor, the control circuit  760  may track the position of the I-beam  764  by aggregating the number and direction of steps that the motor  754  has been instructed to execute. The position sensor  784  may be located in the end effector  752  or at any other portion of the instrument. 
     The control circuit  760  may be in communication with one or more sensors  788 . The sensors  788  may be positioned on the end effector  752  and adapted to operate with the surgical instrument  750  to measure the various derived parameters such as gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensors  788  may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor for measuring one or more parameters of the end effector  752 . The sensors  788  may include one or more sensors. 
     The one or more sensors  788  may comprise a strain gauge, such as a micro-strain gauge, configured to measure the magnitude of the strain in the anvil  766  during a clamped condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensors  788  may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil  766  and the staple cartridge  768 . The sensors  788  may be configured to detect impedance of a tissue section located between the anvil  766  and the staple cartridge  768  that is indicative of the thickness and/or fullness of tissue located therebetween. 
     The sensors  788  may be is configured to measure forces exerted on the anvil  766  by a closure drive system. For example, one or more sensors  788  can be at an interaction point between a closure tube and the anvil  766  to detect the closure forces applied by a closure tube to the anvil  766 . The forces exerted on the anvil  766  can be representative of the tissue compression experienced by the tissue section captured between the anvil  766  and the staple cartridge  768 . The one or more sensors  788  can be positioned at various interaction points along the closure drive system to detect the closure forces applied to the anvil  766  by the closure drive system. The one or more sensors  788  may be sampled in real time during a clamping operation by a processor of the control circuit  760 . The control circuit  760  receives real-time sample measurements to provide and analyze time-based information and assess, in real time, closure forces applied to the anvil  766 . 
     A current sensor  786  can be employed to measure the current drawn by the motor  754 . The force required to advance the I-beam  764  corresponds to the current drawn by the motor  754 . The force is converted to a digital signal and provided to the control circuit  760 . 
     The control circuit  760  can be configured to simulate the response of the actual system of the instrument in the software of the controller. A displacement member can be actuated to move an I-beam  764  in the end effector  752  at or near a target velocity. The surgical instrument  750  can include a feedback controller, which can be one of any feedback controllers, including, but not limited to a PID, a state feedback, LQR, and/or an adaptive controller, for example. The surgical instrument  750  can include a power source to convert the signal from the feedback controller into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example. 
     The actual drive system of the surgical instrument  750  is configured to drive the displacement member, cutting member, or I-beam  764 , by a brushed DC motor with gearbox and mechanical links to an articulation and/or knife system. Another example is the electric motor  754  that operates the displacement member and the articulation driver, for example, of an interchangeable shaft assembly. An outside influence is an unmeasured, unpredictable influence of things like tissue, surrounding bodies and friction on the physical system. Such outside influence can be referred to as drag which acts in opposition to the electric motor  754 . The outside influence, such as drag, may cause the operation of the physical system to deviate from a desired operation of the physical system. 
     Various example aspects are directed to a surgical instrument  750  comprising an end effector  752  with motor-driven surgical stapling and cutting implements. For example, a motor  754  may drive a displacement member distally and proximally along a longitudinal axis of the end effector  752 . The end effector  752  may comprise a pivotable anvil  766  and, when configured for use, a staple cartridge  768  positioned opposite the anvil  766 . A clinician may grasp tissue between the anvil  766  and the staple cartridge  768 , as described herein. When ready to use the instrument  750 , the clinician may provide a firing signal, for example by depressing a trigger of the instrument  750 . In response to the firing signal, the motor  754  may drive the displacement member distally along the longitudinal axis of the end effector  752  from a proximal stroke begin position to a stroke end position distal of the stroke begin position. As the displacement member translates distally, an I-beam  764  with a cutting element positioned at a distal end, may cut the tissue between the staple cartridge  768  and the anvil  766 . 
     In various examples, the surgical instrument  750  may comprise a control circuit  760  programmed to control the distal translation of the displacement member, such as the I-beam  764 , for example, based on one or more tissue conditions. The control circuit  760  may be programmed to sense tissue conditions, such as thickness, either directly or indirectly, as described herein. The control circuit  760  may be programmed to select a firing control program based on tissue conditions. A firing control program may describe the distal motion of the displacement member. Different firing control programs may be selected to better treat different tissue conditions. For example, when thicker tissue is present, the control circuit  760  may be programmed to translate the displacement member at a lower velocity and/or with lower power. When thinner tissue is present, the control circuit  760  may be programmed to translate the displacement member at a higher velocity and/or with higher power. 
     In some examples, the control circuit  760  may initially operate the motor  754  in an open loop configuration for a first open loop portion of a stroke of the displacement member. Based on a response of the instrument  750  during the open loop portion of the stroke, the control circuit  760  may select a firing control program. The response of the instrument may include, a translation distance of the displacement member during the open loop portion, a time elapsed during the open loop portion, energy provided to the motor  754  during the open loop portion, a sum of pulse widths of a motor drive signal, etc. After the open loop portion, the control circuit  760  may implement the selected firing control program for a second portion of the displacement member stroke. For example, during the closed loop portion of the stroke, the control circuit  760  may modulate the motor  754  based on translation data describing a position of the displacement member in a closed loop manner to translate the displacement member at a constant velocity. Additional details are disclosed in U.S. Pat. Application Serial No. 15/720,852, titled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, filed Sep. 29, 2017, which is herein incorporated by reference in its entirety. 
       FIG.  19    is a schematic diagram of a surgical instrument  790  configured to control various functions according to one aspect of this disclosure. In one aspect, the surgical instrument  790  is programmed to control distal translation of a displacement member such as the I-beam  764 . The surgical instrument  790  comprises an end effector  792  that may comprise an anvil  766 , an I-beam  764 , and a removable staple cartridge  768  which may be interchanged with an RF cartridge  796  (shown in dashed line). 
     In one aspect, sensors  788  may be implemented as a limit switch, electromechanical device, solid-state switches, Hall-effect devices, MR devices, GMR devices, magnetometers, among others. In other implementations, the sensors  638  may be solid-state switches that operate under the influence of light, such as optical sensors, IR sensors, ultraviolet sensors, among others. Still, the switches may be solid-state devices such as transistors (e.g., FET, junction FET, MOSFET, bipolar, and the like). In other implementations, the sensors  788  may include electrical conductorless switches, ultrasonic switches, accelerometers, and inertial sensors, among others. 
     In one aspect, the position sensor  784  may be implemented as an absolute positioning system comprising a magnetic rotary absolute positioning system implemented as an AS5055EQFT single-chip magnetic rotary position sensor available from Austria Microsystems, AG. The position sensor  784  may interface with the control circuit  760  to provide an absolute positioning system. The position may include multiple Hall-effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit-by-digit method and Volder’s algorithm, that is provided to implement a simple and efficient algorithm to calculate hyperbolic and trigonometric functions that require only addition, subtraction, bitshift, and table lookup operations. 
     In one aspect, the I-beam  764  may be implemented as a knife member comprising a knife body that operably supports a tissue cutting blade thereon and may further include anvil engagement tabs or features and channel engagement features or a foot. In one aspect, the staple cartridge  768  may be implemented as a standard (mechanical) surgical fastener cartridge. In one aspect, the RF cartridge  796  may be implemented as an RF cartridge. These and other sensors arrangements are described in commonly-owned U.S. Pat. Application Serial No. 15/628,175, titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is herein incorporated by reference in its entirety. 
     The position, movement, displacement, and/or translation of a linear displacement member, such as the I-beam  764 , can be measured by an absolute positioning system, sensor arrangement, and position sensor represented as position sensor  784 . Because the I-beam  764  is coupled to the longitudinally movable drive member, the position of the I-beam  764  can be determined by measuring the position of the longitudinally movable drive member employing the position sensor  784 . Accordingly, in the following description, the position, displacement, and/or translation of the I-beam  764  can be achieved by the position sensor  784  as described herein. A control circuit  760  may be programmed to control the translation of the displacement member, such as the I-beam  764 , as described herein. The control circuit  760 , in some examples, may comprise one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the processor or processors to control the displacement member, e.g., the I-beam  764 , in the manner described. In one aspect, a timer/counter  781  provides an output signal, such as the elapsed time or a digital count, to the control circuit  760  to correlate the position of the I-beam  764  as determined by the position sensor  784  with the output of the timer/counter  781  such that the control circuit  760  can determine the position of the I-beam  764  at a specific time (t) relative to a starting position. The timer/counter  781  may be configured to measure elapsed time, count external events, or time external events. 
     The control circuit  760  may generate a motor set point signal  772 . The motor set point signal  772  may be provided to a motor controller  758 . The motor controller  758  may comprise one or more circuits configured to provide a motor drive signal  774  to the motor  754  to drive the motor  754  as described herein. In some examples, the motor  754  may be a brushed DC electric motor. For example, the velocity of the motor  754  may be proportional to the motor drive signal  774 . In some examples, the motor  754  may be a brushless DC electric motor and the motor drive signal  774  may comprise a PWM signal provided to one or more stator windings of the motor  754 . Also, in some examples, the motor controller  758  may be omitted, and the control circuit  760  may generate the motor drive signal  774  directly. 
     The motor  754  may receive power from an energy source  762 . The energy source  762  may be or include a battery, a super capacitor, or any other suitable energy source. The motor  754  may be mechanically coupled to the I-beam  764  via a transmission  756 . The transmission  756  may include one or more gears or other linkage components to couple the motor  754  to the I-beam  764 . A position sensor  784  may sense a position of the I-beam  764 . The position sensor  784  may be or include any type of sensor that is capable of generating position data that indicate a position of the I-beam  764 . In some examples, the position sensor  784  may include an encoder configured to provide a series of pulses to the control circuit  760  as the I-beam  764  translates distally and proximally. The control circuit  760  may track the pulses to determine the position of the I-beam  764 . Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals indicating motion of the I-beam  764 . Also, in some examples, the position sensor  784  may be omitted. Where the motor  754  is a stepper motor, the control circuit  760  may track the position of the I-beam  764  by aggregating the number and direction of steps that the motor has been instructed to execute. The position sensor  784  may be located in the end effector  792  or at any other portion of the instrument. 
     The control circuit  760  may be in communication with one or more sensors  788 . The sensors  788  may be positioned on the end effector  792  and adapted to operate with the surgical instrument  790  to measure the various derived parameters such as gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensors  788  may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor for measuring one or more parameters of the end effector  792 . The sensors  788  may include one or more sensors. 
     The one or more sensors  788  may comprise a strain gauge, such as a micro-strain gauge, configured to measure the magnitude of the strain in the anvil  766  during a clamped condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensors  788  may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil  766  and the staple cartridge  768 . The sensors  788  may be configured to detect impedance of a tissue section located between the anvil  766  and the staple cartridge  768  that is indicative of the thickness and/or fullness of tissue located therebetween. 
     The sensors  788  may be is configured to measure forces exerted on the anvil  766  by the closure drive system. For example, one or more sensors  788  can be at an interaction point between a closure tube and the anvil  766  to detect the closure forces applied by a closure tube to the anvil  766 . The forces exerted on the anvil  766  can be representative of the tissue compression experienced by the tissue section captured between the anvil  766  and the staple cartridge  768 . The one or more sensors  788  can be positioned at various interaction points along the closure drive system to detect the closure forces applied to the anvil  766  by the closure drive system. The one or more sensors  788  may be sampled in real time during a clamping operation by a processor portion of the control circuit  760 . The control circuit  760  receives real-time sample measurements to provide and analyze time-based information and assess, in real time, closure forces applied to the anvil  766 . 
     A current sensor  786  can be employed to measure the current drawn by the motor  754 . The force required to advance the I-beam  764  corresponds to the current drawn by the motor  754 . The force is converted to a digital signal and provided to the control circuit  760 . 
     An RF energy source  794  is coupled to the end effector  792  and is applied to the RF cartridge  796  when the RF cartridge  796  is loaded in the end effector  792  in place of the staple cartridge  768 . The control circuit  760  controls the delivery of the RF energy to the RF cartridge  796 . 
     Additional details are disclosed in U.S. Pat. Application Serial No. 15/636,096, titled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed Jun. 28, 2017, which is herein incorporated by reference in its entirety. 
     Generator Hardware 
       FIG.  20    is a simplified block diagram of a generator  800  configured to provide inductorless tuning, among other benefits. Additional details of the generator  800  are described in U.S. Pat. No. 9,060,775, titled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, which issued on Jun. 23, 2015, which is herein incorporated by reference in its entirety. The generator  800  may comprise a patient isolated stage  802  in communication with a non-isolated stage  804  via a power transformer  806 . A secondary winding  808  of the power transformer  806  is contained in the isolated stage  802  and may comprise a tapped configuration (e.g., a center-tapped or a non-center-tapped configuration) to define drive signal outputs  810   a ,  810   b ,  810   c  for delivering drive signals to different surgical instruments, such as, for example, an ultrasonic surgical instrument, an RF electrosurgical instrument, and a multifunction surgical instrument which includes ultrasonic and RF energy modes that can be delivered alone or simultaneously. In particular, drive signal outputs  810   a ,  810   c  may output an ultrasonic drive signal (e.g., a 420 V root-mean-square (RMS) drive signal) to an ultrasonic surgical instrument, and drive signal outputs  810   b ,  810   c  may output an RF electrosurgical drive signal (e.g., a 100 V RMS drive signal) to an RF electrosurgical instrument, with the drive signal output  810   b  corresponding to the center tap of the power transformer  806 . 
     In certain forms, the ultrasonic and electrosurgical drive signals may be provided simultaneously to distinct surgical instruments and/or to a single surgical instrument, such as the multifunction surgical instrument, having the capability to deliver both ultrasonic and electrosurgical energy to tissue. It will be appreciated that the electrosurgical signal, provided either to a dedicated electrosurgical instrument and/or to a combined multifunction ultrasonic/electrosurgical instrument may be either a therapeutic or sub-therapeutic level signal where the sub-therapeutic signal can be used, for example, to monitor tissue or instrument conditions and provide feedback to the generator. For example, the ultrasonic and RF signals can be delivered separately or simultaneously from a generator with a single output port in order to provide the desired output signal to the surgical instrument, as will be discussed in more detail below. Accordingly, the generator can combine the ultrasonic and electrosurgical RF energies and deliver the combined energies to the multifunction ultrasonic/electrosurgical instrument. Bipolar electrodes can be placed on one or both jaws of the end effector. One jaw may be driven by ultrasonic energy in addition to electrosurgical RF energy, working simultaneously. The ultrasonic energy may be employed to dissect tissue, while the electrosurgical RF energy may be employed for vessel sealing. 
     The non-isolated stage  804  may comprise a power amplifier  812  having an output connected to a primary winding  814  of the power transformer  806 . In certain forms, the power amplifier  812  may comprise a push-pull amplifier. For example, the non-isolated stage  804  may further comprise a logic device  816  for supplying a digital output to a digital-to-analog converter (DAC) circuit  818 , which in turn supplies a corresponding analog signal to an input of the power amplifier  812 . In certain forms, the logic device  816  may comprise a programmable gate array (PGA), a FPGA, programmable logic device (PLD), among other logic circuits, for example. The logic device  816 , by virtue of controlling the input of the power amplifier  812  via the DAC circuit  818 , may therefore control any of a number of parameters (e.g., frequency, waveform shape, waveform amplitude) of drive signals appearing at the drive signal outputs  810   a ,  810   b ,  810   c . In certain forms and as discussed below, the logic device  816 , in conjunction with a processor (e.g., a DSP discussed below), may implement a number of DSP-based and/or other control algorithms to control parameters of the drive signals output by the generator  800 . 
     Power may be supplied to a power rail of the power amplifier  812  by a switch-mode regulator  820 , e.g., a power converter. In certain forms, the switch-mode regulator  820  may comprise an adjustable buck regulator, for example. The non-isolated stage  804  may further comprise a first processor  822 , which in one form may comprise a DSP processor such as an Analog Devices ADSP-21469 SHARC DSP, available from Analog Devices, Norwood, MA, for example, although in various forms any suitable processor may be employed. In certain forms the DSP processor  822  may control the operation of the switch-mode regulator  820  responsive to voltage feedback data received from the power amplifier  812  by the DSP processor  822  via an ADC circuit  824 . In one form, for example, the DSP processor  822  may receive as input, via the ADC circuit  824 , the waveform envelope of a signal (e.g., an RF signal) being amplified by the power amplifier  812 . The DSP processor  822  may then control the switch-mode regulator  820  (e.g., via a PWM output) such that the rail voltage supplied to the power amplifier  812  tracks the waveform envelope of the amplified signal. By dynamically modulating the rail voltage of the power amplifier  812  based on the waveform envelope, the efficiency of the power amplifier  812  may be significantly improved relative to a fixed rail voltage amplifier schemes. 
     In certain forms, the logic device  816 , in conjunction with the DSP processor  822 , may implement a digital synthesis circuit such as a direct digital synthesizer control scheme to control the waveform shape, frequency, and/or amplitude of drive signals output by the generator  800 . In one form, for example, the logic device  816  may implement a DDS control algorithm by recalling waveform samples stored in a dynamically updated lookup table (LUT), such as a RAM LUT, which may be embedded in an FPGA. This control algorithm is particularly useful for ultrasonic applications in which an ultrasonic transducer, such as an ultrasonic transducer, may be driven by a clean sinusoidal current at its resonant frequency. Because other frequencies may excite parasitic resonances, minimizing or reducing the total distortion of the motional branch current may correspondingly minimize or reduce undesirable resonance effects. Because the waveform shape of a drive signal output by the generator  800  is impacted by various sources of distortion present in the output drive circuit (e.g., the power transformer  806 , the power amplifier  812 ), voltage and current feedback data based on the drive signal may be input into an algorithm, such as an error control algorithm implemented by the DSP processor  822 , which compensates for distortion by suitably pre-distorting or modifying the waveform samples stored in the LUT on a dynamic, ongoing basis (e.g., in real time). In one form, the amount or degree of pre-distortion applied to the LUT samples may be based on the error between a computed motional branch current and a desired current waveform shape, with the error being determined on a sample-by-sample basis. In this way, the pre-distorted LUT samples, when processed through the drive circuit, may result in a motional branch drive signal having the desired waveform shape (e.g., sinusoidal) for optimally driving the ultrasonic transducer. In such forms, the LUT waveform samples will therefore not represent the desired waveform shape of the drive signal, but rather the waveform shape that is required to ultimately produce the desired waveform shape of the motional branch drive signal when distortion effects are taken into account. 
     The non-isolated stage  804  may further comprise a first ADC circuit  826  and a second ADC circuit  828  coupled to the output of the power transformer  806  via respective isolation transformers  830 ,  832  for respectively sampling the voltage and current of drive signals output by the generator  800 . In certain forms, the ADC circuits  826 ,  828  may be configured to sample at high speeds (e.g., 80 mega samples per second (MSPS)) to enable oversampling of the drive signals. In one form, for example, the sampling speed of the ADC circuits  826 ,  828  may enable approximately 200x (depending on frequency) oversampling of the drive signals. In certain forms, the sampling operations of the ADC circuit  826 ,  828  may be performed by a single ADC circuit receiving input voltage and current signals via a two-way multiplexer. The use of highspeed sampling in forms of the generator  800  may enable, among other things, calculation of the complex current flowing through the motional branch (which may be used in certain forms to implement DDS-based waveform shape control described above), accurate digital filtering of the sampled signals, and calculation of real power consumption with a high degree of precision. Voltage and current feedback data output by the ADC circuits  826 ,  828  may be received and processed (e.g., first-in-first-out (FIFO) buffer, multiplexer) by the logic device  816  and stored in data memory for subsequent retrieval by, for example, the DSP processor  822 . As noted above, voltage and current feedback data may be used as input to an algorithm for pre-distorting or modifying LUT waveform samples on a dynamic and ongoing basis. In certain forms, this may require each stored voltage and current feedback data pair to be indexed based on, or otherwise associated with, a corresponding LUT sample that was output by the logic device  816  when the voltage and current feedback data pair was acquired. Synchronization of the LUT samples and the voltage and current feedback data in this manner contributes to the correct timing and stability of the pre-distortion algorithm. 
     In certain forms, the voltage and current feedback data may be used to control the frequency and/or amplitude (e.g., current amplitude) of the drive signals. In one form, for example, voltage and current feedback data may be used to determine impedance phase. The frequency of the drive signal may then be controlled to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (e.g., 0°), thereby minimizing or reducing the effects of harmonic distortion and correspondingly enhancing impedance phase measurement accuracy. The determination of phase impedance and a frequency control signal may be implemented in the DSP processor  822 , for example, with the frequency control signal being supplied as input to a DDS control algorithm implemented by the logic device  816 . 
     In another form, for example, the current feedback data may be monitored in order to maintain the current amplitude of the drive signal at a current amplitude setpoint. The current amplitude setpoint may be specified directly or determined indirectly based on specified voltage amplitude and power setpoints. In certain forms, control of the current amplitude may be implemented by control algorithm, such as, for example, a proportional-integral-derivative (PID) control algorithm, in the DSP processor  822 . Variables controlled by the control algorithm to suitably control the current amplitude of the drive signal may include, for example, the scaling of the LUT waveform samples stored in the logic device  816  and/or the full-scale output voltage of the DAC circuit  818  (which supplies the input to the power amplifier  812 ) via a DAC circuit  834 . 
     The non-isolated stage  804  may further comprise a second processor  836  for providing, among other things user interface (UI) functionality. In one form, the UI processor  836  may comprise an Atmel AT91SAM9263 processor having an ARM 926EJ-S core, available from Atmel Corporation, San Jose, California, for example. Examples of UI functionality supported by the UI processor  836  may include audible and visual user feedback, communication with peripheral devices (e.g., via a USB interface), communication with a foot switch, communication with an input device (e.g., a touch screen display) and communication with an output device (e.g., a speaker). The UI processor  836  may communicate with the DSP processor  822  and the logic device  816  (e.g., via SPI buses). Although the UI processor  836  may primarily support UI functionality, it may also coordinate with the DSP processor  822  to implement hazard mitigation in certain forms. For example, the UI processor  836  may be programmed to monitor various aspects of user input and/or other inputs (e.g., touch screen inputs, foot switch inputs, temperature sensor inputs) and may disable the drive output of the generator  800  when an erroneous condition is detected. 
     In certain forms, both the DSP processor  822  and the UI processor  836 , for example, may determine and monitor the operating state of the generator  800 . For the DSP processor  822 , the operating state of the generator  800  may dictate, for example, which control and/or diagnostic processes are implemented by the DSP processor  822 . For the UI processor  836 , the operating state of the generator  800  may dictate, for example, which elements of a UI (e.g., display screens, sounds) are presented to a user. The respective DSP and UI processors  822 ,  836  may independently maintain the current operating state of the generator  800  and recognize and evaluate possible transitions out of the current operating state. The DSP processor  822  may function as the master in this relationship and determine when transitions between operating states are to occur. The UI processor  836  may be aware of valid transitions between operating states and may confirm if a particular transition is appropriate. For example, when the DSP processor  822  instructs the UI processor  836  to transition to a specific state, the UI processor  836  may verify that requested transition is valid. In the event that a requested transition between states is determined to be invalid by the UI processor  836 , the UI processor  836  may cause the generator  800  to enter a failure mode. 
     The non-isolated stage  804  may further comprise a controller  838  for monitoring input devices (e.g., a capacitive touch sensor used for turning the generator  800  on and off, a capacitive touch screen). In certain forms, the controller  838  may comprise at least one processor and/or other controller device in communication with the UI processor  836 . In one form, for example, the controller  838  may comprise a processor (e.g., a Meg168 8-bit controller available from Atmel) configured to monitor user input provided via one or more capacitive touch sensors. In one form, the controller  838  may comprise a touch screen controller (e.g., a QT5480 touch screen controller available from Atmel) to control and manage the acquisition of touch data from a capacitive touch screen. 
     In certain forms, when the generator  800  is in a “power off” state, the controller  838  may continue to receive operating power (e.g., via a line from a power supply of the generator  800 , such as the power supply  854  discussed below). In this way, the controller  838  may continue to monitor an input device (e.g., a capacitive touch sensor located on a front panel of the generator  800 ) for turning the generator  800  on and off. When the generator  800  is in the power off state, the controller  838  may wake the power supply (e.g., enable operation of one or more DC/DC voltage converters  856  of the power supply  854 ) if activation of the “on/off” input device by a user is detected. The controller  838  may therefore initiate a sequence for transitioning the generator  800  to a “power on” state. Conversely, the controller  838  may initiate a sequence for transitioning the generator  800  to the power off state if activation of the “on/off” input device is detected when the generator  800  is in the power on state. In certain forms, for example, the controller  838  may report activation of the “on/off” input device to the UI processor  836 , which in turn implements the necessary process sequence for transitioning the generator  800  to the power off state. In such forms, the controller  838  may have no independent ability for causing the removal of power from the generator  800  after its power on state has been established. 
     In certain forms, the controller  838  may cause the generator  800  to provide audible or other sensory feedback for alerting the user that a power on or power off sequence has been initiated. Such an alert may be provided at the beginning of a power on or power off sequence and prior to the commencement of other processes associated with the sequence. 
     In certain forms, the isolated stage  802  may comprise an instrument interface circuit  840  to, for example, provide a communication interface between a control circuit of a surgical instrument (e.g., a control circuit comprising handpiece switches) and components of the non-isolated stage  804 , such as, for example, the logic device  816 , the DSP processor  822 , and/or the UI processor  836 . The instrument interface circuit  840  may exchange information with components of the non-isolated stage  804  via a communication link that maintains a suitable degree of electrical isolation between the isolated and non-isolated stages  802 ,  804 , such as, for example, an IR-based communication link. Power may be supplied to the instrument interface circuit  840  using, for example, a low-dropout voltage regulator powered by an isolation transformer driven from the non-isolated stage  804 . 
     In one form, the instrument interface circuit  840  may comprise a logic circuit  842  (e.g., logic circuit, programmable logic circuit, PGA, FPGA, PLD) in communication with a signal conditioning circuit  844 . The signal conditioning circuit  844  may be configured to receive a periodic signal from the logic circuit  842  (e.g., a 2 kHz square wave) to generate a bipolar interrogation signal having an identical frequency. The interrogation signal may be generated, for example, using a bipolar current source fed by a differential amplifier. The interrogation signal may be communicated to a surgical instrument control circuit (e.g., by using a conductive pair in a cable that connects the generator  800  to the surgical instrument) and monitored to determine a state or configuration of the control circuit. The control circuit may comprise a number of switches, resistors, and/or diodes to modify one or more characteristics (e.g., amplitude, rectification) of the interrogation signal such that a state or configuration of the control circuit is uniquely discernable based on the one or more characteristics. In one form, for example, the signal conditioning circuit  844  may comprise an ADC circuit for generating samples of a voltage signal appearing across inputs of the control circuit resulting from passage of interrogation signal therethrough. The logic circuit  842  (or a component of the non-isolated stage  804 ) may then determine the state or configuration of the control circuit based on the ADC circuit samples. 
     In one form, the instrument interface circuit  840  may comprise a first data circuit interface  846  to enable information exchange between the logic circuit  842  (or other element of the instrument interface circuit  840 ) and a first data circuit disposed in or otherwise associated with a surgical instrument. In certain forms, for example, a first data circuit may be disposed in a cable integrally attached to a surgical instrument handpiece or in an adaptor for interfacing a specific surgical instrument type or model with the generator  800 . The first data circuit may be implemented in any suitable manner and may communicate with the generator according to any suitable protocol, including, for example, as described herein with respect to the first data circuit. In certain forms, the first data circuit may comprise a non-volatile storage device, such as an EEPROM device. In certain forms, the first data circuit interface  846  may be implemented separately from the logic circuit  842  and comprise suitable circuitry (e.g., discrete logic devices, a processor) to enable communication between the logic circuit  842  and the first data circuit. In other forms, the first data circuit interface  846  may be integral with the logic circuit  842 . 
     In certain forms, the first data circuit may store information pertaining to the particular surgical instrument with which it is associated. Such information may include, for example, a model number, a serial number, a number of operations in which the surgical instrument has been used, and/or any other type of information. This information may be read by the instrument interface circuit  840  (e.g., by the logic circuit  842 ), transferred to a component of the non-isolated stage  804  (e.g., to logic device  816 , DSP processor  822 , and/or UI processor  836 ) for presentation to a user via an output device and/or for controlling a function or operation of the generator  800 . Additionally, any type of information may be communicated to the first data circuit for storage therein via the first data circuit interface  846  (e.g., using the logic circuit  842 ). Such information may comprise, for example, an updated number of operations in which the surgical instrument has been used and/or dates and/or times of its usage. 
     As discussed previously, a surgical instrument may be detachable from a handpiece (e.g., the multifunction surgical instrument may be detachable from the handpiece) to promote instrument interchangeability and/or disposability. In such cases, conventional generators may be limited in their ability to recognize particular instrument configurations being used and to optimize control and diagnostic processes accordingly. The addition of readable data circuits to surgical instruments to address this issue is problematic from a compatibility standpoint, however. For example, designing a surgical instrument to remain backwardly compatible with generators that lack the requisite data reading functionality may be impractical due to, for example, differing signal schemes, design complexity, and cost. Forms of instruments discussed herein address these concerns by using data circuits that may be implemented in existing surgical instruments economically and with minimal design changes to preserve compatibility of the surgical instruments with current generator platforms. 
     Additionally, forms of the generator  800  may enable communication with instrument-based data circuits. For example, the generator  800  may be configured to communicate with a second data circuit contained in an instrument (e.g., the multifunction surgical instrument). In some forms, the second data circuit may be implemented in a many similar to that of the first data circuit described herein. The instrument interface circuit  840  may comprise a second data circuit interface  848  to enable this communication. In one form, the second data circuit interface  848  may comprise a tri-state digital interface, although other interfaces may also be used. In certain forms, the second data circuit may generally be any circuit for transmitting and/or receiving data. In one form, for example, the second data circuit may store information pertaining to the particular surgical instrument with which it is associated. Such information may include, for example, a model number, a serial number, a number of operations in which the surgical instrument has been used, and/or any other type of information. 
     In some forms, the second data circuit may store information about the electrical and/or ultrasonic properties of an associated ultrasonic transducer, end effector, or ultrasonic drive system. For example, the first data circuit may indicate a burn-in frequency slope, as described herein. Additionally or alternatively, any type of information may be communicated to second data circuit for storage therein via the second data circuit interface  848  (e.g., using the logic circuit  842 ). Such information may comprise, for example, an updated number of operations in which the instrument has been used and/or dates and/or times of its usage. In certain forms, the second data circuit may transmit data acquired by one or more sensors (e.g., an instrument-based temperature sensor). In certain forms, the second data circuit may receive data from the generator  800  and provide an indication to a user (e.g., a light emitting diode indication or other visible indication) based on the received data. 
     In certain forms, the second data circuit and the second data circuit interface  848  may be configured such that communication between the logic circuit  842  and the second data circuit can be effected without the need to provide additional conductors for this purpose (e.g., dedicated conductors of a cable connecting a handpiece to the generator  800 ). In one form, for example, information may be communicated to and from the second data circuit using a one-wire bus communication scheme implemented on existing cabling, such as one of the conductors used transmit interrogation signals from the signal conditioning circuit  844  to a control circuit in a handpiece. In this way, design changes or modifications to the surgical instrument that might otherwise be necessary are minimized or reduced. Moreover, because different types of communications implemented over a common physical channel can be frequency-band separated, the presence of a second data circuit may be “invisible” to generators that do not have the requisite data reading functionality, thus enabling backward compatibility of the surgical instrument. 
     In certain forms, the isolated stage  802  may comprise at least one blocking capacitor  850 - 1  connected to the drive signal output  810   b  to prevent passage of DC current to a patient. A single blocking capacitor may be required to comply with medical regulations or standards, for example. While failure in single-capacitor designs is relatively uncommon, such failure may nonetheless have negative consequences. In one form, a second blocking capacitor  850 - 2  may be provided in series with the blocking capacitor  850 - 1 , with current leakage from a point between the blocking capacitors  850 - 1 ,  850 - 2  being monitored by, for example, an ADC circuit  852  for sampling a voltage induced by leakage current. The samples may be received by the logic circuit  842 , for example. Based changes in the leakage current (as indicated by the voltage samples), the generator  800  may determine when at least one of the blocking capacitors  850 - 1 ,  850 - 2  has failed, thus providing a benefit over single-capacitor designs having a single point of failure. 
     In certain forms, the non-isolated stage  804  may comprise a power supply  854  for delivering DC power at a suitable voltage and current. The power supply may comprise, for example, a 400 W power supply for delivering a 48 VDC system voltage. The power supply  854  may further comprise one or more DC/DC voltage converters  856  for receiving the output of the power supply to generate DC outputs at the voltages and currents required by the various components of the generator  800 . As discussed above in connection with the controller  838 , one or more of the DC/DC voltage converters  856  may receive an input from the controller  838  when activation of the “on/off” input device by a user is detected by the controller  838  to enable operation of, or wake, the DC/DC voltage converters  856 . 
       FIG.  21    illustrates an example of a generator  900 , which is one form of the generator  800  ( FIG.  20   ). The generator  900  is configured to deliver multiple energy modalities to a surgical instrument. The generator  900  provides RF and ultrasonic signals for delivering energy to a surgical instrument either independently or simultaneously. The RF and ultrasonic signals may be provided alone or in combination and may be provided simultaneously. As noted above, at least one generator output can deliver multiple energy modalities (e.g., ultrasonic, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others) through a single port, and these signals can be delivered separately or simultaneously to the end effector to treat tissue. The generator  900  comprises a processor  902  coupled to a waveform generator  904 . The processor  902  and waveform generator  904  are configured to generate a variety of signal waveforms based on information stored in a memory coupled to the processor  902 , not shown for clarity of disclosure. The digital information associated with a waveform is provided to the waveform generator  904  which includes one or more DAC circuits to convert the digital input into an analog output. The analog output is fed to an amplifier  1106  for signal conditioning and amplification. The conditioned and amplified output of the amplifier  906  is coupled to a power transformer  908 . The signals are coupled across the power transformer  908  to the secondary side, which is in the patient isolation side. A first signal of a first energy modality is provided to the surgical instrument between the terminals labeled ENERGY1 and RETURN. A second signal of a second energy modality is coupled across a capacitor  910  and is provided to the surgical instrument between the terminals labeled ENERGY2 and RETURN. It will be appreciated that more than two energy modalities may be output and thus the subscript “n” may be used to designate that up to n ENERGYn terminals may be provided, where n is a positive integer greater than 1. It also will be appreciated that up to “n” return paths RETURNn may be provided without departing from the scope of the present disclosure. 
     A first voltage sensing circuit  912  is coupled across the terminals labeled ENERGY1 and the RETURN path to measure the output voltage therebetween. A second voltage sensing circuit  924  is coupled across the terminals labeled ENERGY2 and the RETURN path to measure the output voltage therebetween. A current sensing circuit  914  is disposed in series with the RETURN leg of the secondary side of the power transformer  908  as shown to measure the output current for either energy modality. If different return paths are provided for each energy modality, then a separate current sensing circuit should be provided in each return leg. The outputs of the first and second voltage sensing circuits  912 ,  924  are provided to respective isolation transformers  916 ,  922  and the output of the current sensing circuit  914  is provided to another isolation transformer  918 . The outputs of the isolation transformers  916 ,  928 ,  922  in the on the primary side of the power transformer  908  (non-patient isolated side) are provided to a one or more ADC circuit  926 . The digitized output of the ADC circuit  926  is provided to the processor  902  for further processing and computation. The output voltages and output current feedback information can be employed to adjust the output voltage and current provided to the surgical instrument and to compute output impedance, among other parameters. Input/output communications between the processor  902  and patient isolated circuits is provided through an interface circuit  920 . Sensors also may be in electrical communication with the processor  902  by way of the interface circuit  920 . 
     In one aspect, the impedance may be determined by the processor  902  by dividing the output of either the first voltage sensing circuit  912  coupled across the terminals labeled ENERGY1/RETURN or the second voltage sensing circuit  924  coupled across the terminals labeled ENERGY2/RETURN by the output of the current sensing circuit  914  disposed in series with the RETURN leg of the secondary side of the power transformer  908 . The outputs of the first and second voltage sensing circuits  912 ,  924  are provided to separate isolations transformers  916 ,  922  and the output of the current sensing circuit  914  is provided to another isolation transformer  916 . The digitized voltage and current sensing measurements from the ADC circuit  926  are provided the processor  902  for computing impedance. As an example, the first energy modality ENERGY1 may be ultrasonic energy and the second energy modality ENERGY2 may be RF energy. Nevertheless, in addition to ultrasonic and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and/or reversible electroporation and/or microwave energy, among others. Also, although the example illustrated in  FIG.  21    shows a single return path RETURN may be provided for two or more energy modalities, in other aspects, multiple return paths RETURNn may be provided for each energy modality ENERGYn. Thus, as described herein, the ultrasonic transducer impedance may be measured by dividing the output of the first voltage sensing circuit  912  by the current sensing circuit  914  and the tissue impedance may be measured by dividing the output of the second voltage sensing circuit  924  by the current sensing circuit  914 . 
     As shown in  FIG.  21   , the generator  900  comprising at least one output port can include a power transformer  908  with a single output and with multiple taps to provide power in the form of one or more energy modalities, such as ultrasonic, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others, for example, to the end effector depending on the type of treatment of tissue being performed. For example, the generator  900  can deliver energy with higher voltage and lower current to drive an ultrasonic transducer, with lower voltage and higher current to drive RF electrodes for sealing tissue, or with a coagulation waveform for spot coagulation using either monopolar or bipolar RF electrosurgical electrodes. The output waveform from the generator  900  can be steered, switched, or filtered to provide the frequency to the end effector of the surgical instrument. The connection of an ultrasonic transducer to the generator  900  output would be preferably located between the output labeled ENERGY1 and RETURN as shown in  FIG.  21   . In one example, a connection of RF bipolar electrodes to the generator  900  output would be preferably located between the output labeled ENERGY2 and RETURN. In the case of monopolar output, the preferred connections would be active electrode (e.g., pencil or other probe) to the ENERGY2 output and a suitable return pad connected to the RETURN output. 
     Additional details are disclosed in U.S. Pat. Application Publication No. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, which published on Mar. 30, 2017, which is herein incorporated by reference in its entirety. 
     As used throughout this description, the term “wireless” and its derivatives may be used to describe circuits, devices, systems, methods, techniques, communications channels, etc., that may communicate data through the use of modulated electromagnetic radiation through a non-solid medium. The term does not imply that the associated devices do not contain any wires, although in some aspects they might not. The communication module may implement any of a number of wireless or wired communication standards or protocols, including but not limited to Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long term evolution (LTE), Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module may include a plurality of communication modules. For instance, a first communication module may be dedicated to shorter range wireless communications such as Wi-Fi and Bluetooth and a second communication module may be dedicated to longer range wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, and others. 
     As used herein a processor or processing unit is an electronic circuit which performs operations on some external data source, usually memory or some other data stream. The term is used herein to refer to the central processor (central processing unit) in a system or computer systems (especially systems on a chip (SoCs)) that combine a number of specialized “processors.” 
     As used herein, a system on a chip or system on chip (SoC or SOC) is an integrated circuit (also known as an “IC” or “chip”) that integrates all components of a computer or other electronic systems. It may contain digital, analog, mixed-signal, and often radio-frequency functions—all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals like graphics processing unit (GPU), Wi-Fi module, or coprocessor. A SoC may or may not contain built-in memory. 
     As used herein, a microcontroller or controller is a system that integrates a microprocessor with peripheral circuits and memory. A microcontroller (or MCU for microcontroller unit) may be implemented as a small computer on a single integrated circuit. It may be similar to a SoC; an SoC may include a microcontroller as one of its components. A microcontroller may contain one or more core processing units (CPUs) along with memory and programmable input/output peripherals. Program memory in the form of Ferroelectric RAM, NOR flash or OTP ROM is also often included on chip, as well as a small amount of RAM. Microcontrollers may be employed for embedded applications, in contrast to the microprocessors used in personal computers or other general purpose applications consisting of various discrete chips. 
     As used herein, the term controller or microcontroller may be a stand-alone IC or chip device that interfaces with a peripheral device. This may be a link between two parts of a computer or a controller on an external device that manages the operation of (and connection with) that device. 
     Any of the processors or microcontrollers described herein, may be implemented by any single core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the processor may be an LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas Instruments, for example, comprising on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), internal read-only memory (ROM) loaded with StellarisWare® software, 2 KB electrically erasable programmable read-only memory (EEPROM), one or more pulse width modulation (PWM) modules, one or more quadrature encoder inputs (QEI) analog, one or more 12-bit Analog-to-Digital Converters (ADC) with 12 analog input channels, details of which are available for the product datasheet. 
     In one aspect, the processor may comprise a safety controller comprising two controller-based families such as TMS570 and RM4x known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options. 
     Modular devices include the modules (as described in connection with  FIGS.  3  and  9   , for example) that are receivable within a surgical hub and the surgical devices or instruments that can be connected to the various modules in order to connect or pair with the corresponding surgical hub. The modular devices include, for example, intelligent surgical instruments, medical imaging devices, suction/irrigation devices, smoke evacuators, energy generators, ventilators, insufflators, and displays. The modular devices described herein can be controlled by control algorithms. The control algorithms can be executed on the modular device itself, on the surgical hub to which the particular modular device is paired, or on both the modular device and the surgical hub (e.g., via a distributed computing architecture). In some exemplifications, the modular devices’ control algorithms control the devices based on data sensed by the modular device itself (i.e., by sensors in, on, or connected to the modular device). This data can be related to the patient being operated on (e.g., tissue properties or insufflation pressure) or the modular device itself (e.g., the rate at which a knife is being advanced, motor current, or energy levels). For example, a control algorithm for a surgical stapling and cutting instrument can control the rate at which the instrument’s motor drives its knife through tissue according to resistance encountered by the knife as it advances. 
     Long Distance Communication and Condition Handling of Devices and Data 
     Surgical procedures are performed by different surgeons at different locations, some with much less experience than others. For a given surgical procedure, there are many parameters that can be varied to attempt to realize a desired outcome. For example, for a given surgical procedure which utilizes energy supplied by a generator, the surgeon often relies on experience alone for determining which mode of energy to utilize, which level of output power to utilize, the duration of the application of the energy, etc., in order to attempt to realize the desired outcome. To increase the likelihood of realizing desired outcomes for a plurality of different surgical procedures, each surgeon should be provided with best practice recommendations which are based on important relationships identified within large, accurate data sets of information associated with multiple surgical procedures performed in multiple locations over time. However, there are many ways that such data sets can be rendered compromised, inaccurate, and/or unsecure, thereby calling into question the applicability of the best practice recommendations derived therefrom. For example, for data sent from a source to a cloud-based system, the data can be lost while in transit to the cloud-based system, the data can be corrupted while in transit to the cloud-based system, the confidentiality of the data can be comprised while in transit to the cloud-based system, and/or the content of the data can be altered while in transit to the cloud-based system. 
     A plurality of operating rooms located in multiple locations can each be equipped with a surgical hub. When a given surgical procedure is performed in a given operating room, the surgical hub can receive data associated with the surgical procedure and communicate the data to a cloud-based system. Over time, the cloud-based system will receive large data sets of information associated with the surgeries. The data can be communicated from the surgical hubs to the cloud-based system in a manner which allows for the cloud-based system to (1) verify the authenticity of the communicated data, (2) authenticate each of the respective surgical hubs which communicated the data, and (3) trace the paths the data followed from the respective surgical hubs to the cloud-based system. 
     Accordingly, in one aspect, the present disclosure provides a surgical hub for transmitting generator data associated with a surgical procedure to a cloud-based system communicatively coupled to a plurality of surgical hubs. The surgical hub comprises a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to receive data from a generator, encrypt the data, generate a message authentication code (MAC) based on the data, generate a datagram comprising the encrypted data, the generated MAC, a source identifier, and a destination identifier, and transmit the datagram to a cloud-based system. The data is structured into a data packet comprising at least two of the following fields: a field that indicates the source of the data, a unique time stamp, a field indicating an energy mode of the generator, a field indicating the power output of the generator, and a field indicating a duration of the power output of the generator. The datagram allows for the cloud-based system to decrypt the encrypted data of the transmitted datagram, verify integrity of the data based on the MAC, authenticate the surgical hub as the source of the datagram, and validate a transmission path followed by the datagram between the surgical hub and the cloud-based system. In various aspects, the present disclosure provides a control circuit to transmit generator data associated with a surgical procedure to a cloud-based system communicatively coupled to a plurality of surgical hubs, as described above. In various aspects, the present disclosure provides a non-transitory computer-readable medium storing computer-readable instructions which, when executed, causes a machine to transmit generator data associated with a surgical procedure to a cloud-based system communicatively coupled to a plurality of surgical hubs, as described above. 
     In another aspect, the present disclosure provides a cloud-based system communicatively coupled to a plurality of surgical hubs. Each surgical hub is configured to transmit generator data associated with a surgical procedure to the cloud-based system. The cloud-based system comprises a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to receive a datagram generated by a surgical hub, decrypt the encrypted generator data of the received datagram, verify integrity of the generator data based on the MAC, authenticate the surgical hub as the source of the datagram, and validate a transmission path followed by the datagram between the surgical hub and the cloud-based system. The datagram comprises generator data captured from a generator associated with the surgical hub, a MAC generated by the surgical hub based on the generator data, a source identifier, and a destination identifier. The generator data has been encrypted by the surgical hub. The encrypted generator data has been structured into a data packet comprising at least two of the following fields: a field that indicates the source of the data, a unique time stamp, a field indicating an energy mode, a field indicating power output, and a field indicating a duration of applied power. 
     In various aspects, the present disclosure provides a control circuit to transmit generator data associated with a surgical procedure to the cloud-based system. In various aspects, the present disclosure provides a non-transitory computer-readable medium storing computer-readable instructions which, when executed, causes a machine to transmit generator data associated with a surgical procedure to the cloud-based system. 
     In another aspect, the present disclosure provides a method, comprising capturing data from a combination generator of a surgical hub during a surgical procedure, wherein the combination generator is configured to supply two or more different modes of energy. Encrypting the captured generator data, generating a MAC based on the captured generator data, generating a datagram comprising the encrypted generator data, the MAC, a source identifier, and a destination identifier, and communicating the datagram from the surgical hub to a cloud-based system. The datagram allows for the cloud-based system to authenticate integrity of the communicated generator data, authenticate the surgical hub as a source of the datagram, and determine a communication path followed by the datagram between the surgical hub and the cloud-based system. 
     By sending captured generator data from a plurality of different surgical hubs to a cloud-based system, the cloud-based system is able to quickly build large data sets of information associated with multiple surgical procedures performed in multiple locations over time. Furthermore, due to the composition of the respective datagrams, for a given datagram, the cloud-based system is able to determine whether the datagram was originally sent by one of the surgical hubs (source validation), thereby providing an indication that the generator data received at the cloud-based system is legitimate data. For the given datagram, the cloud-based system is also able to determine whether the generator data received at the cloud-based system is identical to the generator data sent by the given surgical hub (data integrity), thereby allowing for the authenticity of the received generator data to be verified. Additionally, for the given datagram, the cloud-based system is also able to re-trace the communication path followed by the datagram, thereby allowing for enhanced troubleshooting if a datagram received by the cloud-based system was originally sent from a device other than the surgical hubs and/or if the content of the datagram was altered while in transit to the cloud-based system. Notably, the present disclosure references generator data in particular. Here, the present disclosure should not be limited as being able to process only generator data. For example, the surgical hub  206  and/or the cloud-based system  205  may process data received from any component (e.g., imaging module  238 , generator module  240 , smoke evacuator module  226 , suction/ irrigation module  228 , communication module  230 , processor module  232 , storage array  234 , smart device/instrument  235 , non-contact sensor module  242 , robot hub  222 , a non-robotic surgical hub  206 , wireless smart device/instrument  235 , visualization system  208 ) of the surgical system  202  that is coupled to the surgical hub  206  and/or data from any devices (e.g., endoscope  239 , energy device  241 ) coupled to/through such components (e.g., see  FIGS.  9 - 10   ), in a similar manner as discussed herein. 
     Unfortunately, the outcome of a surgical procedure is not always optimal. For example, a failure event such as a surgical device failure, an unwanted tissue perforation, an unwanted post-operative bleeding, or the like can occur. The occurrence of a failure event can be attributed to any of a variety of different people and devices, including one or more surgeons, one or more devices associated with the surgery, a condition of the patient, and combinations thereof. When a given failure event occurs, it is not always clear regarding who or what caused the failure event or how the occurrence of the failure event can be mitigated in connection with a future surgery. 
     During a given surgical procedure, a large amount of data associated with the surgical procedure can be generated and captured. All of the captured data can be communicated to a surgical hub, and the captured data can be time-stamped either before or after being received at the surgical hub. When a failure event associated with the surgical procedure is detected and/or identified, it can be determined which of the captured data is associated with the failure event and/or which of the captured data is not associated with the failure event. In making this determination, the failure event can be defined to include a period of time prior to the detection/identification of the failure event. Once the determination is made regarding the captured data associated with the failure event, the surgical hub can separate the captured data associated with the failure event from all other captured data, and the captured data can be separated based on tagging, flagging, or the like. The captured data associated with the failure event can then be chronologized based on the time-stamping and the defined time period applicable to the failure event. The chronologized captured data can then be communicated to a cloud-based system on a prioritized basis for analysis, where the prioritized basis is relative to the captured data which is not associated with the failure event. Whether or not the analysis identifies a device associated with the surgical procedure as the causation of the failure event, the surgical hub can tag the device for removal of the device from future use, further analysis of the device, and/or to return the device to the manufacturer. 
     When a given surgical procedure is performed, a large amount of data associated with the surgical procedure can be generated and captured. All of the captured data can be communicated to a surgical hub, where the information can be stripped of all “personal” associations. The captured data can be time-stamped before being received at the surgical hub, after being received at the surgical hub, before being stripped of the “personal” associations, or after being stripped of the “personal” associations. The surgical hub can communicate the stripped data to the cloud-based system for subsequent analysis. Over time, the cloud-based system will receive large data sets of information associated with the surgeries. Accordingly, in one aspect, the present disclosure provides a surgical hub for prioritizing surgical data associated with a surgical procedure to a cloud-based system communicatively coupled to a plurality of surgical hubs. The surgical hub comprises a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to capture surgical data, wherein the surgical data comprises data associated with a surgical device, time-stamp the captured surgical data, identify a failure event, identify a time period associated with the failure event, isolate failure event surgical data from surgical data not associated with the failure event based on the identified time period, chronologize the failure event surgical data by time-stamp, encrypt the chronologized failure event surgical data, generate a datagram comprising the encrypted failure event surgical data, and transmit the datagram to a cloud-based system. The datagram is structured to include a field which includes a flag that prioritizes the encrypted failure event surgical data over other encrypted data of the datagram. The datagram allows for the cloud-based system to decrypt the encrypted failure event surgical data, focus analysis on the failure event surgical data rather than surgical data not associated with the failure event, and flag the surgical device associated with the failure event for at least one of the following: removal from an operating room, return to a manufacturer, or future inoperability in the cloud-based system. 
     In various aspects, the present disclosure provides a control circuit to prioritize surgical data associated with a surgical procedure to a cloud-based system communicatively coupled to a plurality of surgical hubs. In various aspects, the present disclosure provides a non-transitory computer-readable medium storing computer-readable instructions which, when executed, causes a machine to prioritize surgical data associated with a surgical procedure to a cloud-based system communicatively coupled to a plurality of surgical hubs. 
     In another aspect, the present disclosure provides a method, comprising capturing data during a surgical procedure, communicating the captured data to a surgical hub, time-stamping the captured data, identifying a failure event associated with the surgical procedure, determining which of the captured data is associated with the failure event, separating the captured data associated with the failure event from all other captured data, chronologizing the captured data associated with the failure event, and communicating the chronologized captured data to a cloud-based system on a prioritized basis. 
     By capturing the large amount of data associated with the surgical procedure, and with having the captured data time-stamped, the portion of the captured data which is relevant to the detected/identified failure event can be more easily isolated from all of the other captured data, thereby allowing for a more focused subsequent analysis on just the relevant captured data. The data associated with the failure event can then be chronologized (this requires less processing power than chronologizing all of the captured data), thereby allowing for the events leading up to the detection/identification of the failure event to be more easily considered during the subsequent analysis of the failure event. The chronologized data can then be communicated to the cloud-based system (this requires less communication resources than communicating all of the captured data at the same time) on a prioritized basis, thereby allowing for the focused subsequent analysis of the fault event to be performed by the cloud-based system in a more time-sensitive manner. 
     To help ensure that the best practice recommendations are developed based on accurate data, it would be desirable to ensure that the generator data received at the cloud-based system is the same as the generator data communicated to the cloud-based system. Also, to help to be able to determine the cause of a failure event as quickly as possible, it would be desirable to ensure that surgical data associated with the failure event is communicated to the cloud-based system in a prioritized manner (relative to surgical data not associated with the failure event) so that analysis of the surgical data can be performed in an expedited manner. 
     Aspects of a system and method for communicating data associated with a surgical procedure are described herein. As shown in  FIG.  9   , various aspects of the computer implemented interactive surgical system  200  includes a device/instrument  235 , a generator module  240 , a modular control tower  236 , and a cloud-based system  205 . As shown in  FIG.  10   , the device/instrument  235 , the generator module  240 , and the modular control tower  236  are components/portions of a surgical hub  206 . 
     In various aspects, the generator module  240  of the surgical hub  206  can supply radio-frequency energy such as monopolar radio-frequency energy, bipolar radio-frequency energy, and advanced bipolar energy and/or ultrasonic energy to a device/instrument  235  for use in a surgical procedure. Thus, the generator module  240  may be referred to as a combination generator. An example of such a combination generator is shown in  FIG.  22   , where the combination generator  3700  is shown as including a monopolar module  3702 , a bipolar module  3704 , an advanced bipolar module  3706 , and an ultrasound module  3708 . When utilized during a surgical procedure, the respective energy modules (e.g.,  3702 ,  3704 ,  3706 , and/or  3708 ) of the combination generator  3700  can provide generator data such as type of energy supplied to the device instrument (e.g., radio-frequency energy, ultrasound energy, radio-frequency energy and ultrasound energy), type of radio-frequency energy (e.g., monoplar, bipolar, advanced bipolar), frequency, power output, duration, etc., to the data communication module  3710  of the combination generator  3700 . 
       FIG.  23    illustrates various aspects of a method of capturing data from a combination generator  3700  and communicating the captured generator data to a cloud-based system  205 . Notably, as discussed herein, the present disclosure should not be limited to processing generator data. As such, the method of  FIG.  23    similarly extends to other types of data received from other components coupled to the surgical hub  206  (e.g., imaging module data, smoke evacuator data, suction/irrigation data, device/instrument data). The method comprises (1) capturing  3712  data from a combination generator  3700  of a surgical hub  206  during a surgical procedure, wherein the combination generator  3700  is configured to supply two or more different modes of energy; (2) encrypting  3714  the captured generator data; (3) generating  3716  a MAC based on the captured generator data; (4) generating  3718  a datagram comprising the encrypted generator data, the MAC, a source identifier, and a destination identifier; and (5) communicating  3720  the datagram from the surgical hub  206  to a cloud-based system  205 , wherein the datagram allows for the cloud-based system  205  to (i) authenticate integrity of the communicated generator data, (ii) authenticate the surgical hub as a source of the datagram, and (iii) determine a communication path followed by the datagram between the surgical hub  206  and the cloud-based system  205 . 
     More specifically, once the generator data is received at the data communication module  3710  of the combination generator  3700 , the generator data can be communicated to the modular communication hub  203  of the surgical hub  206  for subsequent communication to the cloud-based system  205 . The data communication module  3710  can communicate the generator data to the modular communication hub  203  serially over a single communication line or in parallel over a plurality of communication lines, and such communication can be performed in real time or near real time. Alternatively, such communication can be performed in batches. 
     According to various aspects, prior to communicating the generator data to the modular communication hub  203 , a component of the combination generator  3700  (e.g., the data communication module  3710 ) can organize the generator data into data packets. An example of such a data packet is shown in  FIG.  24   , where the data packet  3722  includes a preamble  3724  or self-describing data header which defines what the data is (e.g., combination generator data -CGD) and fields which indicate where the generator data came from [e.g., combination generator ID number  3726  - (e.g., 017), a unique time stamp  3728  (e.g., 08:27: 16), the energy mode utilized  3730  (e.g., RF, U, RF+U), the type of radio-frequency energy or radio frequency mode  3732  (e.g., MP, BP, ABP), the frequency  3734  (e.g., 500 Khz), the power output  3736  (e.g., 30 watts), the duration of applied power  3738  (e.g., 45 milliseconds), and an authentication/identification certificate of the data point  3740  (e.g., 01101011001011). The example data packet  3722  may be considered a self-describing data packet, and the combination generator  3700  and other intelligent devices (e.g., the surgical hub  206 ) can use the self-describing data packets to minimize data size and data-handling resources. Again, as discussed herein, the present disclosure should not be limited to processing generator data received from a combination generator  3700 . As such, the data packet  3722  of  FIG.  24    similarly extends to other types of data received from other components coupled to the surgical hub  206 . In one aspect, the data packet  3722  may comprise data associated with endoscope  239  (e.g., image data) received from a component of the imaging module  238 . In another aspect, the data packet  3722  may comprises data associated with an evacuation system (e.g., pressures, particle counts, flow rates, motor speeds) received from a component of the smoke evacuator module  226 . In yet another aspect, the data packet  3722  may comprise data associated with a device/instrument (e.g., temperature sensor data, firing data, sealing data) received from a component of the device/instrument  235 . In various other aspects, the data packet  3722  may similarly comprise data received from other components coupled to the surgical hub  206  (e.g., suction/irrigation module  228 , non-contact sensor module  242 ) 
     Additionally, the data communication module  3710  can compress the generator data and/or encrypt the generator data prior to communicating the generator data to the modular communication hub  203 . The specific method of compressing and/or encrypting can be the same as or different from the compressing and/or encrypting which may be performed by the surgical hub  206  as described in more detail below. 
     The modular communication hub  203  can receive the generator data communicated from the combination generator  3700  (e.g., via the data communication module  3710 ), and the generator data can be subsequently communicated to the cloud-based system  205  (e.g., through the Internet). According to various aspects, the modular communication hub  203  can receive the generator data through a hub/switch  207 / 209  of the modular communication hub  203  (See  FIG.  10   ), and the generator data can be communicated to the cloud-based system  205  by a router  211  of the modular communication hub  203  (See  FIG.  10   ). The generator data may be communicated in real time, near real time, or in batches to the cloud-based system  205  or may be stored at the surgical hub  206  prior to being communicated to the cloud-based system  205 . The generator data can be stored, for example, at the storage array  234  or at the memory  249  of the computer system  210  of the surgical hub  206 . 
     In various aspects, for instances where the generator data received at the modular communication hub  203  is not encrypted, prior to the received generator data being communicated to the cloud-based system  205 , the generator data is encrypted to help ensure the confidentiality of the generator data, either while it is being stored at the surgical hub  206  or while it is being transmitted to the cloud  204  using the Internet or other computer networks. According to various aspects, a component of the surgical hub  206  utilizes an encryption algorithm to convert the generator data from a readable version to an encoded version, thereby forming the encrypted generator data. The component of the surgical hub  206  which utilizes/executes the encryption algorithm can be, for example, the processor module  232 , the processor  244  of the computer system  210 , and/or combinations thereof. The utilized/executed encryption algorithm can be a symmetric encryption algorithm and/or an asymmetric encryption algorithm. 
     Using a symmetric encryption algorithm, the surgical hub  206  would encrypt the generator data using a shared secret (e.g., private key, passphrase, password). In such an aspect, a recipient of the encrypted generator data (e.g., cloud-based system  205 ) would then decrypt the encrypted generator data using the same shared secret. In such an aspect, the surgical hub  206  and the recipient would need access to and/or knowledge of the same shared secret. In one aspect, a shared secret can be generated/chosen by the surgical hub  206  and securely delivered (e.g., physically) to the recipient before encrypted communications to the recipient. 
     Alternatively, using an asymmetric encryption algorithm, the surgical hub  206  would encrypt the generator data using a public key associated with a recipient (e.g., cloud-based system  205 ). This public key could be received by the surgical hub  206  from a certificate authority that issues a digital certificate certifying the public key as owned by the recipient. The certificate authority can be any entity trusted by the surgical hub  206  and the recipient. In such an aspect, the recipient of the encrypted generator data would then decrypt the encrypted generator data using a private key (i.e., known only by the recipient) paired to the public key used by the surgical hub  206  to encrypt the generator data. Notably, in such an aspect, the encrypted generator data can only be decrypted using the recipient’s private key. 
     According to aspects of the present disclosure, components (e.g., surgical device/instrument  235 , energy device  241 , endoscope  239 ) of the surgical system  202  are associated with unique identifiers, which can be in the form of serial numbers. As such, according to various aspects of the present disclosure, when a component is coupled to a surgical hub  206 , the component may establish a shared secret with the surgical hub  206  using the unique identifier of the coupled component as the shared secret. Further, in such an aspect, the component may derive a checksum value by applying a checksum function/algorithm to the unique identifier and/or other data being communicated to the surgical hub  206 . Here, the checksum function/algorithm is configured to output a significantly different checksum value if there is a modification to the underlying data. 
     In one aspect, the component may initially encrypt the unique identifier of a coupled component using a public key associated with the surgical hub (e.g., received by the component from the surgical hub  206  upon/after connection) and communicate the encrypted unique identifier to the surgical hub  206 . In other aspects, the component may encrypt the unique identifier and the derived checksum value of a coupled component using a public key associated with the surgical hub  206  and communicate the encrypted unique identifier and linked/associated checksum value to the surgical hub  206 . 
     In yet other aspects, the component may encrypt the unique identifier and a checksum function/algorithm using a public key associated with the surgical hub  206  and communicate the encrypted unique identifier and the checksum function/algorithm to the surgical hub  206 . In such aspects, the surgical hub  206  would then decrypt the encrypted unique identifier or the encrypted unique identifier and the linked/associated checksum value or the encrypted unique identifier and the checksum function/algorithm using a private key (i.e., known only by the surgical hub  206 ) paired to the public key used by the component to encrypt the unique identifier. 
     Since the encrypted unique identifier can only be decrypted using the surgical hub’s  206  private key and the private key is only known by the surgical hub, this is a secure way to communicate a shared secret (e.g., the unique identifier of the coupled component) to the surgical hub  206 . Further, in aspects where a checksum value is linked to/associated with the unique identifier, the surgical hub  206  may apply the same checksum function/algorithm to the decrypted unique identifier to generate a validating checksum value. If the validating checksum value matches the decrypted checksum value, the integrity of the decrypted unique identifier is further verified. Further, in such aspects, with a shared secret established, the component can encrypt future communications to the surgical hub  206 , and the surgical hub  206  can decrypt the future communications from the component using the shared secret (e.g., the unique identifier of the coupled component). Here, according to various aspects, a checksum value may be derived for and communicated with each communication between the component and the surgical hub  206  (e.g., the checksum value based on the communicated data or at least a designated portion thereof). Here, a checksum function/algorithm (e.g., known by the surgical hub  206  and/or component or communicated when establishing the shared secret between the surgical hub  206  and the component as described above) may be used to generate validating checksum values for comparison with communicated checksum values to further verify the integrity of communicated data in each communication. 
     Notably, asymmetric encryption algorithms may be complex and may require significant computational resources to execute each communication. As such, establishing the unique identifier of the coupled component as the shared secret is not only quicker (e.g., no need to generate a shared secret using a pseudorandom key generator) but also increases computational efficiency (e.g., enables the execution of faster, less complex symmetric encryption algorithms) for all subsequent communications. In various aspects, this established shared secret may be utilized by the component and surgical hub  206  until the component is decoupled from the surgical hub (e.g., surgical procedure ended). 
     According to other aspects of the present disclosure, components (e.g., surgical device/instrument  235 , energy device  241 , endoscope  239 ) of the surgical system  202  may comprise sub-components (e.g., handle, shaft, end effector, cartridge) each associated with its own unique identifier. As such, according to various aspects of the present disclosure, when a component is coupled to the surgical hub  206 , the component may establish a shared secret with the surgical hub  206  using a unique compilation/string (e.g., ordered or random) of the unique identifiers associated with the sub-components that combine to form the coupled component. In one aspect, the component may initially encrypt the unique compilation/string of the coupled component using a public key associated with the surgical hub  206  and communicate the encrypted unique compilation/string to the surgical hub  206 . In such an aspect, the surgical hub  206  would then decrypt the encrypted unique compilation/string using a private key (i.e., known only by the surgical hub  206 ) paired to the public key used by the component to encrypt the unique compilation/string. Since the encrypted unique compilation/string can only be decrypted using the surgical hub’s  206  private key and the private key is only known by the surgical hub  206 , this is a secure way to communicate a shared secret (e.g., the unique compilation/string of the coupled component) to the surgical hub  206 . Further, in such an aspect, with a shared secret established, the component can encrypt future communications to the surgical hub  206 , and the surgical hub  206  can decrypt the future communications from the component using the shared secret (e.g., the unique compilation/string of the coupled component). 
     Again, asymmetric encryption algorithms may be complex and may require significant computational resources to execute each communication. As such, establishing the unique compilation/string of the coupled component (i.e., readily combinable by the component) as the shared secret is not only quicker (e.g., no need to generate a shared secret using a pseudorandom key generator) but also increases computational efficiency (e.g., enables the execution of faster, less complex symmetric encryption algorithms) for all subsequent communications. In various aspects, this established shared secret may be utilized by the component and surgical hub  206  until the component is decoupled from the surgical hub  206  (e.g., surgical procedure ended). Furthermore, in such an aspect, since various sub-components may be reusable (e.g., handle, shaft, end effector) while other sub-components may not be reusable (e.g., end effector, cartridge) each new combination of sub-components that combine to form the coupled component provide a unique compilation/string usable as a shared secret for component communications to the surgical hub  206 . 
     According to further aspects of the present disclosure, components (e.g., surgical device/instrument  235 , energy device  241 , endoscope  239 ) of the surgical system  202  are associated with unique identifiers. As such, according to various aspects of the present disclosure, when a component is coupled to the surgical hub  206 , the surgical hub  206  may establish a shared secret with a recipient (e.g., cloud-based system  205 ) using the unique identifier of the coupled component. In one aspect, the surgical hub  206  may initially encrypt the unique identifier of a coupled component using a public key associated with the recipient and communicate the encrypted unique identifier to the recipient. In such an aspect, the recipient would then decrypt the encrypted unique identifier using a private key (i.e., known only by the recipient) paired to the public key used by the surgical hub  206  to encrypt the unique identifier. Since the encrypted unique identifier can only be decrypted using the recipient’s private key and the private key is only known by the recipient, this is a secure way to communicate a shared secret (e.g., the unique identifier of the coupled component) to the recipient (e.g., cloud-based system). Further in such an aspect, with a shared secret established, the surgical hub  206  can encrypt future communications to the recipient (e.g., cloud-based system  205 ), and the recipient can decrypt the future communications from the surgical hub  206  using the shared secret (e.g., the unique identifier of the coupled component). 
     Notably, asymmetric encryption algorithms may be complex and may require significant computational resources to execute each communication. As such, establishing the unique identifier of the coupled component (i.e., already available to the surgical hub  206 ) as the shared secret is not only quicker (e.g., no need to generate a shared secret using a pseudorandom key generator) but also increases computational efficiency by, for example, enabling the execution of faster, less complex symmetric encryption algorithms for all subsequent communications. In various aspects, this established shared secret may be utilized by the surgical hub  206  until the component is decoupled from the surgical hub (e.g., surgical procedure ended). 
     According to yet further aspects of the present disclosure, components (e.g., surgical device/instrument  235 , energy device  241 , endoscope  239 ) of the surgical system  202  may comprise sub-components (e.g., handle, shaft, end effector, cartridge) each associated with its own unique identifier. As such, according to various aspects of the present disclosure, when a component is coupled to the surgical hub  206 , the surgical hub  206  may establish a shared secret with a recipient (e.g., cloud-based system  205 ) using a unique compilation/string (e.g., ordered or random) of the unique identifiers associated with the sub-components that combine to form the coupled component. 
     In one aspect, the surgical hub  206  may initially encrypt the unique compilation/string of the coupled component using a public key associated with the recipient and communicate the encrypted unique compilation/string to the recipient. In such an aspect, the recipient would then decrypt the encrypted unique compilation/string using a private key (i.e., known only by the recipient) paired to the public key used by the surgical hub  206  to encrypt the unique compilation/string. Since the encrypted unique compilation/string can only be decrypted using the recipient’s private key and the private key is only known by the recipient, this is a secure way to communicate a shared secret (e.g., the unique compilation/string of the coupled component) to the recipient. With a shared secret established, the surgical hub  206  can encrypt future communications to the recipient (e.g., cloud-based system  205 ), and the recipient can decrypt the future communications from the surgical hub  206  using the shared secret (e.g., the unique compilation/string of the coupled component). Again, asymmetric encryption algorithms may be complex and may require significant computational resources to execute each communication. As such, establishing the unique compilation/string of the coupled component (i.e., readily combinable by the surgical hub  206 ) as the shared secret is not only quicker (e.g., no need to generate a shared secret using a pseudorandom key generator) but also increases computational efficiency (e.g., enables the execution of faster, less complex symmetric encryption algorithms) for all subsequent communications. 
     In various aspects, this established shared secret may be utilized by the surgical hub  206  until the component is decoupled from the surgical hub (e.g., surgical procedure ended). Furthermore, in such an aspect, since various sub-components may be reusable (e.g., handle, shaft, end effector) while other sub-components may not be reusable (e.g., end effector, cartridge) each new combination of sub-components that combine to form the coupled component provide a unique compilation/string usable as a shared secret for surgical hub  206  communications to the recipient. 
     In some aspects, an encrypt-then-MAC (EtM) approach may be utilized to produce the encrypted generator data. An example of this approach is shown in  FIG.  25   , where the non-encrypted generator data (i.e., the plaintext  3742 , e.g., data packet  3722 ) is first encrypted  3743  (e.g., via key  3746 ) to produce a ciphertext  3744  (i.e., the encrypted generator data), then a MAC  3745  is produced based on the resulting ciphertext  3744 , the key  3746 , and a MAC algorithm (e.g., a hash function  3747 ). More specifically, the ciphertext  3744  is processed through the MAC algorithm using the key  3746 . In one aspect similar to symmetric encryption discussed herein, the key  3746  is a secret key accessible/known by the surgical hub  206  and the recipient (e.g., cloud-based system  205 ). In such an aspect, the secret key is a shared secret associated with/chosen by the surgical hub  206 , a shared secret associated with/chosen by the recipient, or a key selected via a pseudorandom key generator. For this approach, as shown generally at  3748 , the encrypted generator data (i.e., the ciphertext  3744 ) and the MAC  3745  would be communicated together to the cloud-based system  205 . 
     In other aspects, an encrypt-and-MAC (E&amp;M) approach may be utilized to produce the encrypted generator data. An example of this approach is shown in  FIG.  26   , where the MAC  3755  is produced based on the non-encrypted generator data (i.e., the plaintext  3752 , e.g., data packet  3722 ), a key  3756 , and a MAC algorithm (e.g., a hash function  3757 ). More specifically, the plaintext  3752  is processed through the MAC algorithm using the key  3756 . In one aspect similar to symmetric encryption discussed herein, the key  3756  is a secret key accessible/ known by the surgical hub  206  and the recipient (e.g., cloud-based system  205 ). In such an aspect, the secret key is a shared secret associated with/chosen by the surgical hub  206 , a shared secret associated with/chosen by the recipient, or a key selected via a pseudorandom key generator. Further, in such an aspect, the non-encrypted generator data (i.e., the plaintext  3752 , e.g., data packet  3722 ) is encrypted  3753  (e.g., via key  3756 ) to produce a ciphertext  3754 . For this approach, as shown generally at  3758 , the MAC  3755  (i.e., produced based on the non-encrypted generator data) and the encrypted generator data (i.e., the ciphertext  3754 ) would be communicated together to the cloud-based system  205 . 
     In yet other aspects, a MAC-then-encrypt (MtE) approach may be utilized to produce the encrypted generator data. An example of this approach is shown in  FIG.  27   , where the MAC  3765  is produced based on the non-encrypted generator data (i.e., the plaintext  3762 ), a key  3766 , and a MAC algorithm (e.g., a hash function  3767 ). More specifically, the plaintext  3762  is processed through the MAC algorithm using the key  3766 . In one aspect similar to symmetric encryption discussed herein, the key  3766  is a secret key accessible/known by the surgical hub  206  and the recipient (e.g., cloud-based system  205 ). In such an aspect, the secret key is a shared secret associated with/chosen by the surgical hub  206 , a shared secret associated with/chosen by the recipient, or a key selected via a pseudorandom key generator. Next, the non-encrypted generator data (i.e., the plaintext  3762 ) and the MAC  3765  are together encrypted  3763  (e.g., via key  3766 ) to produce a ciphertext  3764  based on both. For this approach, as shown generally at  3768 , the ciphertext  3764  (i.e., which includes the encrypted generator data and the encrypted MAC  3765 ) would be communicated to the cloud-based system  205 . 
     In alternative aspects, the key used to encrypt the non-encrypted generator data (e.g.,  FIG.  25    and  FIG.  26   ) or the non-encrypted generator data and the MAC (e.g.,  FIG.  27   ) may be different from the key (e.g., keys  3746 ,  3756 ,  3766 ) used to produce the MAC. For example, the key used to encrypt the non-encrypted generator data (e.g.,  FIG.  25    and  FIG.  26   ) or the non-encrypted generator data and the MAC (e.g.,  FIG.  27   ) may be a different shared secret or a public key associated with the recipient. 
     In lieu of utilizing the MAC to provide for a subsequent assurance of data integrity to the cloud-based system  205 , according to other aspects, the surgical hub  206  can utilize a digital signature to allow the cloud-based system  205  to subsequently authenticate integrity of the communicated generator data. For example, the processor module  232  and/or the processor  244  of the computer system  210  can utilize one or more algorithms to generate a digital signature associated with the generator data, and the cloud-based system  205  can utilize an algorithm to determine the authenticity of the received generator data. The algorithms utilized by the processor module  232  and/or the processor  244  of the computer system  210  can include: (1) a key generation algorithm that selects a private key uniformly at random from a set of possible private keys, where the key generation algorithm outputs the private key and a corresponding public key; and (2) a signing algorithm that, given the generator data and a private key, produces a digital signature associated with the generator data. The cloud-based system  205  can utilize a signature verifying algorithm that, given the received generator data, public key, and digital signature, can accept the received generator data as authentic if the digital signature is determined to be authentic or consider the generator data to be compromised or altered if the digital signature is not determined to be authentic. 
     According to other aspects of the present disclosure, the surgical hub  206  can utilize a commercial authentication program (e.g., Secure Hash Algorithm, SHA-2 comprising SHA-256) to provide for a subsequent assurance of data integrity of the communicated generator data to the cloud-based system  205 . 
     After the generator data has been encrypted (e.g., via EtM, E&amp;M, MtE), a component of the surgical hub  206  can communicate the encrypted generator data to the cloud-based system  205 . The component of the surgical hub  206  which communicates the encrypted generator data to the cloud-based system  205  can be, for example, the processor module  232 , a hub/switch  207 / 209  of the modular communication hub  203 , the router  211  of the modular communication hub  203 , the communication module  247  of the computer system  210 , etc. 
     According to various aspects, the communication of the encrypted generator data through the Internet can follow an IP which: (1) defines datagrams that encapsulate the encrypted generator data to be delivered and/or (2) defines addressing methods that are used to label the datagram with source and destination information. A high-level representation of an example datagram  3770  is shown in  FIG.  28   , where the datagram  3770  includes a header  3772  and a payload  3774 , and in other aspects also may include a trailer (not shown). A more detailed representation of an example datagram  3780  is shown in  FIG.  29   , where the header  3782  can include fields for information such as, for example, the IP address of the source  3786  which is sending the datagram (e.g., the router  211  of the modular communication hub  203 ), the IP address of the destination  3788  which is to receive the datagram (e.g., the cloud  204  and/or the remote server  213  associated with the cloud-based system  205 ), a type of service designation (not shown), a header length  3790 , a payload length  3792 , and a checksum value  3794 . In such an aspect, the surgical hub  206  may further apply a checksum function/algorithm to the non-encrypted generator data (i.e., the plaintext  3742 , e.g., data packet  3722 ) or at least a portion of the non-encrypted generator data (e.g., combination generator ID  3726 ) to derive the checksum value  3794 . Here, the checksum function/algorithm is configured to output a significantly different checksum value if there is any modification (e.g., even a slight change) to the underlying data (e.g., generator data). After decryption of the encrypted generator data by its recipient (e.g., cloud-based system  205 ), the recipient may apply the same checksum function/algorithm to the decrypted generator data to generate a validating checksum value. If the validating checksum value matches the checksum value  3794  (i.e., stored in the header  3782  of the received datagram  3780 ), the integrity of the received generator data is further verified. The payload  3784  may include the encrypted generator data  3796  and can also include padding  3798  if the encrypted generator data  3796  is less than a specified payload length. Notably, the communicated encrypted generator data  3796  may comprise a MAC as discussed in  FIGS.  25 ,  26 , and  27    above (e.g., references  3748 ,  3758 , and  3768 , respectively). In some aspects, the header  3782  can further include a specific path the datagram is to follow when the datagram is communicated from the surgical hub  206  to the cloud-based system  205  (e.g., from IP address of the source, to IP address of at least one intermediate network component (e.g., specified routers, specified servers), to IP address of the destination). 
     According to various aspects, prior to the generator data being encrypted, the generator data can be time-stamped (if not already time-stamped by the combination generator  3700 ) and/or the generator data can be compressed (if not already compressed by the combination generator  3700 ). Time-stamping allows for the cloud-based system  205  to correlate the generator data with other data (e.g., stripped patient data) which may be communicated to the cloud-based system  205 . The compression allows for a smaller representation of the generator data to be subsequently encrypted and communicated to the cloud-based system  205 . For the compression, a component of the surgical hub  206  can utilize a compression algorithm to convert a representation of the generator data to a smaller representation of the generator data, thereby allowing for a more efficient and economical encryption of the generator data (e.g., less data to encrypt utilizes less processing resources) and a more efficient and economical communication of the encrypted generator data (e.g., smaller representations of the generator data within the payload of the datagrams (e.g.,  FIGS.  28  and  29   ) allow for more generator data to be included in a given datagram, for more generator data to be communicated within a given time period, and/or for generator data to be communicated with fewer communication resources). The component of the surgical hub  206  which utilizes/executes the compression algorithm can be, for example, the processor module  232 , the processor  244  of the computer system, and/or combinations thereof. The utilized/executed compression algorithm can be a lossless compression algorithm or a lossy compression algorithm. 
     Once the generator data and the MAC for a given datagram has been received at the cloud-based system  205  (e.g.,  FIG.  25   , reference  3748 ;  FIG.  26   , reference  3758 ; and  FIG.  27   , reference  3768 ), the cloud-based system  205  can decrypt the encrypted generator data from the payload of the communicated datagram to realize the communicated generator data. 
     In one aspect, referring back to  FIG.  25   , the recipient (e.g., cloud-based system  205 ) may, similar to the surgical hub  206 , process the ciphertext 3744 through the same MAC algorithm using the same known/accessible secret key to produce an authenticating MAC. If the received MAC  3745  matches this authenticating MAC, the recipient (e.g., cloud-based system  205 ) may safely assume that the ciphertext  3744  has not been altered and is from the surgical hub  206 . The recipient (e.g., cloud-based system  205 ) may then decrypt the ciphertext  3744  (e.g., via key  3746 ) to realize the plaintext  3742  (e.g., data packet comprising generator data). 
     In another aspect, referring back to  FIG.  26   , the recipient (e.g., cloud-based system  205 ) may decrypt the ciphertext  3754  (e.g., via key  3756 ) to realize the plaintext  3752  (e.g., data packet comprising generator data). Next, similar to the surgical hub  206 , the recipient (e.g., cloud-based system  205 ) may process the plaintext  3752  through the same MAC algorithm using the same known/accessible secret key to produce an authenticating MAC. If the received MAC  3755  matches this authenticating MAC, the recipient (e.g., cloud-based system  205 ) may safely assume that the plaintext  3752  has not been altered and is from the surgical hub  206 . 
     In yet another aspect, referring back to  FIG.  27   , the recipient (e.g., cloud-based system  205 ) may decrypt the ciphertext  3764  (e.g., via key  3766 ) to realize the plaintext  3762  (e.g., data packet comprising generator data) and the MAC  3765 . Next, similar to the surgical hub  206 , the recipient (e.g., cloud-based system  205 ) may process the plaintext  3762  through the same MAC algorithm using the same known/accessible secret key to produce an authenticating MAC. If the received MAC  3765  matches this authenticating MAC, the recipient (e.g., cloud-based system  205 ) may safely assume that the plaintext  3762  has not been altered and is from the surgical hub  206 . 
     In alternative aspects, the key used to encrypt the non-encrypted generator data (e.g.,  FIG.  25    and  FIG.  26   ) or the non-encrypted generator data and the MAC (e.g.,  FIG.  27   ) may be different from the key (e.g., keys  3746 ,  3756 ,  3766 ) used to produce the MAC. For example, the key used to encrypt the non-encrypted generator data (e.g.,  FIG.  25    and  FIG.  26   ) or the non-encrypted generator data and the MAC (e.g.,  FIG.  27   ) may be a different shared secret or a public key associated with the recipient. In such aspects, referring to  FIG.  25   , the recipient (e.g., cloud-based system  205 ) may, after verifying the authenticating MAC via key  3746  (described above), then decrypt the ciphertext  3744  (e.g., via the different shared secret or private key associated with the recipient) to realize the plaintext  3742  (e.g., data packet comprising generator data). In such aspects, referring to  FIG.  26   , the recipient may decrypt the ciphertext 3754 (e.g., via the different shared secret or private key associated with the recipient) to realize the plaintext  3752  (e.g., data packet comprising generator data), then verify the authenticating MAC via key  3756  (described above). In such aspects, referring to  FIG.  27   , the recipient may decrypt the ciphertext  3764  (e.g., via the different shared secret or private key associated with the recipient) to realize the plaintext  3762  (e.g., data packet comprising generator data) and the MAC  3765 , then verify the authenticating MAC via key  3766  (described above). 
     In sum, referring to  FIGS.  25 - 27   , if an authenticating MAC, as determined/calculated by the cloud-based system  205 , is the same as the MAC which was received with the datagram, the cloud-based system  205  can have confidence that the received generator data is authentic (i.e., it is the same as the generator data which was communicated by the surgical hub  206 ) and that the data integrity of the communicated generator data has not been compromised or altered. As described above, the recipient may further apply the plaintext  3742 ,  3752 ,  3762 , or at least a portion thereof to the same checksum function/algorithm (i.e., used by the surgical hub  206 ) to generate a validating checksum value to further verify the integrity of the generator data based on the checksum value stored in the header of the communicated datagram. 
     Additionally, based on the decrypted datagram, the IP address of the source (e.g.,  FIG.  29   , reference  3786 ) which originally communicated the datagram to the cloud-based system  205  can be determined from the header of the communicated datagram. If the determined source is a recognized source, the cloud-based system  205  can have confidence that the generator data originated from a trusted source, thereby providing source authentication and even more assurance of the data integrity of the generator data. Furthermore, since each router the datagram passed through in route to the cloud-based system  205  includes its IP address with its forwarded communication, the cloud-based system  205  is able to trace back the path followed by the datagram and identify each router which handled the datagram. The ability to identify the respective routers can be helpful in instances where the content of the datagram received at the cloud-based system  205  is not the same as the content of the datagram as originally communicated by the surgical hub  206 . For aspects where the communication path was prespecified and included in the header of the communicated datagram, the ability to identify the respective routers can allow for path validation and provide additional confidence of the authenticity of the received generator data. 
     Furthermore, according to various aspects, after authenticating the received generator data, the cloud-based system  205  can communicate a message (e.g., a handshake or similar message) to the surgical hub  206  via the Internet or another communication network, confirming/guaranteeing that the datagram communicated from the surgical hub  206  was received intact by the cloud-based system  205 , thereby effectively closing the loop for that particular datagram. 
     Aspects of the above-described communication method, and/or variations thereof, can also be employed to communicate data other than generator data to the cloud-based system  205  and/or to communicate generator data and/or other data from the surgical hub  206  to systems and/or devices other than the cloud-based system  205 . For example, according to various aspects, the generator data and/or other data can be communicated from the surgical hub  206  to a hand-held surgical device/instrument (e.g., wireless device/instrument  235 ), to a robotic interface of a surgical device/instrument (e.g., robot hub  222 ) and/or to other servers, including servers (e.g., similar to server  213 ) associated with other cloud-based systems (e.g., similar to cloud-based system  205 ) in accordance with the above-described communication method. For example, in certain instances, an EEPROM chip of a given surgical instrument can initially be provided with merely an electronic chip device ID. Upon connection of the given surgical instrument to the combination generator  3700 , data can be downloaded from the cloud-based system  205  to the surgical hub  206  and subsequently to the EEPROM of the surgical instrument in accordance with the above-described communication method. 
     In addition to communicating generator data to the cloud-based system  205 , the surgical hub  206  can also utilize the above-described method of communication, and/or variations thereof, to communicate data other than generator data to the cloud-based system  205 . For example, the surgical hub  206  can also communicate other information associated with the surgical procedure to the cloud-based system  205 . Such other information can include, for example, the type of surgical procedure being performed, the name of the facility where the surgical procedure is being performed, the location of the facility where the surgical procedure is being performed, an identification of the operating room within the facility where the surgical procedure is being performed, the name of the surgeon performing the surgical procedure, the age of the patient, and data associated with the condition of the patient (e.g., blood pressure, heart rate, current medications). According to various aspects, such other information may be stripped of all information which could identify the specific surgery, the patient, or the surgeon, so that the information is essentially anonymized for further processing and analysis by the cloud-based system  205 . In other words, the stripped data is not correlated to a specific surgery, patient, or surgeon. The stripped information can be communicated to the cloud-based system  205  either together with or distinct from the communicated generator data. 
     For instances where the stripped/other data is to be communicated apart from the generator data, the stripped/other data can be time-stamped, compressed, and/or encrypted in a manner identical to or different from that described above regarding the generator data, and the surgical hub  206  may be programmed/configured to generate a datagram which includes the encrypted stripped/other information in lieu of the encrypted generator data. The datagram can then be communicated from the surgical hub  206  through the Internet to the cloud-based system  205  following an IP which: (1) defines datagrams that encapsulate the encrypted stripped/other data to be delivered, and (2) defines addressing methods that are used to label the datagram with source and destination information. 
     For instances where the stripped/other information is to be communicated with the generator data, the stripped/other data can be time-stamped, compressed, and/or encrypted in a manner identical to or different from that described above regarding the generator data, and the surgical hub  206  may be programmed/configured to generate a datagram which includes both the encrypted generator data and the encrypted stripped/other information. An example of such a datagram in shown in  FIG.  30   , where the payload  3804  of the datagram  3800  is divided into two or more distinct payload data portions (e.g., one for the encrypted generator data  3834 , one for the encrypted stripped/other information  3836 ), with each portion having an identifying bit (e.g., generator data (GD)  3806 , other data (OD)  3812 ), the associated encrypted data  3808 ,  3814 , and the associated padding  3810 ,  3816 , if needed, respectively. Further, as shown in  FIG.  30   , the header  3802  may be the same as (e.g., IP address source  3818 , IP address destination  3820 , header length  3822 ) or different from the header  3782  described with reference to the datagram  3780  shown in  FIG.  29   . For example, the header  3802  may be different in that the header  3802  further includes a field designating the number of payload data portions  3824  (e.g., 2) included in the payload  3804  of the datagram  3800 . The header  3802  can also be different in that it can include fields designating the payload length  3826 ,  3830  and the checksum value  3828 ,  2832  for each payload data portion  3834 ,  3836 , respectively. Although only two payload data portions are shown in  FIG.  30   , it will be appreciated that the payload  3804  of the datagram  3800  may include any quantity/number of payload data portions (e.g., 1, 2, 3, 4, 5), where each payload data portion includes data associated with a different aspect of the surgical procedure. The datagram  3800  can then be communicated from the surgical hub  206  through the Internet to the cloud-based system  205  following an IP which: (1) defines datagrams that encapsulate the encrypted generator data and the encrypted stripped/other data to be delivered, and (2) defines addressing methods that are used to label the datagram with source and destination information. 
     As set forth above, it is an unfortunate reality that the outcomes of all surgical procedures are not always optimal and/or successful. For instances where a failure event is detected and/or identified, a variation of the above-described communication methods can be utilized to isolate surgical data which is associated with the failure event (e.g., failure event surgical data) from surgical data which is not associated with the failure event (e.g., non-failure event surgical data) and communicate the surgical data which is associated with the failure event (e.g., failure event data) from the surgical hub  206  to the cloud-based system  205  on a prioritized basis for analysis. According to one aspect of the present disclosure, failure event surgical data is communicated from the surgical hub  206  to the cloud-based system  205  on a prioritized basis relative to non-failure event surgical data. 
       FIG.  31    illustrates various aspects of a system-implemented method of identifying surgical data associated with a failure event (e.g., failure event surgical data) and communicating the identified surgical data to a cloud-based system  205  on a prioritized basis. The method comprises (1) receiving  3838  surgical data at a surgical hub  206 , wherein the surgical data is associated with a surgical procedure; (2) time-stamping  3840  the surgical data; (3) identifying  3842  a failure event associated with the surgical procedure; (4) determining  3844  which of the surgical data is associated with the failure event (e.g., failure event surgical data); (5) separating  3846  the surgical data associated with the failure event from all other surgical data (e.g., non-failure event surgical data) received at the surgical hub  206 ; (6) chronologizing  3848  the surgical data associated with the failure event; (7) encrypting  3850  the surgical data associated with the failure event; and (8) communicating  3852  the encrypted surgical data to a cloud-based system  205  on a prioritized basis. 
     More specifically, various surgical data can be captured during a surgical procedure and the captured surgical data, as well as other surgical data associated with the surgical procedure, can be communicated to the surgical hub  206 . The surgical data can include, for example, data associated with a surgical device/instrument (e.g.,  FIG.  9   , surgical device/instrument  235 ) utilized during the surgery, data associated with the patient, data associated with the facility where the surgical procedure was performed, and data associated with the surgeon. Either prior to or subsequent to the surgical data being communicated to and received by the surgical hub  206 , the surgical data can be time-stamped and/or stripped of all information which could identify the specific surgery, the patient, or the surgeon, so that the information is essentially anonymized for further processing and analysis by the cloud-based system  205 . 
     Once a failure event has been detected and/or identified (e.g., which can be either during or after the surgical procedure), the surgical hub  206  can determine which of the surgical data is associated with the failure event (e.g., failure event surgical data) and which of the surgical data is not associated with the surgical event (e.g., non-failure event surgical data). According to one aspect of the present disclosure, a failure event can include, for example, a detection of one or more misfired staples during a stapling portion of a surgical procedure. For example, in one aspect, referring to  FIG.  9   , an endoscope  239  may take snapshots while a surgical device/instrument  235  comprising an end effector including a staple cartridge performs a stapling portion of a surgical procedure. In such an aspect, an imaging module  238  may compare the snapshots to stored images and/or images downloaded from the cloud-based system  205  that convey correctly fired staples to detect a misfired staple and/or evidence of a misfired staple (e.g., a leak). In another aspect, the imaging module  238  may analyze the snapshots themselves to detect a misfired staple and/or evidence of a misfired staple. In one alternative aspect, the surgical hub  206  may communicate the snapshots to the cloud-based system  205 , and a component of the cloud-based system  205  may perform the various imaging module functions described above to detect a misfired staple and/or evidence of a misfired staple and to report the detection to the surgical hub  206 . According to another aspect of the present disclosure, a failure event can include a detection of a tissue temperature which is below the expected temperature during a tissue-sealing portion of a surgical procedure and/or a visual indication of excessive bleeding or oozing following a surgical procedure (e.g.,  FIG.  9   , via endoscope  239 ). For example, in one aspect, referring to  FIG.  9   , the surgical device/instrument  235  may comprise an end effector, including a temperature sensor and the surgical hub  206 , and/or the cloud-based system may compare at least one temperature detected by the temperature sensor (e.g., during a tissue-sealing portion of a surgical procedure) to a stored temperature and/or a range of temperatures expected and/or associated with that surgical procedure to detect an inadequate/low sealing temperature. In another aspect, an endoscope  239  may take snapshots during a surgical procedure. In such an aspect, an imaging module  238  may compare the snapshots to stored images and/or images downloaded from the cloud-based system  205  that convey tissue correctly sealed at expected temperatures to detect evidence of an improper/insufficient sealing temperature (e.g., charring, oozing/bleeding). Further, in such an aspect, the imaging module  238  may analyze the snapshots themselves to detect evidence of an improper/insufficient sealing temperature (e.g., charring, oozing/bleeding). In one alternative aspect, the surgical hub  206  may communicate the snapshots to the cloud-based system  205 , and a component of the cloud-based system  205  may perform the various imaging module functions described above to detect evidence of an improper/insufficient sealing temperature and to report the detection to the surgical hub  206 . According to the various aspects described above, in response to the detected and/or identified failure event, the surgical hub  206  may download a program from the cloud-based system  205  for execution by the surgical device/instrument  235  that corrects the detected issue (i.e., program that alters surgical device/instrument parameters to prevent misfired staples, program that alters surgical device/instrument parameters to ensure correct sealing temperature). 
     In some aspects, a failure event is deemed to cover a certain time period, and all surgical data associated with that certain time period can be deemed to be associated with the failure event. 
     After the surgical data associated with the failure event has been identified, the identified surgical data (e.g., failure event surgical data) can be separated or isolated from all of the other surgical data associated with the surgical procedure (e.g., non-failure event surgical data). The separation can be realized, for example, by tagging or flagging the identified surgical data, by storing the identified surgical data apart from all of the other surgical data associated with the surgical procedure, or by storing only the other surgical data while continuing to process the identified surgical data for subsequent prioritized communication to the cloud-based system 205. According to various aspects, the tagging or flagging of the identified surgical data can occur during the communication process when the datagram is generated as described in more detail below. 
     The time-stamping of all of the surgical data (e.g., either before or after the surgical data is received at the surgical hub) can be utilized by a component of the surgical hub 206 to chronologize the identified surgical data associated with the failure event. The component of the surgical hub  206  which utilizes the time-stamping to chronologize the identified surgical data can be, for example, the processor module  232 , the processor  244  of the computer system  210 , and/or combinations thereof. By chronologizing the identified surgical data, the cloud-based system  205  and/or other interested parties can subsequently better understand the conditions which were present leading up to the occurrence of the failure event and possibly pinpoint the exact cause of the failure event, thereby providing the knowledge to potentially mitigate a similar failure event from occurring during a similar surgical procedure performed at a future date. 
     Once the identified surgical data has been chronologized, the chronologized surgical data may be encrypted in a manner similar to that described above with respect to the encryption of the generator data. Thus, the identified surgical data can be encrypted to help ensure the confidentiality of the identified surgical data, either while it is being stored at the surgical hub  206  or while it is being transmitted to the cloud-based system  205  using the Internet or other computer networks. According to various aspects, a component of the surgical hub  206  utilizes an encryption algorithm to convert the identified surgical data from a readable version to an encoded version, thereby forming the encrypted surgical data associated with the failure event (e.g.,  FIGS.  25 - 27   ). The component of the surgical hub which utilizes the encryption algorithm can be, for example, the processor module  232 , the processor  244  of the computer system  210 , and/or combinations thereof. The utilized encryption algorithm can be a symmetric encryption algorithm or an asymmetric encryption algorithm. 
     After the identified surgical data has been encrypted, a component of the surgical hub can communicate the encrypted surgical data associated with the failure event (e.g., encrypted failure event surgical data) to the cloud-based system  205 . The component of the surgical hub which communicates the encrypted surgical data to the cloud-based system  205  can be, for example, the processor module  232 , a hub/switch  207 / 209  of the modular communication hub  203 , the router  211  of the modular communication hub  203 , or the communication module  247  of the computer system  210 . According to various aspects, the communication of the encrypted surgical data (e.g., encrypted failure event surgical data) through the Internet can follow an IP which: (1) defines datagrams that encapsulate the encrypted surgical data to be delivered, and (2) defines addressing methods that are used to label the datagram with source and destination information. The datagram can be similar to the datagram shown in  FIG.  29    or the datagram shown in  FIG.  30   , but can be different in that either the header or the payload of the datagram can include a field which includes a flag or a tag which identifies the encrypted surgical data (e.g., encrypted failure event surgical data) as being prioritized relative to other non-prioritized surgical data (e.g., encrypted non-failure event surgical data). An example of such a datagram is shown in  FIG.  32   , where the payload  3864  of the datagram  3860  includes a field which indicates (e.g., a prioritized designation  3834 ) that the payload  3864  includes prioritized surgical data (e.g., combination generator data  3868 ). According to various aspects, the payload  3864  of the datagram  3860  can also include non-flagged/non-tagged/non-prioritized surgical data  3836  (e.g., other surgical data  3874 ) as shown in  FIG.  32   . 
     According to various aspects, prior to the identified surgical data (e.g., failure event surgical data) being encrypted, the identified surgical data can be compressed (if not already compressed by the source(s) of the relevant surgical data). The compression allows for a smaller representation of the surgical data associated with the failure event to be subsequently encrypted and communicated to the cloud-based system  205 . For the compression, a component of the surgical hub  206  can utilize a compression algorithm to convert a representation of the identified surgical data to a smaller representation of the identified surgical data, thereby allowing for a more efficient and economical encryption of the identified surgical data (less data to encrypt utilizes less processing resources) and a more efficient and economical communication of the encrypted surgical data (smaller representations of the surgical data within the payload of the datagrams allow for more identified surgical data to be included in a given datagram, for more identified surgical data to be communicated within a given time period, and/or for identified surgical data to be communicated with fewer communication resources). The component of the surgical hub  206  which utilizes the compression algorithm can be, for example, the processor module  232 , the processor  244  of the computer system  210 , and/or combinations thereof. The utilized compression algorithm can be a lossless compression algorithm or a lossy compression algorithm. 
     In instances where other non-prioritized surgical data (e.g., non-failure event surgical data) is to be communicated with prioritized surgical data (e.g., failure event surgical data), the other non-prioritized surgical data can be time-stamped, compressed, and/or encrypted in a manner identical to or different from that described above regarding the surgical data identified as associated with a failure event (e.g., failure event surgical data), and the surgical hub  206  may be programmed/configured to generate a datagram which includes both the encrypted prioritized surgical data (e.g., encrypted failure event surgical data) and the encrypted other non-prioritized surgical data (e.g., encrypted non-failure event surgical data). For example, in light of  FIG.  32   , the payload  3864  of the datagram  3860  may be divided into two or more distinct payload data portions (e.g., one for the prioritized surgical data  3834 , one for the non-prioritized surgical data  3836 ), with each portion having an identifying bit (e.g., generator data (GD)  3866 , other data (OD)  3872 ), the associated encrypted data (e.g., encrypted prioritized surgical data  3868 , encrypted non-prioritized surgical data  3874 ), and the associated padding  3870 ,  3876 , if needed, respectively. Further, similar to  FIG.  30   , the header  3862  may be the same as (e.g., IP address source  3878 , IP address destination  3880 , header length  3882 ) or different from the header  3782  described with reference to the datagram  3780  shown in  FIG.  29   . For example, the header  3862  may be different in that the header  3862  further includes a field designating the number of payload data portions  3884  (e.g., 2) included in the payload  3864  of the datagram  3860 . The header  3862  can also be different in that it can include fields designating the payload length  3886 ,  3890  and the checksum value  3888 ,  2892  for each payload data portion  3834 ,  3836 , respectively. Although only two payload data portions are shown in  FIG.  32   , it will be appreciated that the payload  3864  of the datagram  3860  may include any quantity/number of payload data portions (e.g., 1, 2, 3, 4, 5), where each payload data portion includes data associated with a different aspect of the surgical procedure. The datagram  3860  can then be communicated from the surgical hub  206  through the Internet to the cloud-based system  205  following an IP which: (1) defines datagrams that encapsulate the encrypted generator data and the encrypted stripped/other data to be delivered, and (2) defines addressing methods that are used to label the datagram with source and destination information. 
     In some aspects, once a failure event associated with a surgical procedure has been identified, the surgical hub  206  and/or the cloud-based system  205  can subsequently flag or tag a surgical device/instrument  235  which was utilized during the surgical procedure for inoperability and/or removal. For example, in one aspect, information (e.g., serial number, ID) associated with the surgical device/instrument  235  and stored at the surgical hub  206  and/or the cloud-based system  205  can be utilized to effectively block the surgical device/instrument  235  from being used again (e.g., blacklisted). In another aspect, information (e.g., serial number, ID) associated with the surgical device/instrument can initiate the printing of a shipping slip and shipping instructions for returning the surgical device/instrument  235  back to a manufacturer or other designated party so that a thorough analysis/inspection of the surgical device/instrument  235  can be performed (e.g., to determine the cause of the failure). According to various aspects described herein, once the cause of a failure is determined (e.g., via the surgical hub  206  and/or the cloud-based system  205 ), the surgical hub  206  may download a program from the cloud-based system  205  for execution by the surgical device/instrument  235  that corrects the determined cause of the failure (i.e., program that alters surgical device/instrument parameters to prevent the failure from occurring again). 
     According to some aspects, the surgical hub  206  and/or the cloud-based system  205  can also provide/display a reminder (e.g., via hub display  215  and/or surgical device/instrument display  237 ) to administrators, staff, and/or other personnel to physically remove the surgical device/instrument  235  from the operating room (e.g., if detected as still present in the operating room) and/or to send the surgical device/instrument  235  to the manufacturer or the other designated party. In one aspect, the reminder may be set up to be provided/displayed periodically until an administrator can remove the flag or tag of the surgical device/instrument  235  from the surgical hub  206  and/or the cloud-based system  205 . According to various aspects, an administrator may remove the flag or tag once the administrator can confirm (e.g., system tracking of the surgical device/instrument  235  via its serial number/ID) that the surgical device/instrument  235  has been received by the manufacturer or the other designated party. By using the above-described method to flag and/or track surgical data associated with a failure event, a closed loop control of the surgical data associated with the failure event and/or with a surgical device/instrument  235  can be realized. Additionally, in view of the above, it will be appreciated that the surgical hub  206  can be utilized to effectively manage the utilization (or non-utilization) of surgical devices/instruments  235  which have or potentially could be utilized during a surgical procedure. 
     In various aspects of the present disclosure, the surgical hub  206  and/or cloud-based system  205  may want to control which components (e.g., surgical device/instrument  235 , energy device  241 ) are being utilized in its interactive surgical system  100 / 200  to perform surgical procedures (e.g., to minimize future failure events, to avoid the use of unauthorized or knock-off components). 
     As such, in various aspects of the present disclosure, since an interactive surgical system  100  may comprise a plurality of surgical hubs  106 , a cloud-based system  105  and/or each surgical hub  106  of the interactive surgical system  100  may want to track component-surgical hub combinations utilized over time. In one aspect, upon/after a component (See  FIG.  9   , e.g., surgical device/instrument  235 , energy device  241 ) is connected to/used with a particular surgical hub  106  (e.g., surgical device/instrument  235  wired/wirelessly connected to the particular surgical hub  106 , energy device  241  connected to the particular surgical hub  106  via generator module  240 ), the particular surgical hub  106  may communicate a record/block of that connection/use (e.g., linking respective unique identifiers of the connected devices) to the cloud-based system  105  and/or to the other surgical hubs  106  in the interactive surgical system  100 . For example, upon/after the connection/use of an energy device  241 , a particular surgical hub  106  may communicate a record/block (e.g., linking a unique identifier of the energy device  241  to a unique identifier of a generator module  240  to a unique identifier of the particular surgical hub  106 ) to the cloud-based system  105  and/or other surgical hubs  106  in the interactive surgical system  100 . In such an aspect, if this is the first time the component (e.g., energy device) is connected to/used with a surgical hub  106  in the interactive surgical system  100 , the cloud-based system  105  and/or each surgical hub  106  of the interactive surgical system  100  may store the record/block as a genesis record/block. In such an aspect, the genesis record/block stored at the cloud-based system  105  and/or each surgical hub  106  may comprise a time stamp. However, in such an aspect, if this is not the first time the component (e.g., energy device  241 ) has been connected to/used with a surgical hub  106  in the interactive surgical system  100 , the cloud-based system  105  and/or each surgical hub  106  of the interactive surgical system may store the record/block as a new record/block in a chain of record/blocks associated with the component. In such an aspect, the new record/block may comprise a cryptographic hash of the most recently communicated record/block stored at the cloud-based system  105  and/or each surgical hub  106 , the communicated linkage data, and a time stamp. In such an aspect, each cryptographic hash links each new record/block (e.g., each use of the component) to its prior record/block to form a chain confirming the integrity of each prior record/block(s) back to an original genesis record/block (e.g., first use of the component). According to such an aspect, this blockchain of records/blocks may be developed at the cloud-based system  105  and/or each surgical hub  106  of the interactive surgical system  100  to permanently and verifiably tie usage of a particular component to one or more than one surgical hub  106  in the interactive surgical system  100  over time. Here, according to another aspect, this approach may be similarly applied to subcomponents (e.g., handle, shaft, end effector, cartridge) of a component when/after the component is connected to/used with a particular surgical hub  106  of an interactive surgical system  100 . 
     According to various aspects of the present disclosure, the cloud-based system  105  and/or each surgical hub  106  may utilize such records/blocks to trace usage of a particular component and/or a sub-component back to its initial usage in the interactive surgical system  100 . For example, if a particular component (e.g., surgical device/instrument  235 ) is flagged/tagged as related to a failure event, the cloud-based system  105  and/or a surgical hub  106  may analyze such records/blocks to determine whether past usage of that component and/or a sub-component of that component contributed to or caused the failure event (e.g., overused). In one example, the cloud-based system  105  may determine that a sub-component (e.g., end effector) of that component may actually be contributing/causing the failure event and then tag/flag that component for inoperability and/or removal based on the determination. 
     According to another aspect, the cloud-based system  205  and/or surgical hub  206  may control which components (e.g., surgical device/instrument  235 , energy device  241 ) are being utilized in an interactive surgical system  200  to perform surgical procedures by authenticating the component and/or its supplier/manufacturer. In one aspect, the supplier/manufacturer of a component may associate a serial number and a source ID with the component. In such an aspect, the supplier/manufacturer may create/generate a private key for the serial number, encrypt the serial number with the private key, and store the encrypted serial number and the source ID on an electronic chip (e.g., memory) in the component prior to shipment to a surgical site. Here, upon/after connection of the component to a surgical hub  206 , the surgical hub  206  may read the encrypted serial number and the source ID from the electronic chip. In response, the surgical hub  206  may send a message (i.e., comprising the encrypted serial number) to a server of the supplier/manufacturer associated with the source ID (e.g., directly or via the cloud-based system  205 ). In such an aspect, the surgical hub  206  may encrypt the message using a public key associated with that supplier/manufacturer. In response, the surgical hub  206  may receive a message (i.e., comprising the private key the supplier/manufacturer generated for/associated with that encrypted serial number) from the supplier/manufacturer server (e.g., directly or via the cloud-based system  205 ). In such an aspect, the supplier/manufacturer server may encrypt the message using a public key associated with the surgical hub  206 . Further, in such an aspect, the surgical hub  206  may then decrypt the message (e.g., using a private key paired to the public key used to encrypt the message) to reveal the private key associated with the encrypted serial number. The surgical hub  206  may then decrypt the encrypted serial number, using that private key, to reveal the serial number. Further, in such an aspect, the surgical hub  206  may then compare the decrypted serial number to a comprehensive list of authorized serial numbers (e.g., stored at the surgical hub  206  and/or the cloud-based system and/or downloaded from the cloud-based system, e.g., received separately from the supplier/manufacturer) and permit use of the connected component if the decrypted serial number matches an authorized serial number. Initially, such a process permits the surgical hub  206  to authenticate the supplier/manufacturer. In particular, the surgical hub  206  encrypted the message comprising the encrypted serial number using a public key associated with the supplier/manufacturer. As such, receiving a response message (i.e., comprising the private key) authenticates the supplier/manufacturer to the surgical hub  206  (i.e., otherwise the supplier/manufacturer would not have access to the private key paired to the public key used by the surgical hub  206  to encrypt the message, and the supplier/manufacturer would not have been able to associate the encrypted serial number received in the message to its already generated private key). Furthermore, such a process permits the surgical hub  206  to authenticate the connected component/device itself. In particular, the supplier/manufacturer (e.g., just authenticated) encrypted the serial number of the component using the delivered private key. Upon secure receipt of the private key, the surgical hub  206  is able to decrypt the encrypted serial number (i.e., read from the connected component), which authenticates the component and/or its association with the supplier/manufacturer (i.e., only that private key as received from that supplier/manufacturer would decrypt the encrypted serial number). Nonetheless, the surgical hub  206  further verifies the component as authentic (e.g., compares the decrypted serial number to a comprehensive list of authorized serial numbers received separately from the supplier/manufacturer). Notably, such aspects as described above can alternatively be performed by the cloud-based system  205  and/or a combination of the cloud-based system  205  and the surgical hub  206  to control which components (e.g., surgical device/instrument  235 , energy device  241 ) are being utilized in an interactive surgical system  200  (e.g., to perform surgical procedures) by authenticating the component and/or its supplier/manufacturer. In one aspect, such described approaches may prevent the use of knock-off component(s) within the interactive surgical system  200  and ensure the safety and well-being of surgical patients. 
     According to another aspect, the electronic chip of a component (e.g., surgical device/instrument  235 , energy device  241 ) may store (e.g., in memory) data associated with usage of that component (i.e., usage data, e.g., number of uses with a limited use device, number of uses remaining, firing algorithms executed, designation as a single-use component). In such an aspect, the surgical hub  206  and/or the cloud-based system  205 , upon/after connection of the component to the interactive surgical system, may read such usage data from the memory of a component and write back at least a portion of that usage data for storage (e.g., in memory  249 ) at the surgical hub  206  and/or for storage at the cloud-based system  205  (e.g., individually and/or under a blockchain approach discussed herein). According to such an aspect, the surgical hub  206  and/or the cloud-based system  205 , upon/after a subsequent connection of that component to the interactive surgical system, may again read such usage data and compare that usage to previously stored usage data. Here, if a discrepancy exists or if a predetermined/authorized usage has been met, the surgical hub  206  and/or the cloud-based system  205  may prevent use of that component (e.g., blacklisted, rendered inoperable, flagged for removal) on the interactive surgical system  200 . In various aspects, such an approach prevents bypass of the encryption chip systems. If the component’s electronic chip/memory has been tampered with (e.g., memory reset, number of uses altered, firing algorithms altered, single-use device designated as a multi-use device), a discrepancy will exist, and the component’s use will be controlled/prevented. 
     Additional details are disclosed in U.S. Pat. Application Publication No. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, which published on Mar. 30, 2017, which is incorporated herein by reference in its entirety. 
     Surgical Hub Coordination of Device Pairing in an Operating Room 
     One of the functions of the surgical hub  106  is to pair (also referred to herein as “connect” or “couple”) with other components of the surgical system  102  to control, gather information from, or coordinate interactions between the components of the surgical system  102 . Since the operating rooms of a hospital are likely in close physical proximity to one another, a surgical hub  106  of a surgical system  102  may unknowingly pair with components of a surgical system  102  in a neighboring operating room, which would significantly interfere with the functions of the surgical hub  106 . For example, the surgical hub  106  may unintentionally activate a surgical instrument in a different operating room or record information from a different ongoing surgical procedure in a neighboring operating room. 
     Aspects of the present disclosure present a solution, wherein a surgical hub  106  only pairs with detected devices of the surgical system  102  that are located within the bounds of its operating room. 
     Furthermore, the surgical hub  106  relies on its knowledge of the location of other components of the surgical system  102  within its operating room in making decisions about, for example, which surgical instruments should be paired with one another or activated. A change in the position of the surgical hub  106  or another component of the surgical system  102  can be problematic. 
     Aspects of the present disclosure further present a solution wherein the surgical hub  106  is configured to reevaluate or redetermine the bounds of its operating room upon detecting that the surgical hub  106  has been moved. Aspects of the present disclosure further present a solution wherein the surgical hub  106  is configured to redetermine the bounds of its operating room upon detection of a potential device of the surgical system  102 , which can be an indication that the surgical hub  106  has been moved. 
     In various aspects, a surgical hub  106  is used with a surgical system  102  in a surgical procedure performed in an operating room. The surgical hub  106  comprises a control circuit configured to determine the bounds of the operating room, determine devices of the surgical system  102  located within the bounds of the operating room, and pair the surgical hub  106  with the devices of the surgical system  102  located within the bounds of the operating room. 
     In one aspect, the control circuit is configured to determine the bounds of the operating room after activation of the surgical hub  106 . In one aspect, the surgical hub  106  includes a communication circuit configured to detect and pair with the devices of the surgical system located within the bounds of the operating room. In one aspect, the control circuit is configured to redetermine the bounds of the operating room after a potential device of the surgical system  102  is detected. In one aspect, the control circuit is configured to periodically determine the bounds of the operating room. 
     In one aspect, the surgical hub  106  comprises an operating room mapping circuit that includes a plurality of non-contact sensors configured to measure the bounds of the operating room. 
     In various aspects, the surgical hub  106  includes a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to pair the surgical hub with devices of the surgical system  102  located within the bounds of the operating room, as described above. In various aspects, the present disclosure provides a non-transitory computer-readable medium storing computer-readable instructions which, when executed, cause a machine to pair the surgical hub  106  with devices of the surgical system  102  located within the bounds of the operating room, as described above. 
       FIGS.  35  and  36    are logic flow diagrams of processes depicting control programs or logic configurations for pairing the surgical hub  106  with devices of the surgical system  102  located within the bounds of the operating room, as described above. 
     The surgical hub  106  performs a wide range of functions that requires short- and long-range communication, such as assisting in a surgical procedure, coordinating between devices of the surgical system  102 , and gathering and transmitting data to the cloud  104 . To properly perform its functions, the surgical hub  106  is equipped with a communication module  130  capable of short-range communication with other devices of the surgical system  102 . The communication module  130  is also capable of long-range communication with the cloud  104 . 
     The surgical hub  106  is also equipped with an operating-room mapping module  133  which is capable of identifying the bounds of an operating room, and identifying devices of the surgical system  102  within the operating room. The surgical hub  106  is configured to identify the bounds of an operating room, and only pair with or connect to potential devices of the surgical system  102  that are detected within the operating room. 
     In one aspect, the pairing comprises establishing a communication link or pathway. In another aspect, the pairing comprises establishing a control link or pathway. 
     An initial mapping or evaluation of the bounds of the operating room takes place during an initial activation of the surgical hub  106 . Furthermore, the surgical hub  106  is configured to maintain spatial awareness during operation by periodically mapping its operating room, which can be helpful in determining if the surgical hub  106  has been moved. The reevaluation  3017  can be performed periodically or it can be triggered by an event such as observing a change in the devices of the surgical system  102  that are deemed within the operating room. In one aspect, the change is detection  3010  of a new device that was not previously deemed as within the bounds of the operating room, as illustrated in  FIG.  37   . In another aspect, the change is a disappearance, disconnection, or un-pairing of a paired device that was previously deemed as residing within the operating room, as illustrated in  FIG.  38   . The surgical hub  106  may continuously monitor  3035  the connection with paired devices to detect  3034  the disappearance, disconnection, or un-pairing of a paired device. 
     In other aspects, reevaluation triggering events can be, for example, changes in surgeons’ positions, instrument exchanges, or sensing of a new set of tasks being performed by the surgical hub  106 . 
     In one aspect, the evaluation of the bounds of the room by the surgical hub  106  is accomplished by activation of a sensor array of the operating-room mapping module  133  within the surgical hub  106  which enables it to detect the walls of the operating room. 
     Other components of the surgical system  102  can be made to be spatially aware in the same, or a similar, manner as the surgical hub  106 . For example, a robotic hub  122  may also be equipped with an operating-room mapping module  133 . 
     The spatial awareness of the surgical hub  106  and its ability to map an operating room for potential components of the surgical system  102  allows the surgical hub  106  to make autonomous decisions about whether to include or exclude such potential components as part of the surgical system  102 , which relieves the surgical staff from dealing with such tasks. Furthermore, the surgical hub  106  is configured to make inferences about, for example, the type of surgical procedure to be performed in the operating room based on information gathered prior to, during, and/or after the performance of the surgical procedure. Examples of gathered information include the types of devices that are brought into the operating room, time of introduction of such devices into the operating room, and/or the devices sequence of activation. 
     In one aspect, the surgical hub  106  employs the operating-room mapping module  133  to determine the bounds of the surgical theater (e.g., a fixed, mobile, or temporary operating room or space) using either ultrasonic or laser non-contact measurement devices. 
     Referring to  FIG.  34   , ultrasound based non-contact sensors  3002  can be employed to scan the operating theater by transmitting a burst of ultrasound and receiving the echo when it bounces off a perimeter wall  3006  of an operating theater to determine the size of the operating theater and to adjust Bluetooth pairing distance limits. In one example, the non-contact sensors  3002  can be Ping ultrasonic distance sensors, as illustrated in  FIG.  34   . 
       FIG.  34    shows how an ultrasonic sensor  3002  sends a brief chirp with its ultrasonic speaker  3003  and makes it possible for a micro-controller  3004  of the operating-room mapping module  133  to measure how long the echo takes to return to the ultrasonic sensor’s ultrasonic microphone  3005 . The micro-controller  3004  has to send the ultrasonic sensor  3002  a pulse to begin the measurement. The ultrasonic sensor  3002  then waits long enough for the micro-controller program to start a pulse input command. Then, at about the same time the ultrasonic sensor  3002  chirps a 40 kHz tone, it sends a high signal to the micro-controller  3004 . When the ultrasonic sensor  3002  detects the echo with its ultrasonic microphone  3005 , it changes that high signal back to low. The micro-controller’s pulse input command measures the time between the high and low changes and stores its measurement in a variable. This value can be used along with the speed of sound in air to calculate the distance between the surgical hub  106  and the operating-room wall  3006 . 
     In one example, as illustrated in  FIG.  33   , a surgical hub  106  can be equipped with four ultrasonic sensors  3002 , wherein each of the four ultrasonic sensors is configured to assess the distance between the surgical hub  106  and a wall of the operating room  3000 . A surgical hub  106  can be equipped with more or less than four ultrasonic sensors  3002  to determine the bounds of an operating room. 
     Other distance sensors can be employed by the operating-room mapping module  133  to determine the bounds of an operating room. In one example, the operating-room mapping module  133  can be equipped with one or more photoelectric sensors that can be employed to assess the bounds of an operating room. In one example, suitable laser distance sensors can also be employed to assess the bounds of an operating room. Laser-based non-contact sensors may scan the operating theater by transmitting laser light pulses, receiving laser light pulses that bounce off the perimeter walls of the operating theater, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating theater and to adjust Bluetooth pairing distance limits. 
     Referring to the top left corner of  FIG.  33   , a surgical hub  106  is brought into an operating room  3000 . The surgical hub  106  is activated at the beginning of the set-up that occurs prior to the surgical procedure. In the example of  FIG.  33   , the set-up starts at an actual time of 11:31:14 (EST) based on a real-time clock. However, at the stated procedure set-up start time, the surgical hub  106  starts  3001  an artificial randomized real-time clock timing scheme at artificial real time 07:36:00 to protect private patient information. 
     At artificial real time 07:36:01, the operating-room mapping module  133  employs the ultrasonic distance sensors to ultrasonically ping the room (e.g., sends out a burst of ultrasound and listens for the echo when it bounces off the perimeter walls of the operating room as described above) to verify the size of the operating room and to adjust pairing distance limits. 
     At artificial real time 07:36:03, the data is stripped and time-stamped. At artificial real time 07:36:05, the surgical hub  106  begins pairing devices located only within the operating room  3000  as verified using ultrasonic distance sensors  3002  of the operating-room mapping module  133 . The top right corner of  FIG.  33    illustrates several example devices that are within the bounds of the operating room  3000  and are paired with the surgical hub  106 , including a secondary display device  3020 , a secondary hub  3021 , a common interface device  3022 , a powered stapler  3023 , a video tower module  3024 , and a powered handheld dissector  3025 . On the other hand, secondary hub  3021 ′, secondary display device  3020 ′, and powered stapler  3026  are all outside the bounds of the operating room  3000  and, accordingly, are not paired with the surgical hub  106 . 
     In addition to establishing a communication link with the devices of the surgical system  102  that are within the operating room, the surgical hub  106  also assigns a unique identification and communication sequence or number to each of the devices. The unique sequence may include the device’s name and a time stamp of when the communication was first established. Other suitable device information may also be incorporated into the unique sequence of the device. 
     As illustrated in the top left corner of  FIG.  33   , the surgical hub  106  has determined that the operating room  3000  bounds are at distances a, -a, b, and -b from the surgical hub  106 . Since Device “D” is outside the determined bounds of its operating room  3000 , the surgical hub  106  will not pair with the Device “D.”  FIG.  35    is an example algorithm illustrating how the surgical hub  106  only pairs with devices within the bounds of its operating room. After activation, the surgical hub  106  determines  3007  bounds of the operating room using the operating-room mapping module  133 , as described above. After the initial determination, the surgical hub  106  continuously searches for or detects  3008  devices within a pairing range. If a device is detected  3010 , the surgical hub  106  then determines  3011  whether the detected device is within the bounds of the operating room. The surgical hub  106  pairs  3012  with the device if it is determined that the device is within the bounds of the operating room. In certain instances, the surgical hub  106  will also assign  3013  an identifier to the device. If, however, the surgical hub  106  determines that the detected device is outside the bounds of the operating room, the surgical hub  106  will ignore  3014  the device. 
     Referring to  FIG.  36   , after an initial determination of the bounds of the room, and after an initial pairing of devices located within such bounds, the surgical hub  106  continues to detect  3015  new devices that become available for pairing. If a new device is detected  3016 , the surgical hub  106  is configured to reevaluate  3017  the bounds of the operating room prior to pairing with the new device. If the new device is determined  3018  to be within the newly determined bounds of the operating room, then the surgical hub  106  pairs with the device  3019  and assigns  3030  a unique identifier to the new device. If, however, the surgical hub  106  determines that the new device is outside the newly determined bounds of the operating room, the surgical hub  106  will ignore  3031  the device. 
     For pairing, the operating-room mapping module  133  contains a compass and integrated Bluetooth transceiver. Other communication mechanisms, which are not significantly affected by the hospital environment or geographical location, can be employed. Bluetooth Low Energy (BLE) beacon technology can currently achieve indoor distance measurements with accuracy of about 1-2 meters, with improved accuracy in closer proximities (within 0-6 meters). To improve the accuracy of the distance measurements, a compass is used with the BLE. The operating-room mapping module  133  utilizes the BLE and the compass to determine where modules are located in relation to the patient. For example, two modules facing each other (detected by compass) with greater than one meter distance between them may clearly indicate that the modules are on opposite sides of the patient. The more “Hub”-enabled modules that reside in the operating room, the greater the achievable accuracy becomes due to triangulation techniques. 
     In the situations where multiple surgical hubs  106 , modules, and/or other peripherals are present in the same operating room, as illustrated in the top right corner of  FIG.  33   , the operating-room mapping module  133  is configured to map the physical location of each module that resides within the operating room. This information could be used by the user interface to display a virtual map of the room, enabling the user to more easily identify which modules are present and enabled, as well as their current status. In one aspect, the mapping data collected by surgical hubs  106  are uploaded to the cloud  104 , where the data are analyzed for identifying how an operating room is physically setup, for example. 
     The surgical hub  106  is configured to determine a device’s location by assessing transmission radio signal strength and direction. For Bluetooth protocols, the Received Signal Strength Indication (RSSI) is a measurement of the received radio signal strength. In one aspect, the devices of the surgical system  102  can be equipped with USB Bluetooth dongles. The surgical hub  106  may scan the USB Bluetooth beacons to get distance information. In another aspect, multiple high-gain antennas on a Bluetooth access point with variable attenuators can produce more accurate results than RSSI measurements. In one aspect, the hub is configured to determine the location of a device by measuring the signal strength from multiple antennas. Alternatively, in some examples, the surgical hub  106  can be equipped with one or more motion sensor devices configured to detect a change in the position of the surgical hub  106 . 
     Referring to the bottom left corner of  FIG.  33   , the surgical hub  106  has been moved from its original position, which is depicted in dashed lines, to a new position closer to the device “D,” which is still outside the bounds of the operating room  3000 . The surgical hub  106  in its new position, and based on the previously determined bounds of the operating room, would naturally conclude that the device “D” is a potential component of the surgical system  102 . However, the introduction of a new device is a triggering event for reevaluation  3017  of the bounds of the operating room, as illustrated in the example algorithm of  FIGS.  35 ,  37   . After performing the reevaluation, the surgical hub  106  determines that the operating room bounds have changed. Based on the new bounds, at distances a new , -a new , b new , and -b new , the surgical hub  106  concludes that it has been moved and that the Device “D” is outside the newly determined bounds of its operating room. Accordingly, the surgical hub  106  will still not pair with the Device “D.” 
     In one aspect, one or more of the processes depicted in  FIGS.  35 - 39    can be executed by a control circuit of a surgical hub  106 , as depicted in  FIG.  10    (processor  244 ). In another aspect, one or more of the processes depicted in  FIGS.  35 - 39    can be executed by a cloud computing system  104 , as depicted in  FIG.  1   . In yet another aspect, one or more of the processes depicted in  FIGS.  35 - 39    can be executed by at least one of the aforementioned cloud computing systems  104  and/or a control circuit of a surgical hub  106  in combination with a control circuit of a modular device, such as the microcontroller  461  of the surgical instrument depicted in  FIG.  12   , the microcontroller  620  of the surgical instrument depicted in  FIG.  16   , the control circuit  710  of the robotic surgical instrument  700  depicted in  FIG.  17   , the control circuit  760  of the surgical instruments  750 ,  790  depicted in  FIGS.  18 - 19   , or the controller  838  of the generator  800  depicted in  FIG.  20   . 
     Spatial Awareness of Surgical Hubs in Operating Rooms 
     During a surgical procedure, a surgical instrument such as an ultrasonic or an RF surgical instrument can be coupled to a generator module  140  of the surgical hub  106 . In addition, a separate surgical instrument controller such as a foot, or hand, switch or activation device can be used by an operator of the surgical instrument to activate the energy flow from the generator to the surgical instrument. Multiple surgical instrument controllers and multiple surgical instruments can be used concurrently in an operating room. Pressing or activating the wrong surgical instrument controller can lead to undesirable consequences. Aspects of the present disclosure present a solution in which the surgical hub  106  coordinates the pairing of surgical instrument controllers and surgical instruments to ensure patient and operator safety. 
     Aspects of the present disclosure are presented for a surgical hub  106  configured to establish and sever pairings between components of the surgical system  102  within the bounds of the operating room to coordinate flow of information and control actions between such components. The surgical hub  106  can be configured to establish a pairing between a surgical instrument controller and a surgical instrument that reside within the bounds of an operating room of surgical hub  106 . 
     In various aspects, the surgical hub  106  can be configured to establish and sever pairings between components of the surgical system  102  based on operator request or situational and/or spatial awareness. The hub situational awareness is described in greater detail below in connection with  FIG.  86   . 
     Aspects of the present disclosure are presented for a surgical hub for use with a surgical system in a surgical procedure performed in an operating room. The surgical hub includes a control circuit that selectively forms and severs pairings between devices of the surgical system. In one aspect, the hub includes a control circuit is configured to pair the hub with a first device of the surgical system, assign a first identifier to the first device, pair the hub with a second device of the surgical system, assign a second identifier to the second device, and selectively pair the first device with the second device. In one aspect, the surgical hub includes a storage medium, wherein the control circuit is configured to store a record indicative of the pairing between the first device and the second device in the storage medium. In one aspect, the pairing between the first device and the second device defines a communication pathway therebetween. In one aspect, the pairing between the first device and the second device defines a control pathway for transmitting control actions from the second device to the first device. 
     Further to the above, in one aspect, the control circuit is further configured to pair the hub with a third device of the surgical system, assign a third identifier to the third device, sever the pairing between the first device and the second device, and selectively pair the first device with the third device. In one aspect, the control circuit is further configured to store a record indicative of the pairing between the first device and the third device in the storage medium. In one aspect, the pairing between the first device and the third device defines a communication pathway therebetween. In one aspect, the pairing between the first device and the third device defines a control pathway for transmitting control actions from the third device to the first device. 
     In various aspects, the surgical hub includes a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to selectively form and sever pairings between the devices of the surgical system, as described above. In various aspects, the present disclosure provides a non-transitory computer-readable medium storing computer-readable instructions which, when executed, cause a machine to selectively form and sever pairings between the devices of the surgical system, as described above.  FIGS.  40  and  41    are logic flow diagrams of processes depicting control programs or logic configurations for selectively forming and severing pairings between the devices of the surgical system, as described above. 
     In one aspect, the surgical hub  106  establishes a first pairing with a surgical instrument and a second pairing with the surgical instrument controller. The surgical hub  106  then links the pairings together allowing the surgical instrument and the surgical instrument controller to operate with one another. In another aspect, the surgical hub  106  may sever an existing communication link between a surgical instrument and a surgical instrument controller, then link the surgical instrument to another surgical instrument controller that is linked to the surgical hub  106 . 
     In one aspect, the surgical instrument controller is paired to two sources. First, the surgical instrument controller is paired to the surgical hub  106 , which includes the generator module  140 , for control of its activation. Second, the surgical instrument controller is also paired to a specific surgical instrument to prevent inadvertent activation of the wrong surgical instrument. 
     Referring to  FIGS.  40  and  42   , the surgical hub  106  may cause the communication module  130  to pair  3100  or establish a first communication link  3101  with a first device  3102  of the surgical system  102 , which can be a first surgical instrument. Then, the hub may assign  3104  a first identification number to the first device  3102 . This is a unique identification and communication sequence or number that may include the device’s name and a time stamp of when the communication was first established. 
     In addition, the surgical hub  106  may then cause the communication module  130  to pair  3106  or establish a second communication link  3107  with a second device  3108  of the surgical system  102 , which can be a surgical instrument controller. The surgical hub  106  then assigns  3110  a second identification number to the second device  3108 . 
     In various aspects, the steps of pairing a surgical hub  106  with a device may include detecting the presence of a new device, determining that the new device is within bounds of the operating room, as described above in greater detail, and only pairing with the new device if the new device is located within the bounds of the operating room. 
     The surgical hub  106  may then pair  3112  or authorize a communication link  3114  to be established between the first device  3102  and the second device  3108 , as illustrated in  FIG.  42   . A record indicative of the communication link  3114  is stored by the surgical hub  106  in the storage array  134 . In one aspect, the communication link  3114  is established through the surgical hub  106 . In another aspect, as illustrated in  FIG.  42   , the communication link  3114  is a direct link between the first device  3102  and the second device  3108 . 
     Referring to  FIGS.  41  and  43   , the surgical hub  106  may then detect and pair  3120  or establish a third communication link  3124  with a third device  3116  of the surgical system  102 , which can be another surgical instrument controller, for example. The surgical hub  106  may then assign  3126  a third identification number to the third device  3116 . 
     In certain aspects, as illustrated in  FIG.  43   , the surgical hub  106  may then pair  3130  or authorize a communication link  3118  to be established between the first device  3102  and the third device  3116 , while causing the communication link  3114  to be severed  3128 , as illustrated in  FIG.  43   . A record indicative of the formation of the communication link  3118  and severing of the communication link  3114  is stored by the surgical hub  106  in the storage array  134 . In one aspect, the communication link  3118  is established through the surgical hub  106 . In another aspect, as illustrated in  FIG.  43   , the communication link  3118  is a direct link between the first device  3102  and the third device  3116 . 
     As described above, the surgical hub  106  can manage an indirect communication between devices of the surgical system  102 . For example, in situations where the first device  3102  is a surgical instrument and the second device  3108  is a surgical instrument controller, an output of the surgical instrument controller can be transmitted through the communication link  3107  to the surgical hub  106 , which may then transmit the output to the surgical instrument through the communication link  3101 . 
     In making a decision to connect or sever a connection between devices of the surgical system  102 , the surgical hub  106  may rely on perioperative data received or generated by the surgical hub  106 . Perioperative data includes operator input, hub-situational awareness, hub-spatial awareness, and/or cloud data. For example, a request can be transmitted to the surgical hub  106  from an operator user-interface to assign a surgical instrument controller to a surgical instrument. If the surgical hub  106  determines that the surgical instrument controller is already connected to another surgical instrument, the surgical hub  106  may sever the connection and establish a new connection per the operator’s request. 
     In certain examples, the surgical hub  106  may establish a first communication link between the visualization system  108  and the primary display  119  to transmit an image, or other information, from the visualization system  108 , which resides outside the sterile field, to the primary display  119 , which is located within the sterile field. The surgical hub  106  may then sever the first communication link and establish a second communication link between a robotic hub  122  and the primary display  119  to transmit another image, or other information, from the robotic hub  122  to the primary display  119 , for example. The ability of the surgical hub  106  to assign and reassign the primary display  119  to different components of the surgical system  102  allows the surgical hub  106  to manage the information flow within the operating room, particularly between components inside the sterile field and outside the sterile field, without physically moving these components. 
     In another example that involves the hub-situational awareness, the surgical hub  106  may selectively connect or disconnect devices of the surgical system  102  within an operating room based on the type of surgical procedure being performed or based on a determination of an upcoming step of the surgical procedure that requires the devices to be connected or disconnected. The hub situational awareness is described in greater detail below in connection with  FIG.  86   . 
     Referring to  FIG.  44   , the surgical hub  106  may track  3140  the progression of surgical steps in a surgical procedure and may coordinate pairing and unpairing of the devices of the surgical system  102  based upon such progression. For example, the surgical hub  106  may determine that a first surgical step requires use of a first surgical instrument, while a second surgical step, occurring after completion of the first surgical step, requires use of a second surgical instrument. Accordingly, the surgical hub  106  may assign a surgical instrument controller to the first surgical instrument for the duration of the first surgical step. After detecting completion  3142  of the first surgical step, the surgical hub  106  may cause the communication link between the first surgical instrument and the surgical instrument controller to be severed  3144 . The surgical hub  106  may then assign the surgical instrument controller to the second surgical instrument by pairing  3146  or authorizing the establishment of a communication link between the surgical instrument controller and the second surgical instrument. 
     Various other examples of the hub-situational awareness, which can influence the decision to connect or disconnect devices of the surgical system  102 , are described in greater detail below in connection with  FIG.  86   . 
     In certain aspects, the surgical hub  106  may utilize its spatial awareness capabilities, as described in greater detail elsewhere herein, to track progression of the surgical steps of a surgical procedure and autonomously reassign a surgical instrument controller from one surgical instrument to another surgical instrument within the operating room of the surgical hub  106 . In one aspect, the surgical hub  106  uses Bluetooth pairing and compass information to determine the physical position of the components of the surgical system  102 . 
     In the example illustrated in  FIG.  2   , the surgical hub  106  is paired with a first surgical instrument held by a surgical operator at the operating table and a second surgical instrument positioned on a side tray. A surgical instrument controller can be selectively paired with either the first surgical instrument or the second surgical instrument. Utilizing the Bluetooth pairing and compass information, the surgical hub  106  autonomously assigns the surgical instrument controller to the first surgical instrument because of its proximity to the patient. 
     After completion of the surgical step that involved using the first surgical instrument, the first surgical instrument may be returned to the side tray or otherwise moved away from the patient. Detecting a change in the position of the first surgical instrument, the surgical hub  106  may sever the communication link between the first surgical instrument and the surgical instrument controller to protect against unintended activation of the first surgical instrument by the surgical instrument controller. The surgical hub  106  may also reassign the surgical instrument controller to another surgical instrument if the surgical hub  106  detects that it has been moved to a new position at the operating table. 
     In various aspects, devices of the surgical system  102  are equipped with an easy hand-off operation mode that would allow one user to give activation control of a device they currently control to another surgical instrument controller within reach of another operator. In one aspect, the devices are equipped to accomplish the hand-off through a predetermined activation sequence of the devices that causes the devices that are activated in the predetermined activation sequence to pair with one another. 
     In one aspect, the activation sequence is accomplished by powering on the devices to be paired with one another in a particular order. In another aspect, the activation sequence is accomplished by powering on the devices to be paired with one another within a predetermined time period. In one aspect, the activation sequence is accomplished by activating communication components, such as Bluetooth, of the devices to be paired with one another in a particular order. In another aspect, the activation sequence is accomplished by activating communication components, such as Bluetooth, of the devices to be paired within one another within a predetermined time period. 
     Alternatively, the hand-off can also be accomplished by a selection of a device through one of the surgical-operator input devices. After the selection is completed, the next activation by another controller would allow the new controller to take control. 
     In various aspects, the surgical hub  106  can be configured to directly identify components of the surgical system  102  as they are brought into an operating room. In one aspect, the devices of the surgical system  102  can be equipped with an identifier recognizable by the surgical hub  106 , such as, for example, a bar code or an RFID tag. NFC can also be employed. The surgical hub  106  can be equipped with a suitable reader or scanner for detecting the devices brought into the operating room. 
     The surgical hub  106  can also be configured to check and/or update various control programs of the devices of the surgical system  102 . Upon detecting and establishing a communication link of a device of the surgical system  102 , the surgical hub  106  may check if its control program is up to date. If the surgical hub  106  determines that a later version of the control program is available, the surgical hub  106  may download the latest version from the cloud  104  and may update the device to the latest version. The surgical hub  106  may issue a sequential identification and communication number to each paired or connected device. 
     Cooperative Utilization of Data Derived From Secondary Sources by Intelligent Surgical Hubs 
     In a surgical procedure, the attention of a surgical operator must be focused on the tasks at hand. Receiving information from multiple sources, such as, for example, multiple displays, although helpful, can also be distracting. The imaging module  138  of the surgical hub  106  is configured to intelligently gather, analyze, organize/package, and disseminate relevant information to the surgical operator in a manner that minimizes distractions. 
     Aspects of the present disclosure are presented for cooperative utilization of data derived from multiple sources, such as, for example, an imaging module  138  of the surgical hub  106 . In one aspect, the imaging module  138  is configured to overlay data derived from one or more sources onto a livestream destined for the primary display  119 , for example. In one aspect, the overlaid data can be derived from one or more frames acquired by the imaging module  138 . The imaging module  138  may commandeer image frames on their way for display on a local display such as, for example, the primary display  119 . The imaging module  138  also comprises an image processor that may preform an array of local image processing on the commandeered images. 
     Furthermore, a surgical procedure generally includes a number of surgical tasks which can be performed by one or more surgical instruments guided by a surgical operator or a surgical robot, for example. Success or failure of a surgical procedure depends on the success or failure of each of the surgical tasks. Without relevant data on the individual surgical tasks, determining the reason for a failed surgical procedure is a question of probability. 
     Aspects of the present disclosure are presented for capturing one or more frames of a livestream of a surgical procedure for further processing and/or pairing with other data. The frames may be captured at the completion of a surgical task (also referred to elsewhere herein as “surgical step”) to assess whether the surgical task was completed successfully. Furthermore, the frames, and the paired data, can be uploaded to the cloud for further analysis. 
     In one aspect, one or more captured images are used to identify at least one previously completed surgical task to evaluate the outcome of the surgical task. In one aspect, the surgical task is a tissue-stapling task. In another aspect, the surgical task is an advanced energy transection. 
       FIG.  45    is a logic flow diagram of a process  3210  depicting a control program or a logic configuration for overlaying information derived from one or more still frames of a livestream of a remote surgical site onto the livestream. The process  3210  includes receiving  3212  a livestream of a remote surgical site from a medical imaging device  124 , for example, capturing  3214  at least one image frame of a surgical step of the surgical procedure from the livestream, deriving  3216  information relevant to the surgical step from data extracted from the at least one image frame, and overlaying  3218  the information onto the livestream. 
     In one aspect, the still frames can be of a surgical step performed at the remote surgical site. The still frames can be analyzed for information regarding completion of the surgical step. In one aspect, the surgical step comprises stapling tissue at the surgical site. In another aspect, the surgical task comprises applying energy to tissue at the surgical site. 
       FIG.  46    is a logic flow diagram of a process  3220  depicting a control program or a logic configuration for differentiating among surgical steps of a surgical procedure. The process  3220  includes receiving  3222  a livestream of a surgical site from a medical imaging device  124 , for example, capturing  3224  at least one first image frame of a first surgical step of the surgical procedure from the livestream, deriving  3226  information relevant to the first surgical step from data extracted from the at least one image frame, capturing  3228  at least one second image frame of a second surgical step of the surgical procedure from the livestream, and differentiating  3229  among the first surgical step and the second surgical step based on the at least one first image frame and the at least one second image frame. 
       FIG.  47    is a logic flow diagram of a process  3230  depicting a control program or a logic configuration for differentiating among surgical steps of a surgical procedure. The process  3232  includes receiving  3232  a livestream of the surgical site from a medical imaging device  124 , for example, capturing  3234  image frames of the surgical steps of the surgical procedure from the livestream and differentiating  3236  among the surgical steps based on data extracted from the image frames. 
       FIG.  48    is a logic flow diagram of a process  3240  depicting a control program or a logic configuration for identifying a staple cartridge from information derived from one or more still frames of staples deployed from the staple cartridge into tissue. The process  3240  includes receiving  3242  a livestream of the surgical site from medical imaging device  124 , for example, capturing  3244  an image frame from the livestream, detecting  3246  a staple pattern in the image frame, wherein the staple pattern is defined by staples deployed from a staple cartridge into tissue at the surgical site. The process  3240  further includes identifying  3248  the staple cartridge based on the staple pattern. 
     In various aspects, one or more of the steps of the processes  3210 ,  3220 ,  3230 ,  3240  can be executed by a control circuit of an imaging module of a surgical hub, as depicted in  FIGS.  3 ,  9 ,  10   . In certain examples, the control circuit may include a processor and a memory coupled to the processor, wherein the memory stores instructions executable by the processor to perform one or more of the steps of the processes  3210 ,  3220 ,  3230 ,  3240 . In certain examples, a non-transitory computer-readable medium stores computer-readable instructions which, when executed, cause a machine to perform one or more of the steps of the processes  3210 ,  3220 ,  3230 ,  3240 . For economy, the following description of the processes  3210 ,  3220 ,  3230 ,  3240  will be described as being executed by the control circuit of an imaging module of a surgical hub; however, it should be understood that the execution of the processes  3210 ,  3220 ,  3230 ,  3240  can be accomplished by any of the aforementioned examples. 
     Referring to  FIGS.  34  and  49   , a surgical hub  106  is in communication with a medical imaging device  124  located at a remote surgical site during a surgical procedure. The imaging module  138  receives a livestream of the remote surgical site transmitted by the imaging device  124  to a primary display  119 , for example, in accordance with steps  3212 ,  3222 ,  3232 ,  3242 . 
     Further to the above, the imaging module  138  of the surgical hub  106  includes a frame grabber  3200 . The frame grabber  3200  is configured to capture (i.e., “grabs”) individual, digital still frames from the livestream transmitted by the imaging device  124 , for example, to a primary display  119 , for example, during a surgical procedure, in accordance with steps  3214 ,  3224 ,  3234 ,  3244 . The captured still frames are stored and processed by a computer platform  3203  ( FIG.  49   ) of the imaging module  138  to derive information about the surgical procedure. Processing of the captured frames may include performance of simple operations, such as histogram calculations, 2D filtering, and arithmetic operations on arrays of pixels to the performance of more complex tasks, such as object detection, 3D filtering, and the like. 
     In one aspect, the derived information can be overlaid onto the livestream. In one aspect, the still frames and/or the information resulting from processing the still frames can be communicated to a cloud  104  for data aggregation and further analysis. 
     In various aspects, the frame grabber  3200  may include a digital video decoder and a memory for storing the acquired still frames, such as, for example, a frame buffer. The frame grabber  3200  may also include a bus interface through which a processor can control the acquisition and access the data and a general purpose I/O for triggering image acquisition or controlling external equipment. 
     As described above, the imaging device  124  can be in the form of an endoscope, including a camera and a light source positioned at a remote surgical site, and configured to provide a livestream of the remote surgical site at the primary display  119 , for example. 
     In various aspects, image recognition algorithms can be implemented to identify features or objects in still frames of a surgical site that are captured by the frame grabber  3200 . Useful information pertaining to the surgical steps associated with the captured frames can be derived from the identified features. For example, identification of staples in the captured frames indicates that a tissue-stapling surgical step has been performed at the surgical site. The type, color, arrangement, and size of the identified staples can also be used to derive useful information regarding the staple cartridge and the surgical instrument employed to deploy the staples. As described above, such information can be overlaid on a livestream directed to a primary display  119  in the operating room. 
     The image recognition algorithms can be performed at least in part locally by the computer platform  3203  ( FIG.  49   ) of the imaging module  138 . In certain instances, the image recognition algorithms can be performed at least in part by the processor module  132  of the surgical hub  106 . An image database can be utilized in performance of the image recognition algorithms and can be stored in a memory  3202  of the computer platform  3203 . Alternatively, the imaging database can be stored in the storage array  134  ( FIG.  3   ) of the surgical hub  106 . The image database can be updated from the cloud  104 . 
     An example image recognition algorithm that can be executed by the computer platform  3203  may include a key points-based comparison and a region-based color comparison. The algorithm includes: receiving an input at a processing device, such as, for example, the computer platform  3203 ; the input, including data related to a still frame of a remote surgical site; performing a retrieving step, including retrieving an image from an image database and, until the image is either accepted or rejected, designating the image as a candidate image; performing an image recognition step, including using the processing device to perform an image recognition algorithm on the still frame and candidate images in order to obtain an image recognition algorithm output; and performing a comparison step, including: if the image recognition algorithm output is within a pre-selected range, accepting the candidate image as the still frame and if the image recognition algorithm output is not within the pre-selected range, rejecting the candidate image and repeating the retrieving, image recognition, and comparison steps. 
     Referring to  FIGS.  50 - 52   , in one example, a surgical step involves stapling and cutting tissue.  FIG.  50    depicts a still frame  3250  of a stapled and cut tissue T. A staple deployment  3252  includes staples  3252 ′,  3252 ″ from a first staple cartridge. A second staple deployment  3254  includes staples  3254 ′,  3254 ″ from a second staple cartridge. A proximal portion  3253  of the staple deployment  3252  overlaps with a distal portion  3255  of the staple deployment  3254 . Six rows of staples were deployed in each deployment. Tissue T was cut between the third and fourth rows of each deployment, but only one side of the stapled tissue T is fully shown. 
     In various aspects, the imaging module  138  identifies one or more of the staples  3252 ′,  3252 ″,  3254 ′,  3254 ″ in the still frame  3250 , which were absent in a previous still frame captured by the frame grabber  3200 . The imaging module  138  then concludes that a surgical stapling and cutting instrument has been used at the surgical site. 
     In the example of  FIG.  50   , the staple deployment  3252  includes two different staples  3252 ′,  3252 ″. Likewise, the staple deployment  3254  includes two different staples  3254 ′,  3254 ″. For brevity, the following description focuses on the staples  3252 ′,  3252 ″, but is equally applicable to the staples  3254 ′,  3254 ″. The staples  3252 ′,  3252 ″ are arranged in a predetermined pattern or sequence that forms a unique identifier corresponding to the staple cartridge that housed the staples  3252 ′,  3252 ″. The unique pattern can be in a single row or multiple rows of the staples  3250 . In one example, the unique pattern can be achieved by alternating the staples  3252 ′,  3252 ″ at a predetermined arrangement. 
     In one aspect, multiple patterns can be detected in a firing of staples. Each pattern can be associated with a unique characteristic of the staples, the staple cartridge that housed the staples, and/or the surgical instrument that was employed to fire the staple. For example, a firing of staples may include patterns that represent staple form, staple size, and/or location of the firing. 
     In the example, of  FIG.  50   , the imaging module  138  may identify a unique pattern of the staples  3252  from the still frame  3250 . A database storing staple patterns and corresponding identification numbers of staple cartridges can then be explored to determine an identification number of a staple cartridge that housed the staples  3252 . 
     The patterns of the example of  FIG.  50    are based on only two different staples; however, other aspects may include three or more different staples. The different staples can be coated with different coatings, which can be applied to the staples by one or more of the following methods: anodizing, dying, electro-coating, photoluminescent coating, application of nitrides, methyl methacylate, painting, powder coating, coating with paraffins, oil stains or phosphor coatings, the use of hydroxyapatite, polymers, titanium oxinitrides, zinc sulfides, carbides, etc. It should be noted that, while the listed coatings are fairly specific as disclosed herein, other coatings known in the art to distinguish the staple are within the contemplated scope of the present disclosure. 
     In the example of  FIGS.  50 - 52   , the staples  3252 ′ are anodized staples, while the staples  3252 ″ are non-anodized staples. In one aspect, the different staples may comprise two or more different colors. Different metal staples may comprise magnetic or radioactive staple markers that differentiate them from unmarked staples. 
       FIG.  51    illustrates a staple deployment  3272  deployed into tissue from a staple cartridge via a surgical instrument. Only three staple rows  3272   a ,  3272   b ,  3272   c  are depicted in  FIG.  51   . The rows  3272   a ,  3272   b ,  3272   c  are arranged between a medial line, where the tissue was cut, and a lateral line at the tissue edge. For clarity, the inner row  3272   a  of staples is redrawn separately to the left and the outer two rows  3272   b ,  3272   c  are redrawn separately to the right. A proximal end  3273  and a distal end portion of the staple deployment  3272  are also redrawn in  FIG.  51    for clarity. 
     The staple deployment  3272  includes two different staples  3272 ′,  3272 ″ that are arranged in predetermined patterns that serve various functions. For example, the inner row  3272   a  comprises a pattern of alternating staples  3272 ′,  3272 ″, which defines a metric for distance measurements in the surgical field. In other words, the pattern of the inner row  3272   a  acts as a ruler for measuring distances, which can be helpful in accurately determining the position of a leak, for example. The outer rows  3272   b ,  3272   c  define a pattern that represents an identification number of the staple cartridge that housed the staples  3272 ′,  3272 ″. 
     Furthermore, unique patterns at the ends of the staple deployment  3272  identify the proximal end portion  3273  and distal end portion  3275 . In the example of  FIG.  51   , a unique arrangement of three staples  3272 ″ identifies the distal end  3275 , while a unique arrangement of four staples  3272 ″ identifies the proximal end  3273 . Identification of the proximal and distal ends of a staple deployment allows the imaging module  128  to distinguish between different staple deployments within a captured frame, which can be useful in pointing the source of a leak, for example. 
     In various aspects, the imaging module  138  may detect a sealed tissue in a still frame of a remote surgical site captured by the frame grabber  3200 . Detection of the sealed tissue can be indicative of a surgical step that involves applying therapeutic energy to tissue. 
     Sealing tissue can be accomplished by the application of energy, such as electrical energy, for example, to tissue captured or clamped within an end effector of a surgical instrument in order to cause thermal effects within the tissue. Various mono-polar and bi-polar RF surgical instruments and harmonic surgical instruments have been developed for such purposes. In general, the delivery of energy to captured tissue can elevate the temperature of the tissue and, as a result, the energy can at least partially denature proteins within the tissue. Such proteins, like collagen, for example, can be denatured into a proteinaceous amalgam that intermixes and fuses, or seals, together as the proteins renature. 
     Accordingly, sealed tissue has a distinct color and/or shape that can be detected by the imaging module  138  using image recognition algorithms, for example. In addition, smoke detection at the surgical site can indicate that therapeutic energy application to the tissue is in progress. 
     Further to the above, the imaging module  138  of the surgical hub  106  is capable of differentiating between surgical steps of a surgical procedure based on the captured frames. As described above, a still frame that comprises fired staples is indicative of a surgical step involving tissue stapling, while a still frame that comprises a sealed tissue is indicative of a surgical step involving energy application to tissue. 
     In one aspect, the surgical hub  106  may selectively overlay information relevant to a previously completed surgical task onto the livestream. For example, the overlaid information may comprise image data from a still frame of the surgical site captured during the previously completed surgical task. Furthermore, guided by common landmark locations at the surgical site, the imaging module  138  can interlace one image frame to another to establish and detect surgical locations and relationship data of a previously completed surgical task. 
     In one example, the surgical hub  106  is configured to overlay information regarding a potential leak in a tissue treated by stapling or application of therapeutic energy in a previously completed surgical task. The potential leak can be spotted by the imaging module  138  during the processing of a still frame of the tissue. The surgical operator can be alerted about the leak by overlaying information about the potential leak onto the livestream. 
     In various aspects, still frames of an end effector of a surgical instrument at a surgical site can be used to identify the surgical instrument. For example, the end effector may include an identification number that can be recognized by the imaging module  138  during image processing of the still frame. Accordingly, the still frames captured by the imaging module  138  may be used to identify a surgical instrument utilized in a surgical step of a surgical procedure. The still frames may also include useful information regarding the performance of the surgical instrument. All such information can be uploaded to the cloud  104  for data aggregation and further analysis. 
     In various examples, the surgical hub  106  may also selectively overlay information relevant to a current or upcoming surgical task, such as an anatomical location or a surgical instrument suitable for the surgical task. 
     The imaging module  138  may employ various images and edge detection techniques to track a surgical site where a surgical instrument was used to complete a surgical task. Success or failure of the surgical task can then be assessed. For example, a surgical instrument can be employed to seal and/or cut tissue at the surgical site. A still frame of the surgical site can be stored in the memory  3202  or the storage array  134  of the surgical hub  106 , for example, upon completion of the surgical task. 
     In the following surgical step, the quality of the seal can be tested via different mechanisms. To ensure that the testing is accurately applied to the treated tissue, the stored still frame of the surgical site is overlaid onto the livestream in search of a match. Once a match is found, the testing can take place. One or more additional still frames can be taken during the testing, which can be later analyzed by the imaging module  138  of the surgical hub  106 . The testing mechanisms include bubble detection, bleeding detection, dye detection (where a dye is employed at the surgical site), and/or burst stretch detection (where a localized strain is applied adjacent to an anastomosis site), for example. 
     The imaging module  138  may capture still frames of the response of the treated tissue to these tests, which can be stored in the memory  3202  or the storage array  134  of the surgical hub  106 , for example. The still frames can be stored alone or in combination with other data, such as, for example, data from the surgical instrument that performed the tissue treatment. The paired data can also be uploaded to the cloud  104  for additional analysis and/or pairing. 
     In various aspects, the still frames captured by the frame grabber  3200  can be processed locally, paired with other data, and can also be transmitted to the cloud  104 . The size of the processed and/or transmitted data will depend on the number of captured frames. In various aspects, the rate at which the frame grabber  3200  captures the still frames from the livestream can be varied in an effort to reduce the size of the data without sacrificing quality. 
     In one aspect, the frame-capturing rate may depend on the type of surgical task being performed. Certain surgical tasks may need a higher number of still frames than others for an evaluation of success or failure. The frame-capturing rate can be scalded to accommodate such needs. 
     In one aspect, the frame-capturing rate is dependent upon the detected motion of the imaging device  124 . In use, an imaging device  124  may target one surgical site for a period of time. Observing no or minor changes in the still frames captured while the imaging device  124  is not being moved, the imaging module  138  may reduce the frame-capturing rate of the frame grabber  3200 . If the situation changes, however, where frequent motion is detected, the imaging module  138  may respond by increasing the frame-capturing rate of the frame grabber  3200 . In other words, the imaging module  138  may be configured to correlate the frame-capturing rate of the frame grabber  3200  with the detected degree of motion of the imaging device  124 . 
     For additional efficiency, only portions of the still frames, where motion is detected, need to be stored, processed, and/or transmitted to the cloud  104 . The imaging module  138  can be configured to select the portions of the still frames where motion is detected. In one example, motion detection can be achieved by comparing a still frame to a previously captured still frame. If movement is detected, the imaging module  138  may cause the frame grabber  3200  to increase the frame-capturing rate, but only the portions where motion is detected are stored, processed, and/or transmitted to the cloud  104 . 
     In another aspect, the data size can be managed by scaling the resolution of the captured information based on the area of the screen where the focal point is or where end effectors are located, for example. The remainder of the screen could be captured at a lower resolution. 
     In one aspect, the corners of the screen and the edges could generally be captured at a lower resolution. The resolution, however, can be scalded up if an event of significance is observed. 
     During a surgical procedure, the surgical hub  106  can be connected to various operating-room monitoring devices, such as, for example, heart rate monitors and insufflation pumps. Data collected from these devices can improve the situational awareness of the surgical hub  106 . The hub situational awareness is described in greater detail below in connection with  FIG.  86   . 
     In one example, the surgical hub  106  can be configured to utilize patient data received from a heart rate monitor connected along with data regarding the location of the surgical site to assess proximity of the surgical site to sensory nerves. An increase in the patient’s heart rate, when combined with anatomical data indicating that the surgical site is in a region high in sensory nerves, can be construed as an indication of sensory nerve proximity. Anatomical data can be available to the surgical hub  106  through accessing patient records (e.g., an EMR database containing patient records). 
     The surgical hub  106  may be configured to determine the type of surgical procedure being performed on a patient from data received from one or more of the operating-room monitoring devices, such as, for example, heart rate monitors and insufflation pumps. Abdominal surgical procedures generally require insufflation of the abdomen, while insufflation is not required in theoretic surgery. The surgical hub  106  can be configured to determine whether a surgical procedure is an abdominal or a thoracic surgical procedure by detecting whether the insufflation pump is active. In one aspect, the surgical hub  106  may be configured to monitor insufflation pressure on the output side of the insufflation pump in order to determine whether the surgical procedure being performed is one that requires insufflation. 
     The surgical hub  106  may also gather information from other secondary devices in the operating room to assess, for example, whether the surgical procedure is a vascular or avascular procedure. 
     The surgical hub  106  may also monitor AC current supply to one or more of its components to assess whether a component is active. In one example, the surgical hub  106  is configured to monitor AC current supply to the generator module to assess whether the generator is active, which can be an indication that the surgical procedure being performed is one that requires application of energy to seal tissue. 
     In various aspects, secondary devices in the operating room that are incapable of communication with the surgical hub  106  can be equipped with communication interface devices (communication modules) that can facilitate pairing of these devices with the surgical hub  106 . In one aspect, the communication interface devices may be configured to be bridging elements, which would allow them two-way communication between the surgical hub  106  and such devices. 
     In one aspect, the surgical hub  106  can be configured to control one or more operational parameters of a secondary device through a communication interface device. For example, the surgical hub  106  can be configured to increase or decrease the insufflation pressure through a communication interface device coupled to an insufflation device. 
     In one aspect, the communication interface device can be configured to engage with an interface port of the device. In another aspect, the communication interface device may comprise an overlay or other interface that directly interacts with a control panel of the secondary device. In other aspects, the secondary devices, such as, for example, the heart rate monitor and/or the insufflation devices, can be equipped with integrated communication modules that allow them to pair with the hub for two-way communication therewith. 
     In one aspect, the surgical hub  106  can also be connected through a communication interface device, for example, to muscle pads that are connected to the neuro-stim detection devices to improve resolution of a nerve-sensing device. 
     Furthermore, the surgical hub  106  can also be configured to manage operating room supplies. Different surgical procedures require different supplies. For example, two different surgical procedures may require different sets of surgical instruments. Certain surgical procedures may involve using a robotic system, while others may not. Furthermore, two different surgical procedures may require staple cartridges that are different in number, type, and/or size. Accordingly, the supplies brought into the operating room can provide clues as to the nature of the surgical procedure that will be performed. 
     In various aspects, the surgical hub  106  can be integrated with an operating room supplies scanner to identify items pulled into the operating room and introduced into the sterile field. The surgical hub  106  may utilize data from the operating room supplies scanner, along with data from the devices of the surgical system  102  that are paired with the surgical hub  106 , to autonomously determine the type of surgical procedure that will be performed. In one example, the surgical hub  106  may record a list of serial numbers of the smart cartridge that are going to be used in the surgical procedure. During the surgical procedure, the surgical hub  106  may gradually remove the staples that have been fired, based on information collected from the staple cartridge chips. In one aspect, the surgical hub  106  is configured to make sure that all the items are accounted for at the end of the procedure. 
     Surgical Hub Control Arrangements 
     In a surgical procedure, a second surgical hub may be brought into an operating room already under the control of a first surgical hub. The second surgical hub can be, for example, a surgical robotic hub brought into the operating room as a part of a robotic system. Without coordination between the first and second surgical hubs, the robotic surgical hub will attempt to pair with all the other components of the surgical system  102  that are within the operating room. The confusion arising from the competition between two hubs in a single operating room can lead to undesirable consequences. Also, sorting out the instrument distribution between the hubs during the surgical procedure can be time consuming. 
     Aspects of the present disclosure are presented for a surgical hub for use with a surgical system in a surgical procedure performed in an operating room. A control circuit of the surgical hub is configured to determine the bounds of the operating room and establish a control arrangement with a detected surgical hub located within the bounds of the operating room. 
     In one aspect, the control arrangement is a peer-to-peer arrangement. In another aspect, the control arrangement is a master-slave arrangement. In one aspect, the control circuit is configured to select one of a master mode of operation or a slave mode of operation in the master-slave arrangement. In one aspect, the control circuit is configured to surrender control of at least one surgical instrument to the detected surgical hub in the slave mode of operation. 
     In one aspect, the surgical hub includes an operating room mapping circuit that includes a plurality of non-contact sensors configured to measure the bounds of the operating room. 
     In various aspects, the surgical hub includes a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to coordinate a control arrangement between surgical hubs, as described above. In various aspects, the present disclosure provides a non-transitory computer-readable medium storing computer-readable instructions which, when executed, cause a machine to coordinate a control arrangement between surgical hubs, as described above. 
     Aspects of the present disclosure are presented for a surgical system comprising two independent surgical hubs that are configured to interact with one another. Each of the hubs has their own linked surgical devices and the control designation of and distribution of where data is recorded and processed. This interaction causes one or both hubs to change how they were behaving before the interaction. In one aspect, the change involves a redistribution of devices previously assigned to each of the hubs. In another aspect, the change involves establishing a master-slave arrangement between the hubs. In yet another aspect, the change can be a change in the location of the processing shared between the hubs. 
       FIG.  53    is a logic flow diagram of a process depicting a control program or a logic configuration for coordinating a control arrangement between surgical hubs. The process of  FIG.  53    is similar in many respects to the process of  FIG.  35    except that the process of  FIG.  53    addresses detection of a surgical hub by another surgical hub. As illustrated in  FIG.  53   , the surgical hub  106  determines  3007  the bounds of the operating room. After the initial determination, the surgical hub  106  continuously searches for or detects  3008  devices within a pairing range. If a device is detected  3010 , and if the detected device is located  3011  within the bounds of the operating room, the surgical hub  106  pairs  3012  with the device and assigns  3013  an identifier to the device. If through an initial interaction, as described below in greater detail, the surgical hub  106  determines  3039  that the device is another surgical hub, a control arrangement is established  3040  therebetween. 
     Referring to  FIG.  54   , a robotic surgical hub  3300  enters an operating room already occupied by a surgical hub  3300 . The robotic surgical hub  3310  and the surgical hub  3300  are similar in many respects to other surgical hubs described in greater detail elsewhere herein, such as, for example, the surgical hubs  106 . For example, the robotic surgical hub  3310  includes non-contact sensors configured to measure the bounds of the operating room, as described in greater detail elsewhere herein in connection with  FIGS.  33 ,  34   . 
     As the robotic surgical hub  3310  is powered up, it determines the bounds of the operating room and begins to pair with other components of the surgical system  102  that are located within the bounds of the operating room. The robotic surgical hub  3310  pairs with a robotic advanced energy tool  3311 , a robotic stapler  3312 , a monopolar energy tool  3313 , and a robotic visualization tower  3314 , which are all located within the bounds of the operating room. The surgical hub  3300  is already paired with a handheld stapler  3301 , a handheld powered dissector  3302 , a secondary display  3303 , a surgeon interface  3304 , and a visualization tower  3305 . Since the handheld stapler  3301 , the handheld powered dissector  3302 , the secondary display  3303 , the surgeon interface  3304 , and the visualization tower  3305  are already paired with the surgical hub  3300 , such devices cannot pair with another surgical hub without permission from the surgical hub  3300 . 
     Further to the above, the robotic surgical hub  3310  detects and/or is detected by the surgical hub  3300 . A communication link is established between the communication modules of the surgical hubs  3300 ,  3310 . The surgical hubs  3300 ,  3310  then determine the nature of their interaction by determining a control arrangement therebetween. In one aspect, the control arrangement can be a master-slave arrangement. In another aspect, the control arrangement can be a peer-to-peer arrangement. 
     In the example of  FIG.  54   , a master-slave arrangement is established. The surgical hubs  3300 ,  3310  request permission from a surgical operator for the robotic surgical hub  3310  to take control of the operating room from the surgical hub  3300 . The permission can be requested through a surgeon interface or console  3304 . Once permission is granted, the robotic surgical hub  3310  requests the surgical hub  3300  to transfer control to the robotic surgical hub  3310 . 
     Alternatively, the surgical hubs  3300 ,  3310  can negotiate the nature of their interaction without external input based on previously gathered data. For example, the surgical hubs  3300 ,  3310  may collectively determine that the next surgical task requires use of a robotic system. Such determination may cause the surgical hub  3300  to autonomously surrender control of the operating room to the robotic surgical hub  3310 . Upon completion of the surgical task, the robotic surgical hub  3310  may then autonomously return the control of the operating room to surgical hub  3300 . 
     The outcome of the interaction between the surgical hubs  3300 ,  3310  is illustrated on the right of  FIG.  54   . The surgical hub  3300  has transferred control to the robotic surgical hub  3310 , which has also taken control of the surgeon interface  3304  and the secondary display  3303  from the surgical hub  3300 . The robotic surgical hub  3310  assigns new identification numbers to the newly transferred devices. The surgical hub  3300  retains control the handheld stapler  3301 , the handheld powered dissector  3302 , and visualization tower  3305 . In addition, the surgical hub  3300  performs a supporting role, wherein the processing and storage capabilities of the surgical hub  3300  are now available to the robotic surgical hub  3310 . 
       FIG.  55    is a logic flow diagram of a process depicting a control program or a logic configuration for coordinating a control arrangement between surgical hubs. In various aspects, two independent surgical hubs will interact with one another in a predetermined manner to assess the nature of their relationship. In one example, after establishing  3321  a communication link, the surgical hubs exchange  3322  data packets. A data packet may include type, identification number, and/or status of a surgical hub. A data packet may further include a record of devices under control of the surgical hub and/or any limited communication connections, such as data ports for other secondary operating room devices. 
     The control arrangement between the surgical hubs is then determined  3323  based on input from a surgical operator or autonomously between the surgical hubs. The surgical hubs may store instructions as to how to determine a control arrangement therebetween. The control arrangement between two surgical hubs may depend on the type of surgical procedure being performed. The control arrangement between two surgical hubs may depend on their types, identification information, and/or status. The control arrangement between two surgical hubs may depend on the devices paired with the surgical hubs. The surgical hubs then redistribute  3324  the devices of the surgical system  102  therebetween based upon the determined control arrangement. 
     In the master-slave arrangement, the record communication can be unidirectional from the slave hub to the master hub. The master hub may also require the slave hub to hand-off some of its wireless devices to consolidate communication pathways. In one aspect, the slave hub can be relegated to a relay configuration with the master hub originating all commands and recording all data. The slave hub can remain linked to the master hub for a distributed sub-processing of the master hub commands, records, and/or controls. Such interaction expands the processing capacity of the dual linked hubs beyond the capabilities of the master hub by itself. 
     In a peer-to-peer arrangement, each surgical hub may retain control of its devices. In one aspect, the surgical hubs may cooperate in controlling a surgical instrument. In one aspect, an operator of the surgical instrument may designate the surgical hub that will control the surgical instrument at the time of its use. 
     Referring generally to  FIGS.  56 - 61   , the interaction between surgical hubs can be extended beyond the bounds of the operating room. In various aspects, surgical hubs in separate operating rooms may interact with one another within predefined limits. Depending on their relative proximity, surgical hubs in separate operating rooms may interact through any suitable wired or wireless data communication network such as Bluetooth and WiFi. As used here, a “data communication network” represents any number of physical, virtual, or logical components, including hardware, software, firmware, and/or processing logic configured to support data communication between an originating component and a destination component, where data communication is carried out in accordance with one or more designated communication protocols over one or more designated communication media. 
     In various aspects, a first surgical operator in a first operating room may wish to consult a second surgical operator in a second operating room, such as in case of an emergency. A temporary communication link may be established between the surgical hubs of the first and second operating room to facilitate the consult while the first and second surgical operators remain in their respective operating rooms. 
     The surgical operator being consulted can be presented with a consult request through the surgical hub in his/her operating room. If the surgical operator accepts, he/she will have access to all the data compiled by the surgical hub requesting the consult. The surgical operator may access all previously stored data, including a full history of the procedure. In addition, a livestream of the surgical site at the requesting operating room can be transmitted through the surgical hubs to a display at the receiving operating room. 
     When a consult request begins, the receiving surgical hub begins to record all received information in a temporarily storage location, which can be a dedicated portion of the storage array of the surgical hub. At the end of the consult, the temporary storage location is purged from all the information. In one aspect, during a consult, the surgical hub records all accessible data, including blood pressure, ventilation data, oxygen stats, generator settings and uses, and all patient electronic data. The recorded data will likely be more than the data stored by the surgical hub during normal operation, which is helpful in providing the surgical operator being consulted with as much information as possible for the consult. 
     Referring to  FIG.  56   , a non-limiting example of an interaction between surgical hubs in different operating rooms is depicted.  FIG.  56    depicts an operating room OR  1  that includes a surgical system  3400  supporting a thoracic segmentectomy and a second operating room OR  3  that includes a surgical system  3410  supporting a colorectal procedure. The surgical system  3400  includes surgical hub  3401 , surgical hub  3402 , and robotic surgical hub  3403 . The surgical system  3400  further includes a personal interface  3406 , a primary display  3408 , and secondary displays  3404 ,  3405 . The surgical system  3410  includes a surgical hub  3411  and a secondary display  3412 . For clarity, several components of the surgical systems  3400 ,  3410  are removed. 
     In the example of  FIG.  56   , the surgical operator of OR  3  is requesting a consult from the surgical operator of OR  1 . A surgical hub  3411  of the OR  3  transmits the consult request to one of the surgical hubs of the OR  1 , such as the surgical hub  3401 . In OR  1 , the surgical hub  3401  presents the request at a personal interface  3406  held by the surgical operator. The consult is regarding selecting an optimal location of a colon transection. The surgical operator of OR  1 , through a personal interface  3406 , recommends an optimal location for the transection site that avoids a highly vascular section of the colon. The recommendation is transmitted in real time through the surgical hubs  3401 ,  3411 . Accordingly, the surgical operator is able to respond to the consult request in real time without having to leave the sterile field of his own operating room. The surgical operator requesting the consult also did not have to leave the sterile field of OR  3 . 
     If the surgical hub  3401  is not in communication with the personal interface  3406 , it may relay the message to another surgical hub such as, for example, the surgical hub  3402  or the robotic surgical hub  3403 . Alternatively, the surgical hub  3401  may request control of the personal interface  3406  from another surgical hub. 
     In any event, if the surgical operator of OR  1  decides to accept the consult request, a livestream, or frames, of a surgical site  3413  of the colorectal procedure of OR  3  is transmitted to OR  1  through a connection established between the surgical hubs  3401 ,  3411 , for example.  FIG.  57    illustrates a livestream of the surgical site  3413  displayed on a secondary display of OR  3 . The surgical hubs  3401 ,  3411  cooperate to transmit the livestream of the surgical site of OR  3  to the personal interface  3406  of the OR  1 , as illustrated in  FIG.  58   . 
     Referring to  FIGS.  59 - 61   , the surgical operator may expand the laparoscopic livestream from OR  3  onto the primary display  3405  in OR  1 , for example, through the controls of the personal interface  3406 . The personal interface  3406  allows the surgical operator to select a destination for the livestream by presenting the surgical operator with icons that represent the displays that are available in OR  1 , as illustrated in  FIG.  60   . Other navigation controls  3407  are available to the surgical operator through the personal interface  3406 , as illustrated in  FIG.  61   . For example, the personal interface  3406  includes navigation controls for adjusting the livestream of the surgical site of OR  3  in OR  1  by the surgical operator moving his or her fingers on the livestream displayed on the personal interface  3406 . To visualize the high vasculature regions, the consulted surgical operator may change the view of the livestream from OR  3  through the personal interface  3406  to an advanced imaging screen. The surgical operator may then manipulate the image in multiple planes to see the vascularization using a wide-angle multispectral view, for example. 
     As illustrated in  FIG.  61   , the surgical operator also has access to an array of relevant information  3420 , such as, for example, heart rate, blood pressure, ventilation data, oxygen stats, generator settings and uses, and all patient electronic data of the patient in OR  3 . 
     Data Management and Collection 
     In one aspect the surgical hub provides data storage capabilities. The data storage includes creation and use of self-describing data including identification features, management of redundant data sets, and storage of the data in a manner of paired data sets which can be grouped by surgery but not necessarily keyed to actual surgical dates and surgeons to maintain data anonymity. The following description incorporates by reference all of the “hub” and “cloud” analytics system hardware and software processing techniques to implement the specific data management and collection techniques described hereinbelow, as incorporated by reference herein.  FIGS.  62 - 80    will be described in the context of the interactive surgical system  100  environment including a surgical hub  106 ,  206  described in connection  FIGS.  1 - 11    and intelligent instruments and generators described in connection with  FIGS.  12 - 21   . 
     Electronic Medical Record (EMR) Interaction 
       FIG.  62    is a diagram  4000  illustrating a technique for interacting with a patient Electronic Medical Record (EMR) database  4002 , according to one aspect of the present disclosure. In one aspect, the present disclosure provides a method of embedding a key  4004  within the EMR database  4002  located within the hospital or medical facility. A data barrier  4006  is provided to preserve patient data privacy and allows the reintegration of stripped and isolated data pairs, as described hereinbelow, from the surgical hub  106 ,  206  or the cloud  104 ,  204 , to be reassembled. A schematic diagram of the surgical hub  206  is described generally in  FIGS.  1 - 11    and in particular in  FIGS.  9 - 10   . Therefore, in the description of  FIG.  62   , the reader is guided to  FIGS.  1 - 11    and in particular  FIGS.  9 - 10    for any implementation details of the surgical hub  206  that may be omitted here for conciseness and clarity of disclosure. Returning to  FIG.  62   , the method allows the users full access to all the data collected during a surgical procedure and patient information stored in the form of electronic medical records  4012 . The reassembled data can be displayed on a monitor  4010  coupled to the surgical hub  206  or secondary monitors but is not permanently stored on any surgical hub storage device  248 . The reassembled data is temporarily stored in a storage device  248  located either in the surgical hub  206  or the cloud  204  and is deleted at the end of its use and overwritten to insure it cannot be recovered. The key  4004  in the EMR database  4002  is used to reintegrate anonymized hub data back into full integrated patient electronic medical records  4012  data. 
     As shown in  FIG.  62   , the EMR database  4002  is located within the hospital data barrier  4006 . The EMR database  4002  may be configured for storing, retrieving, and managing associative arrays, or other data structures known today as a dictionary or hash. Dictionaries contain a collection of obj ects, or records, which in turn have many different fields within them, each containing data. The patient electronic medical records  4012  may be stored and retrieved using a key  4004  that uniquely identifies the patient electronic medical record  4012 , and is used to quickly find the data within the EMR database  4002 . The key-value EMR database  4002  system treats the data as a single opaque collection which may have different fields for every record. 
     Information from the EMR database  4002  may be transmitted to the surgical hub  206  and the patient electronic medical records  4012  data is redacted and stripped before it is sent to an analytics system based either on the hub  206  or the cloud  204 . An anonymous data file  4016  is created by redacting personal patient data and stripping relevant patient data  4018  from the patient electronic medical record  4012 . As used herein, the redaction process includes deleting or removing personal patient information from the patient electronic medical record  4012  to create a redacted record that includes only anonymous patient data. A redacted record is a record from which sensitive patient information has been expunged. Un-redacted data may be deleted  4019 . The relevant patient data  4018  may be referred to herein as stripped/extracted data  4018 . The relevant patient data  4018  is used by the surgical hub  206  or cloud  204  processing engines for analytic purposes and may be stored on the storage device  248  of the surgical hub  206  or may be stored on the cloud  204  based analytics system storage device  205 . The surgical hub anonymous data file  4016  can be rebuilt using a key  4004  stored in the EMR database  4002  to reintegrate the surgical hub anonymous data file  4016  back into a fully integrated patient electronic medical record  4012 . The relevant patient data  4018  that is used in analytic processes may include information such as the patient’s diagnoses of emphysema, pre-operative treatment (e.g., chemotherapy, radiation, blood thinner, blood pressure medication, etc.), typical blood pressures, or any data that alone cannot be used to ascertain the identity of the patient. Data  4020  to be redacted includes personal information removed from the patient electronic medical record  4012 , may include age, employer, body mass index (BMI), or any data that can be used to ascertain the identify of the patient. The surgical hub  206  creates a unique anonymous procedure ID number (e.g., 380i4z), for example, as described in  FIG.  63   . Within the EMR database  4002  located in the hospital data barrier  4006 , the surgical hub  206  can reunite the data in the anonymous data file  4016  stored on the surgical hub  206  storage device  248  with the data in the patient electronic medical record  4012  stored on the EMR database  4002  for surgeon review. The surgical hub  206  displays the combined patient electronic medical record  4012  on a display or monitor  4010  coupled to the surgical hub  206 . Ultimately, un-redacted data is deleted  4019  from the surgical hub  206  storage  248 . 
     Creation of a Hospital Data Barrier, Inside Which the Data From Hubs Can be Compared Using Non-Anonymized Data and Outside Of Which the Data Has to be Stripped 
     In one aspect, the present disclosure provides a surgical hub  206  as described in  FIGS.  9  and  10   , for example, where the surgical hub  206  comprises a processor  244 ; and a memory  249  coupled to the processor  244 . The memory  249  stores instructions executable by the processor  244  to interrogate a surgical instrument  235 , retrieve a first data set from the surgical instrument  235 , interrogate a medical imaging device  238 , retrieve a second data set from the medical imaging device  238 , associate the first and second data sets by a key, and transmit the associated first and second data sets to a remote network, e.g., the cloud  204 , outside of the surgical hub  206 . The surgical instrument  235  is a first source of patient data and the first data set is associated with a surgical procedure. The medical imaging device  238  is a second source of patient data and the second data set is associated with an outcome of the surgical procedure. The first and second data records are uniquely identified by the key. 
     In another aspect, the surgical hub  206  provides a memory  249  storing instructions executable by the processor  244  to retrieve the first data set using the key, anonymize the first data set, retrieve the second data set using the key, anonymize the second data set, pair the anonymized first and second data sets, and determine success rate of surgical procedures grouped by the surgical procedure based on the anonymized paired first and second data sets. 
     In another aspect, the surgical hub  206  provides a memory  249  storing instructions executable by the processor  244  to retrieve the anonymized first data set, retrieve the anonymized second data set, and reintegrate the anonymized first and second data sets using the key. 
     In another aspect, the first and second data sets define first and second data payloads in respective first and second data packets. 
     In various aspects, the present disclosure provides a control circuit to associate the first and second data sets by a key as described above. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, causes a machine to associate the first and second data sets by a key as described above. 
     During a surgical procedure it would be desirable to monitor data associated with the surgical procedure to enable configuration and operation of instruments used during the procedure to improve surgical outcomes. The technical challenge is to retrieve the data in a manner that maintains the anonymity of the patient to maintain privacy of the data associated with the patient. The data may be used for conglomeration with other data without individualizing the data. 
     One solution provides a surgical hub  206  to interrogate an electronic medical records database  4002  for patient electronic medical records  4012  data, strip out desirable or relevant patient data  4018  from the patient electronic medical record  4012 , and redact any personal information that could be used to identify the patient. The redaction technique removes any information that could be used to correlate the stripped relevant patient data  4018  to a specific patient, surgery, or time. The surgical hub  206  and the instruments  235  coupled to the surgical hub  206  can then be configured and operated based on the stripped relevant patient data  4018 . 
     As disclosed in connection with  FIG.  62   , extracting (or stripping) relevant patient data  4018  from a patient electronic medical record  4012  while redacting any information that can be used to correlate the patient with the surgery or a scheduled time of the surgery enables the relevant patient data  4018  to be anonymized. The anonymous data file  4016  can then be sent to the cloud  204  for aggregation, processing, and manipulation. The anonymous data file  4016  can be used to configure the surgical instrument  235 , or any of the modules shown in  FIGS.  9  and  10    or the surgical hub  206  during the surgery based on the extracted anonymous data file  4016 . 
     In one aspect, a hospital data barrier  4006  is created such that inside the data barrier  4006  data from various surgical hubs  206  can be compared using non-anonymized un-redacted data and outside the data barrier  4006  data from various surgical hubs  206  are stripped to maintain anonymity and protect the privacy of the patient and the surgeon. This aspect is discussed further in connection with  FIG.  66   . 
     In one aspect, the data from a surgical hub  206  can be exchanged between surgical hubs  206  (e.g., hub-to-hub, switch-to-switch, or router-to-router) to provide in-hospital analysis and display of the data.  FIG.  1    shows an example of multiple hubs  106  in communication which each other and with the cloud  104 . This aspect also is discussed further in connection with  FIG.  66   . 
     In another aspect, an artificial time measure is substituted for a real time clock for all information stored internally within an instrument  235 , a robot located in a robot hub  222 , a surgical hub  206 , and/or hospital computer equipment. The anonymized data, which may include anonymized patient and surgeon data, is transmitted to the server  213  in the cloud  204  and it is stored in the cloud storage device  205  coupled to the server  213 . The substitution of an artificial real time clock enables anonymizing the patient data and surgeon data while maintaining data continuity. In one aspect, the instrument  235 , robot hub  222 , surgical hub  206 , and/or the cloud  204  are configured to obscure patient identification (ID) while maintaining data continuity. This aspect is discussed further in connection with  FIG.  63   . 
     Within the surgical hub  206 , a local decipher key  4004  allows information retrieved from the surgical hub  206  itself to reinstate the real-time information from the anonymized data set located in the anonymous data file  4016 . The data stored on the hub  206  or the cloud  204 , however, cannot be reinstated to real-time information from the anonymized data set in the anonymous data file  4016 . The key  4004  is held locally in the surgical hub  206  computer/storage device  248  in an encrypted format. The surgical hub  206  network processor ID is part of the decryption mechanism such that if the key  4004  and data is removed, the anonymized data set in the anonymous data file  4016  cannot be restored without being on the original surgical hub  206  computer/storage device  248 . 
     Substituting Artificial Time Measure For Real Time Clock For All Internally Stored Information And Sent to the Cloud As a Means to Anonymizing the Patient and Surgeon Data 
       FIG.  63    illustrates a process  4030  of anonymizing a surgical procedure by substituting an artificial time measure for a real time clock for all information stored internally within the instrument, robot, surgical hub, and/or hospital computer equipment, according to one aspect of the present disclosure. As shown in  FIG.  63   , the surgical procedure set-up start time  4032  was scheduled to begin at an actual time of 11:31:14 (EST) based on a real time clock. At the stated procedure set-up start time  4032 , the surgical hub  206  starts  4034  an artificial randomized real time clock timing scheme at artificial real time at 07:36:00. The surgical hub  206  then ultrasonically pings  4036  the operating theater (e.g., sends out a burst of ultrasound and listens for the echo when it bounces off the perimeter walls of an operating theater (e.g., a fixed, mobile, temporary, or field the operating room) as described in connection with  FIG.  64    to verify the size of the operating theater and to adjust short range wireless, e.g., Bluetooth, pairing distance limits at artificial real time 07:36:01. At artificial real time 07:36:03, the surgical hub  206  strips  4038  the relevant data and applies a time stamp to the stripped data. At artificial real time 07:36:05, the surgical hub  206  wakes up and begins pairing  4040  only devices located within the operating theater as verified using the ultrasonic pinging  4036  process. 
       FIG.  64    illustrates ultrasonic pinging of an operating room wall to determine a distance between a surgical hub and the operating room wall, in accordance with at least one aspect of the present disclosure. With reference also to  FIG.  2   , the spatial awareness of the surgical hub  206  and its ability to map an operating room for potential components of the surgical system allows the surgical hub  206  to make autonomous decisions about whether to include or exclude such potential components as part of the surgical system, which relieves the surgical staff from dealing with such tasks. Furthermore, the surgical hub  206  is configured to make inferences about, for example, the type of surgical procedure to be performed in the operating room based on information gathered prior to, during, and/or after the performance of the surgical procedure. Examples of gathered information include the types of devices that are brought into the operating room, time of introduction of such devices into the operating room, and/or the devices sequence of activation. 
     In one aspect, the surgical hub  206  employs the operating-room mapping module, such as, for example, the non-contact sensor module  242  to determine the bounds of the surgical theater (e.g., a fixed, mobile, or temporary operating room or space) using either ultrasonic or laser non-contact measurement devices. 
     Referring now to  FIG.  64   , ultrasound based non-contact sensors  3002  can be employed to scan the operating theater by transmitting a burst of ultrasound and receiving the echo when it bounces off a perimeter wall  3006  of an operating theater to determine the size of the operating theater and to adjust short range wireless, e.g., Bluetooth, pairing distance limits. In one example, the non-contact sensors  3002  can be Ping ultrasonic distance sensors, as illustrated in  FIG.  64   . 
       FIG.  64    shows how an ultrasonic sensor  3002  sends a brief chirp with its ultrasonic speaker  3003  and makes it possible for a micro-controller  3004  of the operating-room mapping module to measure how long the echo takes to return to the ultrasonic sensor’s ultrasonic microphone  3005 . The micro-controller  3004  has to send the ultrasonic sensor  3002  a pulse to begin the measurement. The ultrasonic sensor  3002  then waits long enough for the micro-controller program to start a pulse input command. Then, at about the same time the ultrasonic sensor  3002  chirps a 40 kHz tone, it sends a high signal to the micro-controller  3004 . When the ultrasonic sensor  3002  detects the echo with its ultrasonic microphone  3005 , it changes that high signal back to low. The micro-controller’s pulse input command measures the time between the high and low changes, and stores it measurement in a variable. This value can be used along with the speed of sound in air to calculate the distance between the surgical hub  106  and the operating-room wall  3006 . 
     In one example, a surgical hub  206  can be equipped with four ultrasonic sensors  3002 , wherein each of the four ultrasonic sensors is configured to assess the distance between the surgical hub  206  and a wall of the operating room  3000 . A surgical hub  206  can be equipped with more or less than four ultrasonic sensors  3002  to determine the bounds of an operating room. 
     Other distance sensors can be employed by the operating-room mapping module to determine the bounds of an operating room. In one example, the operating-room mapping module can be equipped with one or more photoelectric sensors that can be employed to assess the bounds of an operating room. In one example, suitable laser distance sensors can also be employed to assess the bounds of an operating room. Laser based non-contact sensors may scan the operating theater by transmitting laser light pulses, receiving laser light pulses that bounce off the perimeter walls of the operating theater, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating theater and to adjust short range wireless, e.g., Bluetooth, pairing distance limits. 
     Stripping Out Data From Images and Connected Smart Instrument Data to Allow Conglomeration But Not Individualization 
     In one aspect, the present disclosure provides a data stripping method which interrogates the electronic patient records provided, extracts the relevant portions to configure and operate the surgical hub and instruments coupled to the surgical hub, while anonymizing the surgery, patient, and all identifying parameters to maintain patient privacy. 
     With reference now back to  FIG.  63    and also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , once the size of the operating theater has been verified and Bluetooth pairing is complete, based on artificial real time, the computer processor  244  of the surgical hub  206  begins stripping  4038  data received from the modules coupled to the surgical hub  206 . In one example, the processor  244  begins stripping  4083  images received from the imaging module  238  and connected smart instruments  235 , for example. Stripping  4038  the data allows conglomeration of the data but not individualization of the data. This enables stripping  4038  the data identifier, linking the data, and monitoring an event while maintaining patient privacy by anonymizing the data. 
     With reference to  FIGS.  1 - 64   , in one aspect, a data stripping  4038  method is provided. In accordance with the data stripping  4038  method, the surgical hub  206  processor  244  interrogates the patient records stored in the surgical hub database  238  and extracts the relevant portions of the patient records to configure and operate the surgical hub  206  and its instruments  235 , robots, and other modular devices, e.g., modules. The data stripping  4038  method anonymizes the surgical procedure, patient, and all identifying parameters associated with the surgical procedure. Stripping  4038  the data on the fly ensures that at no time the data is correlated to a specific patient, surgical procedure, surgeon, time or other possible identifier that can be used to correlate the data. 
     The data may be stripped  4038  for compilation of the base information at a remote cloud  204  database storage device  205  coupled to the remote server  213 . The data stored in the database storage device  248  can be used in advanced cloud based analytics, as described in U.S. Provisional Pat. Application Serial No. 62/611,340, filed Dec. 28, 2017, titled CLOUD-BASED MEDICAL ANALYTICS, which is incorporated herein by reference in its entirety. A copy of the information with data links intact also can be stored into the patient EMR database  4002  ( FIG.  62   ). For example, the surgical hub  206  may import patient tissue irregularities or co-morbidities to add to an existing data set stored in the database  248 . The data may be stripped  4038  before the surgery and/or may be stripped  4038  as the data is transmitted to the cloud  204  database storage device  205  coupled to the remote server  213 . 
     With continued reference to  FIGS.  1 - 11  and  62 - 64   ,  FIG.  65    is a diagram  4050  depicting the process of importing patient electronic medical records  4012  containing surgical procedure and relevant patient data  4018  stored in the EMR database  4002 , stripping  4038  the relevant patient data  4018  from the imported medical records  4012 , and identifying  4060  smart device implications  4062 , or inferences, according to one aspect of the present disclosure. As shown in  FIG.  65   , the patient electronic medical records  4012 , containing information stored in the patient EMR database  4002 , are retrieved from the EMR database  4002 , imported into the surgical hub  206 , and stored in the surgical hub  206  storage device  248 . Un-redacted data is removed or deleted  4019  from the patient electronic medical records  4012  before they are stored in the surgical hub  206  storage device  248  as an anonymous data file  4016  ( FIG.  62   ). The relevant patient data  4018  is then stripped  4038  from the medical records  4012  to remove the desired relevant patient data  4018  and delete  4019  un-redacted data to maintain patient anonymity. In the illustrated example, the stripped data  4058  includes emphysema, high blood pressure, small lung cancer, warfarin/blood thinner, and/or radiation pretreatment. The stripped data  4058  is employed to identify  4060  smart device implications while maintaining patient anonymity as described hereinbelow. 
     Although the surgical procedure data and relevant patient data  4018  is described as being imported from patient electronic medical records  4012  stored in the EMR database  4002 , in various aspects, the surgical procedure data and relevant patient data  4018  may be retrieved from a modular device coupled to the surgical hub  206  before being stored in the EMR database  4002 . For example, the surgical hub  206  may interrogate the module to retrieve the surgical procedure data and relevant patient data  4018  from the module. As described herein, a module includes an imaging module  238  that is coupled to an endoscope  239 , a generator module  240  that is coupled to an energy device  241 , a smoke evacuator module  226 , a suction/irrigation module  228 , a communication module  230 , a processor module  232 , a storage array  234 , a smart device/instrument  235  optionally coupled to a display  237 , and a non-contact sensor module  242 , among other modules as illustrated in  FIGS.  3  and  8 - 10   . 
     For example, the anonymized stripped data  4058  may be employed to identify  4060  catastrophic failures of instruments, and other smart devices, and may initiate an automatic archive process and submission of data for further implications analysis. For example, the implication of detecting a counterfeit component or adapter on an original equipment manufacturer (OEM) device would be to initiate documentation of the component and recording of the results and outcome of its use. For example, the surgical hub  206  may execute situational awareness algorithms as described in connection  FIG.  86   . In one aspect, the surgical hub  206  may initially receive or identify a variety of implications  4062  that are derived from anonymized stripped data  4058 . The surgical hub  206  is configured to control the instruments  235 , or other modules, so that they operate correspondingly to the derived implications  4062 . In one example, the surgical hub  206  control logic identifies that (i) lung tissue may be more fragile than normal (e.g., due to emphysema), (ii) hemostasis issues are more likely (e.g., due to high blood pressure and/or the patient being on a blood thinner, such as warfarin), (iii) cancer may be more aggressive (e.g., due to the target of the procedure being a small cell lung cancer), and (iv) lung tissue may be stiffer and more prone to fracture (e.g., due to the patient having received a radiation pretreatment). The control logic or processor  244  of the surgical hub  206  then interprets how this data impacts the instruments  235 , or other modules, so that the instruments  235  are operated consistently with the data and then communicates the corresponding adjustments to each of the instruments  235 . 
     In one example relating to a stapler type of surgical instrument  235 , based on the implications  4062  identified  4060  from the anonymized stripped data  4058 , the control logic or processor  244  of the surgical hub  206  may (i) notify the stapler to adjust the compression rate threshold parameter, (ii) adjust the surgical hub  206  visualization threshold value to quantify the bleeding and internal parameters, (iii) notify the combo generator module  240  of the lung tissue and vessel tissue types so that the power and generator module  240  control algorithms are adjusted accordingly, (iv) notify the imaging module  238  of the aggressive cancer tag to adjust the margin ranges accordingly, (v) notify the stapler of the margin parameter adjustment needed (the margin parameter corresponds to the distance or amount of tissue around the cancer that will be excised), and (vi) notify the stapler that the tissue is potentially fragile. Furthermore, the anonymized stripped data  4058 , upon which the implications  4062  are based, is identified by the surgical hub  206  and is fed into the situational awareness algorithm (see  FIG.  86   ). Examples include, without limitations, thoracic lung resection, e.g., segmentectomy, among others. 
       FIG.  66    is a diagram  4070  illustrating the application of cloud based analytics to un-redacted data, stripped relevant patient data  4018 , and independent data pairs, according to one aspect of the present disclosure. As shown, multiple surgical hubs Hub #1  4072 , Hub #3  4074 , and Hub #4  4076  are located within the hospital data barrier  4006  (see also  FIG.  62   ). The un-redacted patient electronic medical record  4012  including patient data and surgery related data may be used and exchanged between the surgical hubs: Hub #1  4072 , Hub #3  4074 , and Hub #4  4076  located within the hospital data barrier  4006 . Prior to transmitting the un-redacted patient electronic medical record  4012  containing patient data and surgery related data outside the hospital data barrier  4006 , however, the patient electronic medical record  4012  patient data is redacted and stripped to create an anonymous data file  4016  containing anonymized information for further analysis and processing of the redacted/stripped data by a cloud based analytic processes in the cloud  204 . 
       FIG.  67    is a logic flow diagram  4080  of a process depicting a control program or a logic configuration for associating patient data sets from first and second sources of data, according to one aspect of the present disclosure. With reference to  FIG.  67    and with reference also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , in one aspect, the present disclosure provides a surgical hub  206 , comprising a processor  244 ; and a memory  249  coupled to the processor  244 . The memory  249  stores instructions executable by the processor  244  to interrogate  4082  a surgical instrument  235 , retrieve  4084  a first data set from the surgical instrument  235 , interrogate  4086  a medical imaging device  238 , retrieve  4088  a second data set from the medical imaging device  238 , associate  4090  the first and second data sets by a key, and transmit the associated first and second data sets to a remote network outside of the surgical hub  206 . The surgical instrument  235  is a first source of patient data and the first data set is associated with a surgical procedure. The medical imaging device  238  is a second source of patient data and the second data set is associated with an outcome of the surgical procedure. The first and second data records are uniquely identified by the key. 
     In another aspect, the surgical hub  206  provides a memory  249  storing instructions executable by the processor  244  to retrieve the first data set using the key, anonymize the first data set, retrieve the second data set using the key, anonymize the second data set, pair the anonymized first and second data sets, and determine success rate of surgical procedures grouped by the surgical procedure based on the anonymized paired first and second data sets. 
     In another aspect, the surgical hub  206  provides a memory  249  storing instructions executable by the processor  244  to retrieve the anonymized first data set, retrieve the anonymized second data set, and reintegrate the anonymized first and second data sets using the key. 
       FIG.  68    is a logic flow diagram of a process  4400  depicting a control program or a logic configuration for stripping data to extract relevant portions of the data to configure and operate the surgical hub  206  and modules (e.g., instruments  235 ) coupled to the surgical hub  206 , according to one aspect of the present disclosure. With reference to  FIG.  68    and with reference also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , in one aspect, the surgical hub  206  may be configured to interrogate a module coupled to surgical hub  206  for data, and strip the data to extract relevant portions of the data to configure and operate the surgical hub  206  and modules (e.g., instruments  235 ) coupled to the surgical hub  206  and anonymize the surgery, patient, and other parameters that can be used to identify the patient to maintain patient privacy. According to the process  4400 , in one aspect the present disclosure provides a surgical hub  206  including a processor  244 , a modular communication hub  203  coupled to the processor  244 , where the modular communication hub  203  is configured to connect modular devices located in one or more operating theaters to the surgical hub  206 . The processor  244  is coupled to a memory  249 , where the memory  249  stores instructions executable by the processor  244  to cause the processor to interrogate  4402  a modular device coupled to the processor  244  via the modular communication hub  203 . The modular device is a source of data sets that include patient identity data and surgical procedure data. The processor  244  receives  4404  a data set from the modular device. The processor  244  discards  4406  the patient identity data and any portion of the surgical procedure data that identifies the patient from the data set. The processor  244  extracts  4408  anonymous data from the data set and creates  4410  an anonymized data set. The processor  244  configures  4412  the operation of the surgical hub  206  or the modular device based on the anonymized data set. 
     In another aspect, where the anonymized data set includes catastrophic failure of a modular device, the memory  249  stores instructions executable by the processor  244  to initiate automatic archiving and submission of data for implications analysis based on the catastrophic failure of the modular device. In another aspect, the memory  249  stores instructions executable by the processor  244  to detect counterfeit component information from the anonymized data set. In another aspect, the memory  249  stores instructions executable by the processor  244  to derive implications of the modular device from the anonymized data set and the memory  249  stores instructions executable by the processor  244  to configure the modular device to operate based on the derived implications or to configure the surgical hub based on the derived implications. In another aspect, the memory  249  stores instructions executable by the processor  244  to conglomerate the anonymized data. In another aspect, the memory  249  stores instructions executable by the processor  244  to extract the anonymized data prior to storing the received data in a storage device coupled to the surgical hub. In another aspect, the memory  249  stores instructions executable by the processor to transmit the anonymized data to a remote network outside of the surgical hub, compile the anonymized data at the remote network, and store a copy of the data set from the modular device in a patient electronic medical records database. 
     Storage Of Data Creation And Use Of Self-Describing Data Including Identification Features 
     In one aspect, the present disclosure provides self-describing data packets generated at the issuing instrument and including identifiers for all devices that handled the packet. The self description allows the processor to interpret the data in the self-describing packet without knowing the data type in advance prior to receipt of the self-describing packet. The data applies to every data point or data string and includes the type of data, the source of the self-describing packet, the device identification that generated the packet, the units, the time of generation of the packet, and an authentication that the data contained in the packet is unaltered. When the processor (in the device or the surgical hub) receives an unexpected packet and verifies the source of the packet, the processor alters the collection techniques to be ready for any subsequent packets from that source. 
     With reference also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , during a surgical procedure being performed in a surgical hub  206  environment, the size and quantity of data being generated by surgical devices  235  coupled to the surgical hub  206  can become quite large. Also, data exchanged between the surgical devices  235  and/or the surgical hub  206  can become quite large. 
     One solution provides a techniques for minimizing the size of the data and handling the data within a surgical hub  206  by generating a self-describing packet. The self-describing packet is initially assembled by the instrument  235  that generated it. The packet is then ordered and encrypted b generating an encryption certificate which is unique for each data packet. The data is then communicated from the instrument  235  via encrypted wired or wireless protocols and stored on the surgical hub  206  for processing and transmission to the cloud  204  analytics engine. Each self-describing data packet includes an identifier to identify the specific instrument that generated it and the time it was generated. A surgical hub  206  identifier is added to the packet when the packet is received by the surgical hub  206 . 
     In one aspect, the present disclosure provides a surgical hub  206  comprising a processor  244  and a memory  249  coupled to the processor  244 . The memory  249  storing instructions executable by the processor  244  to receive a first data packet from a first source, receive a second data packet from a second source, associate the first and second data packets, and generate a third data packet comprising the first and second data payloads. The first data packet comprises a first preamble, a first data payload, a source of the first data payload, and a first encryption certificate. The first preamble defines the first data payload and the first encryption certificate verifies the authenticity of the first data packet. The second data packet comprises a second preamble, a second data payload, a source of the second data payload, and a second encryption certificate. The second preamble defines the second data payload and the second encryption certificate verifies the authenticity of the second data packet. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to determine that a data payload is from a new source, verify the new source of the data payload, and alter a data collection process at the surgical hub to receive subsequent data packets from the new source. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to associate the first and second data packets based on a key. In another aspect, the memory  249  stores instructions executable by the processor  244  to anonymize the data payload of the third data packet. In another aspect, the memory  249  stores instructions executable by the processor  244  to receive an anonymized third data packet and reintegrate the anonymized third data packet into the first and second data packets using the key. 
     In various aspects, the present disclosure provides a control circuit to receive and process data packets as described above. In various aspects, the present disclosure provides a non-transitory computer-readable medium storing computer readable instructions, which when executed, causes a machine to receive and process data packets as described above. 
     In other aspects, the present disclosure a method of generating a data packet comprising self- describing data. In one aspect, a surgical instrument includes a processor and a memory coupled to the processor, a control circuit, and/or a computer-readable medium configured to generate a data packet comprising a preamble, a data payload, a source of the data payload, and an encryption certificate. The preamble defines the data payload and the encryption certificate verifies the authenticity of the data packet. In various aspects, the data packet may be generated by any module coupled to the surgical hub. Self-describing data packets minimize data size and data handing in the surgical hub. 
     In one aspect, the present disclosure provides a self-describing data packet generated at an issuing device (e.g., instrument, tool, robot). The self-describing data packet comprises identifiers for all devices that handle the data packet along a communication path; a self description to enable a processor to interpret that data contained in the data packet without having been told in advance of receipt of the data packet along a path; data for every data point or data string; and type of data, source of data, device IDs that generated the data, units of the data, time of generation, and authentication that the data packet is unaltered. In another aspect, when a processor receives a data packet from an unexpected source and verifies the source of the data, the processor alters the data collection technique to prepare for any subsequent data packets from the source. 
     In the creation and use of a data packet comprising self-describing data, the surgical hub includes identification features. The hub and intelligent devices use self-describing data packets to minimize data size and data handling. In a surgical hub that generates large volumes of data, the self-describing data packets minimize data size and data handling, thus saving time and enabling the operating theater to run more efficiently. 
       FIG.  69    illustrates a self-describing data packet  4100  comprising self-describing data, according to one aspect of the present disclosure. With reference also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , in one aspect, self-describing data packets  4100  as shown in  FIG.  69    are generated at an issuing instrument  235 , or device or module located in or in communication with the operating theater, and include identifiers for all devices  235  that handle the packet along a communication path. The self description allows a processor  244  to interpret the data payload of the packet  4100  without having advance knowledge of the definition of the data payload prior to receiving the self-describing data packet  4100 . The processor  244  can interpret the data payload by parsing an incoming self-describing packet  4100  as it is received and identifying the data payload without being notified in advance that the self-describing packet  4100  was received. The data is for every data point or data string. The data payload includes type of data, source of data, device IDs that generated the data, data units, time when data was generated, and an authentication that the self-describing data packet  4100  is unaltered. Once the processor  244 , which may be located either in the device or the surgical hub  206 , receives an unexpected self-describing data packet  4100  and verifies the source of the self-describing data packet  4100 , the processor  244  alters the data collection means to be ready for any subsequent self-describing data packets  4100  from that source. In one example, the information contained in a self-describing packet  4100  may be recorded during the first firing  4172  in the lung tumor resection surgical procedure described in connection with  FIGS.  71 - 75   . 
     The self-describing data packet  4100  includes not only the data but a preamble which defines what the data is and where the data came from as well as an encryption certificate verifying the authenticity of each data packet  4100 . As shown in  FIG.  69   , the data packet  4100  may comprise a self-describing data header  4102  (e.g., force-to-fire [FTF], force-to-close [FTC], energy amplitude, energy frequency, energy pulse width, speed of firing, and the like), a device ID  4104  (e.g., 002), a shaft ID  4106  (e.g., W30), a cartridge ID  4108  (e.g., ESN736), a unique time stamp  4110  (e.g., 09:35:15), a force-to-fire value  4112  (e.g., 85) when the self-describing data header  4102  includes FTF (force-to-fire), otherwise, this position in the data packet  4100  includes the value of force-to-close, energy amplitude, energy frequency, energy pulse width, speed of firing, and the like. The data packet  4100 , further includes tissue thickness value  4114  (e.g., 1.1 mm), and an identification certificate of data value  4116  (e.g., 01101010001001) that is unique for each data packet  4100 . Once the self-describing data packet  4100  is received by another instrument  235 , surgical hub  206 , cloud  204 , etc., the receiver parses the self-describing data header  4102  and based on its value knows what data type is contained in the self-describing data packet  4100 . TABLE 1 below lists the value of the self-describing data header  4102  and the corresponding data value.  
     
       
         
          TABLE 1
           
               
               
             
               
                 Self-Describing Data Header (4102) 
                 Data Type 
               
             
            
               
                 FTF 
                 Force To Fire (N) 
               
               
                 FTC 
                 Force To Close (N) 
               
               
                 EA 
                 Energy Amplitude (J) 
               
               
                 EF 
                 Energy Frequency (Hz) 
               
               
                 EPW 
                 Energy Pulse Width (Sec) 
               
               
                 SOF 
                 Speed Of Firing (mm/sec) 
               
            
           
         
       
     
     Each self-describing data packet  4100  comprising self-describing data is initially assembled by the instrument  235 , device, or module that generated the self-describing data packet  4100 . Subsequently, the self-describing data packet  4100  comprising self-describing data is ordered and encrypted to generate an encryption certificate. The encryption certificate is unique for each self-describing data packet  4100 . That data is then communicated via encrypted wired or wireless protocols and stored on the surgical hub  206  for processing and transmission to the cloud  204  analytics engine. 
     Each self-describing data packet  4100  comprising self-describing data includes a device ID  4104  to identify the specific instrument  235  that generated the self-describing data packet  4100 , a time stamp  4110  to indicate the time that the data packet  4100  was generated, and when the self-describing data packet  4100  is received by the surgical hub  206 . The surgical hub  206  ID also may be added to the self- describing data packet  4100 . 
     Each of the self-describing data packets  4100  comprising self-describing data may include a packet wrapper that defines the beginning of the data packet  4100  and the end of the data packet  4100  including any identifiers necessary to forecast the number and order of the bits in the self-describing data packet. 
     The surgical hub  206  also manages redundant data sets. As the device  235  functions and interconnects with other surgical hubs  206 , multiple sets of the same data may be created and stored on various devices  235 . Accordingly, the surgical hub  206  manages multiple images of redundant data as well as anonymization and security of data. The surgical hub  206  also provides temporary visualization and communication, incident management, peer-to-peer processing or distributed processing, and storage backup and protection of data. 
       FIG.  70    is a logic flow diagram  4120  of a process depicting a control program or a logic configuration for using data packets comprising self-describing data, according to one aspect of the present disclosure. With reference to  FIGS.  1 - 69   , in one aspect, the present disclosure provides a surgical hub  206  comprising a processor  244  and a memory  249  coupled to the processor  244 . The memory  249  storing instructions executable by the processor  244  to receive a first data packet from a first source, receive a second data packet from a second source, associate the first and second data packets, and generate a third data packet comprising the first and second data payloads. The first data packet comprises a first preamble, a first data payload, a source of the first data payload, and a first encryption certificate. The first preamble defines the first data payload and the first encryption certificate verifies the authenticity of the first data packet. The second data packet comprises a second preamble, a second data payload, a source of the second data payload, and a second encryption certificate. The second preamble defines the second data payload and the second encryption certificate verifies the authenticity of the second data packet. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to determine that a data payload is from a new source, verify the new source of the data payload, and alter a data collection process at the surgical hub to receive subsequent data packets from the new source. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to associate the first and second data packets based on a key. In another aspect, the memory  249  stores instructions executable by the processor  244  to anonymize the data payload of the third data packet. In another aspect, the memory  244  stores instructions executable by the processor  244  to receive an anonymized third data packet and reintegrate the anonymized third data packet into the first and second data packets using the key. 
       FIG.  71    is a logic flow diagram  4130  of a process depicting a control program or a logic configuration for using data packets comprising self-describing data, according to one aspect of the present disclosure. With reference to  FIG.  71    and with reference also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , in one aspect, the present disclosure provides a surgical hub  206  comprising a processor  244  and a memory  249  coupled to the processor  244 . The memory  249  storing instructions executable by the processor  244  to receive  4132  a first self-describing data packet from a first data source, the first self-describing data packet comprising a first preamble, a first data payload, a source of the first data payload, and a first encryption certificate. The first preamble defines the first data payload and the first encryption certificate verifies the authenticity of the first data packet. The memory  249  storing instructions executable by the processor  244  to parse  4134  the received first preamble and interpret  4136  the first data payload based on the first preamble. 
     In various aspects, the memory  249  stores instructions executable by the processor  244  to receive a second self-describing data packet from a second data source, the second self-describing data packet comprising a second preamble, a second data payload, a source of the second data payload, and a second encryption certificate. The second preamble defines the second data payload and the second encryption certificate verifies the authenticity of the second data packet. The memory  249  storing instructions executable by the processor  244  to parse the received second preamble, interpret the second data payload based on the second preamble, associate the first and second self-describing data packets, and generate a third self-describing data packet comprising the first and second data payloads. In one aspect, the memory stores instructions executable by the processor to anonymize the data payload of the third self-describing data packet. 
     In various aspects, the memory stores instructions executable by the processor to determine that a data payload was generated by a new data source, verify the new data source of the data payload, and alter a data collection process at the surgical hub to receive subsequent data packets from the new data source. In one aspect, the memory stores instructions executable by the processor to associate the first and second self-describing data packets based on a key. In another aspect, the memory stores instructions executable by the processor to receive an anonymized third self-describing data packet and reintegrate the anonymized third self-describing data packet into the first and second self-describing data packets using the key. Storage Of The Data In A Manner Of Paired Data Sets Which Can Be Grouped By Surgery But Not Necessarily Keyed To Actual Surgical Dates And Surgeons 
     In one aspect, the present disclosure provides a data pairing method that allows a surgical hub to interconnect a device measured parameter with a surgical outcome. The data pair includes all the relevant surgical data or patient qualifiers without any patient identifier data. The data pair is generated at two separate and distinct times. The disclosure further provides configuring and storing the data in such a manner as to be able to rebuild a chronological series of events or merely a series of coupled but unconstrained data sets. The disclosure further provides storing data in an encrypted form and having predefined backup and mirroring to the cloud. 
     To determine the success or failure of a surgical procedure, data stored in a surgical instrument should be correlated with the outcome of the surgical procedure while simultaneously anonymizing the data to protect the privacy of the patient. One solution is to pair data associated with a surgical procedure, as recorded by the surgical instrument during the surgical procedure, with data assessing the efficacy of the procedure. The data is paired without identifiers associated with surgery, patient, or time to preserve anonymity. The paired data is generated at two separate and distinct times. 
     In one aspect, the present disclosure provides a surgical hub configured to communicate with a surgical instrument. The surgical hub comprises a processor and a memory coupled to the processor. The memory storing instructions executable by the processor to receive a first data set associated with a surgical procedure, receive a second data set associated with the efficacy of the surgical procedure, anonymize the first and second data sets by removing information that identifies a patient, a surgery, or a scheduled time of the surgery, and store the first and second anonymized data sets to generate a data pair grouped by surgery. The first data set is generated at a first time, the second data set is generated at a second time, and the second time is separate and distinct from the first time. 
     In another aspect, the memory stores instructions executable by the processor to reconstruct a series of chronological events based on the data pair. In another aspect, the memory stores instructions executable by the processor to reconstruct a series of coupled but unconstrained data sets based on the data pair. In another aspect, the memory stores instructions executable by the processor to encrypt the data pair, define a backup format for the data pair, and mirror the data pair to a cloud storage device. 
     In various aspects, the present disclosure provides a control circuit to receive and process data sets as described above. In various aspects, the present disclosure provides a non-transitory computer-readable medium storing computer readable instructions, which when executed, causes a machine to receive and process data sets as described above. 
     Storage of paired anonymous data enables the hospital or surgeon to use the data pairs locally to link to specific surgeries or to store the data pairs to analyze overall trends without extracting specific events in chronological manner. 
     In one aspect, the surgical hub provides user defined storage and configuration of data. Storage of the data may be made in a manner of paired data sets which can be grouped by surgery, but not necessarily keyed to actual surgical dates and surgeons. This technique provides data anonymity with regard to the patient and surgeon. 
     In one aspect, the present disclosure provides a data pairing method. The data pairing method comprises enabling a surgical hub to interconnect a device measured parameter with an outcome, wherein a data pair includes all the relevant tissue or patient qualifiers without any of the identifiers, wherein the data pair is generated at two distinct and separate times. In another aspect, the present disclosure provides a data configuration that includes whether the data is stored in such a manner as to enable rebuilding a chronological series of events or merely a series of coupled but unconstrained data sets. In another aspect, the data may be stored in an encrypted form. The stored data may comprise a predefined backup and mirroring to the cloud. 
     The data may be encrypted locally to the device. The data backup may be automatic to an integrated load secondary storage device. The device and/or the surgical hub may be configured to maintain the time of storage of the data and compile and transmit the data to another location for storage, e.g., another surgical hub or a cloud storage device. The data may be grouped together and keyed for transmission to the cloud analytics location. A cloud based analytics system is described in commonly-owned U.S. Provisional Pat. Application Serial No. 62/611,340, filed Dec. 28, 2017, titled CLOUD-BASED MEDICAL ANALYTICS, which is incorporated herein by reference in its entirety. 
     In another aspect, the hub provides user selectable options for storing the data. In one technique, the hub enables the hospital or the surgeon to select if the data should be stored in such a manner that it could be used locally in a surgical hub to link to specific surgeries. In another technique, the surgical hub enables the data to be stored as data pairs so that overall trends can be analyzed without specific events extracted in a chronological manner. 
       FIG.  72    is a diagram  4150  of a tumor  4152  embedded in the right superior posterior lobe  4154  of the right lung  4156 , according to one aspect of the present disclosure. To remove the tumor  4152 , the surgeon cuts around the tumor  4152  along the perimeter generally designated as a margin  4158 . A fissure  4160  separates the upper lobe  4162  and the middle lobe  4164  of the right lung  4156 . In order to cut out the tumor  4152  about the margin  4158 , the surgeon must cut the bronchial vessels  4166  leading to and from the middle lobe  4164  and the upper lobe  4162  of the right lung  4156 . The bronchial vessels  4166  must be sealed and cut using a device such as a surgical stapler, electrosurgical instrument, ultrasonic instrument, a combo electrosurgical/ultrasonic instrument, and/or a combo stapler/electrosurgical device generally represented herein as the instrument/device  235  coupled to the surgical hub  206 . The device  235  is configured to record data as described above, which is formed as a data packet, encrypted, stored, and/or transmitted to a remote data storage device  105  and processed by the server  113  in the cloud  104 .  FIGS.  77  and  78    are diagrams that illustrate the right lung  4156  and the bronchial tree  4250  embedded within the parenchyma tissue of the lung. 
     In one aspect, the data packet may be in the form of the self-describing data  4100  described in connection with  FIGS.  69 - 71   . The self-describing data packet  4100  will contain the information recorded by the device  235  during the procedure. Such information may include, for example, a self-describing data header  4102  (e.g., force-to-fire [FTF], force-to-close [FTC], energy amplitude, energy frequency, energy pulse width, speed of firing, and the like) based on the particular variable. The device ID  4104  (e.g., 002) of the instrument/device  235  used in the procedure including components of the instrument/device  235  such as the shaft ID  4106  (e.g., W30) and the cartridge ID  4108  (e.g., ESN736). The self-describing packet  4100  also records a unique time stamp  4110  (e.g., 09:35:15) and procedural variables such as a force-to-fire value  4112  (e.g., 85) when the self-describing data header  4102  includes FTF (force-to-fire), otherwise, this position in the data packet  4100  includes the value of force-to-close (FTC), energy amplitude, energy frequency, energy pulse width, speed of firing, and the like, as shown in TABLE 1, for example. The data packet  4100 , further may include tissue thickness value  4114  (e.g., 1.1 mm), which in this example refers to the thickness of the bronchial vessel  4166  exposed in the fissure  4160  that were sealed and cut. Finally, each self-describing packet  4100  includes an identification certificate of data value  4116  (e.g., 01101010001001) that uniquely identifies each data packet  4100  transmitted by the device/instrument  235  to the surgical hub  206 , further transmitted from the surgical hub  206  to the cloud  204  and stored on the storage device  205  coupled to the server  213 , and/or further transmitted to the robot hub  222  and stored. 
     The data transmitted by way of a self-describing data packet  4100  is sampled by the instrument device  235  at a predetermined sample rate. Each sample is formed into a self-describing data packet  4100  which is transmitted to the surgical hub  206  and eventually is transmitted from the surgical hub  206  to the cloud  204 . The samples may be stored locally in the instrument device  235  prior to packetizing or may be transmitted on the fly. The predetermined sampling rate and transmission rate are dictated by communication traffic in the surgical hub  206  and may be adjusted dynamically to accommodate current bandwidth limitations. Accordingly, in one aspect, the instrument device  235  may record all the samples taken during surgery and at the end of the procedure packetize each sample into a self-describing packet  4100  and transmit the self-describing packet  4100  to the surgical hub  206 . In another aspect, the sampled data may be packetized as it is recorded and transmitted to the surgical hub  206  on the fly. 
       FIG.  73    is a diagram  4170  of a lung tumor resection surgical procedure including four separate firings of a surgical stapler device  235  to seal and cut bronchial vessels  4166  exposed in the fissure  4160  leading to and from the upper and lower lobes  4162 ,  4164  of the right lung  4156  shown in  FIG.  72   , according to one aspect of the present disclosure. The surgical stapler device  235  is identified by a Device ID “002”. The data from each firing of the surgical stapler device  235  is recorded and formed into a data packet  4100  comprising self- describing data as shown in  FIG.  70   . The self-describing data packet  4100  shown in  FIG.  70    is representative of the first firing of device “002” having a staple cartridge serial number of ESN736, for example. In the following description, reference also is made to  FIGS.  12 - 19    for descriptions of various architectures of instruments/devices  235  that include a processor or a control circuit coupled to a memory for recording (e.g., saving or storing) data collected during a surgical procedure. 
     The first firing  4172  is recorded at anonymous time 09:35: 15. The first firing  4172  seals and severs a first bronchial vessel  4166  leading to and from the middle lobe  4164  and the upper lobe  4162  of the right lung  4156  into a first portion  4166   a  and a second portion  4166   b , where each portion  4166   a ,  4166   b  is sealed by respective first and second staple lines  4180   a ,  4180   b . Information associated with the first firing  4172 , for example the information described in connection with  FIG.  70   , is recorded in the surgical stapler device  235  memory and is used to build a first self-describing data packet  4100  described in connection with  FIGS.  69 - 71   . The first self-describing packet  4100  may be transmitted upon completion of the first firing  4172  or may be kept stored in the surgical stapler device  235  memory until the surgical procedure is completed. Once transmitted by the surgical stapler device  235 , the first self-describing data packet  4100  is received by the surgical hub  206 . The first self-describing data packet  4100  is anonymized by stripping and time stamping  4038  the data, as discussed, for example, in connection with  FIG.  63   . After the lung resection surgical is completed, the integrity of the seals of the first and second staple lines  4182   a ,  4182   b  will be evaluated as shown in  FIG.  74   , for example, and the results of the evaluation will be paired with information associated with the first firing  4172 . 
     The second firing  4174  seals and severs a second bronchial vessel of the bronchial vessels  4166  leading to and from the middle lobe  4164  and the upper lobe  4162  of the right lung  4156  into a first portion  4166   c  and a second portion  4166   d , where each portion  4166   c ,  4166   d  is sealed by first and second staple lines  4180   c ,  4180   d . Information associated with the second firing  4174 , for example the information described in connection with  FIGS.  69 - 71   , is recorded in the surgical stapler device  235  memory and is used to build a second self-describing data packet  4100  described in connection with  FIGS.  69 - 71   . The second self-describing data packet  4100  may be transmitted upon completion of the second firing  4174  or may be kept stored in the surgical stapler device  235  memory until the surgical procedure is completed. Once transmitted by the surgical stapler device  235 , the second self-describing data packet  4100  is received by the surgical hub  206 . The second self-describing data packet  4100  is anonymized by stripping and time stamping  4038  the data as discussed, for example, in connection with  FIG.  63   . After the lung resection surgical is completed, the integrity of the seals of the first and second staple lines  4182   c ,  4182   d  will be evaluated as shown in  FIG.  74   , for example, and the results of the evaluation will be paired with information associated with the second firing  4174 . 
     The third firing  4176  is recorded at anonymous time 09:42:12. The third firing  4176  seals and severs an outer portion of the upper and middle lobes  4162 ,  4164  of the right lung  4156 . First and second staple lines  4182   a ,  4182   b  are used to seal the outer portion of the upper and middle lobes  4162 ,  4162 . Information associated with the third firing  4176 , for example the information described in connection with  FIGS.  69 - 71   , is recorded in the surgical stapler device  235  memory and is used to build a third self-describing data packet  4100  described in connection with  FIGS.  69 - 71   . The third self-describing packet  4100  may be transmitted upon completion of the third firing  4176  or may be kept stored in the surgical stapler device  235  memory until the surgical procedure is completed. Once transmitted by the surgical stapler device  235 , the third self-describing data packet  4100  is received by the surgical hub  206 . The third self-describing data packet  4100  is anonymized by stripping and time stamping  4038  the data, as discussed, for example, in connection with  FIG.  63   . After the lung resection surgical is completed, the integrity of the seals of the first and second staple lines  4180   a ,  4180   b  will be evaluated as shown in  FIG.  74   , for example, and the results of the evaluation will be paired with information associated with the third firing  4172 . 
     The fourth firing  4178  seals and severs an inner portion of the upper and middle lobes  4162 ,  4162  of the right lung  4156 . First and second staple lines  4182   c ,  4182   d  are used to seal the inner portions of the upper and middle lobes  4162 ,  4164 . Information associated with the fourth firing  4178 , for example the information described in connection with  FIG.  70   , is recorded in the surgical stapler device  235  memory and is used to build a fourth self-describing data packet  4100  described in connection with  FIGS.  69 - 71   . The fourth self-describing packet  4100  may be transmitted upon completion of the fourth firing  4178  or may be kept stored in the surgical stapler device  235  memory until the surgical procedure is completed. Once transmitted by the surgical stapler device  235 , the fourth self-describing data packet  4100  is received by the surgical hub  206 . The fourth self-describing data packet  4100  is anonymized by stripping and time stamping  4038  the data, as discussed, for example, in connection with  FIG.  63   . After the lung resection surgical is completed, the integrity of the seals of the first and second staple lines  4182   a ,  4182   b  will be evaluated as shown in  FIG.  74   , for example, and the results of the evaluation will be paired with information associated with the fourth firing  4172 . 
       FIG.  74    is a graphical illustration  4190  of a force-to-close (FTC) versus time curve  4192  and a force-to-fire (FTF) versus time curve  4194  characterizing the first firing  4172  of device  002  shown in  FIG.  73   , according to one aspect of the present disclosure. The surgical stapler device  235  is identified as  002  with a 30 mm staple cartridge S/N ESN736 with a PVS shaft S/N M3615N (Shaft ID W30). The surgical stapler device  235  was used for the first firing  4172  to complete the lung resection surgical procedure shown in  FIG.  73   . As shown in  FIG.  74   , the peak force-to-fire force of 85 N. is recorded at anonymous time 09:35:15. Algorithms in the surgical stapler device  235  determine a tissue thickness of about 1.1 mm. As described hereinbelow, the FTC versus time curve  4192  and the FTF versus time curve  4194  characterizing the first firing  4172  of the surgical device  235  identified by ID  002  will be paired with the outcome of the lung resection surgical procedure, transmitted to the surgical hub  206 , anonymized, and either stored in the surgical hub  206  or transmitted to the cloud  204  for aggregation, further processing, analysis, etc. 
       FIG.  75    is a diagram  4200  illustrating a staple line visualization laser Doppler to evaluate the integrity of staple line seals by monitoring bleeding of a vessel after a firing of a surgical stapler, according to one aspect of the present disclosure. A laser Doppler technique is described in above under the heading “Advanced Imaging Acquisition Module,” in U.S. Provisional Pat. Application Serial No. 62/611,341, filed Dec. 28, 2017, and titled INTERACTIVE SURGICAL PLATFORM, which is hereby incorporated by reference herein in its entirety. The laser Doppler provides an image  4202  suitable for inspecting seals along the staple lines  4180   a ,  4180   b ,  4182   a  and for visualizing bleeding  4206  of any defective seals. Laser Doppler inspection of the first firing  4172  of device  002  shows a defective seal at the first staple line  4180   a  of the first portion  4166   a  of the bronchial vessel sealed during the first firing  4172 . The staple line  4180   a  seal is bleeding  4206  out at a volume of 0.5 cc. The image  4202  is recorded at anonymous time 09:55:15  4204  and is paired with the force-to-close curve  4192  and force-to-fire curve  4194  shown in  FIG.  74   . The data pair set is grouped by surgery and is stored locally in the surgical hub  206  storage  248  and/or remotely to the cloud  204  storage  205  for aggregation, processing, and analysis, for example. For example, the cloud  204  analytics engine associates the information contained in the first self-describing packet  4100  associated with the first firing  4172  and indicate that a defective seal was produced at the staple line  4166   a . Over time, this information can be aggregated, analyzed, and used to improve outcomes of the surgical procedure, such as, resection of a lung tumor, for example. 
       FIG.  76    illustrates two paired data sets  4210  grouped by surgery, according to one aspect of the present disclosure. The upper paired data set  4212  is grouped by one surgery and a lower paired data set  4214  grouped by another surgery. The upper paired data set  4212 , for example, is grouped by the lung tumor resection surgery discussed in connection with  FIGS.  73 - 76   . Accordingly, the rest of the description of  FIG.  76    will reference information described in  FIGS.  32 - 35    as well as  FIGS.  1 - 21    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 . The lower paired data set  4214  is grouped by a liver tumor resection surgical procedure where the surgeon treated parenchyma tissue. The upper paired data set is associated with a failed staple line seal and the bottom paired data set is associated with a successful staple line seal. The upper and lower paired data sets  4212 ,  4214  are sampled by the instrument device  235  and each sample formed into a self-describing data packet  4100  which is transmitted to the surgical hub  206  and eventually is transmitted from the surgical hub  206  to the cloud  204 . The samples may be stored locally in the instrument device  235  prior to packetizing or may be transmitted on the fly. Sampling rate and transmission rate are dictated by communication traffic in the surgical hub  206  and may be adjusted dynamically to accommodate current bandwidth limitations. 
     The upper paired data set  4212  includes a left data set  4216  recorded by the instrument/device  235  during the first firing  4172  linked  4224  to a right data set  4218  recorded at the time the staple line seal  4180   a  of the first bronchial vessel  4166   a  was evaluated. The left data set  4216  indicates a “Vessel” tissue type  4236  having a thickness  4238  of 1.1 mm. Also included in the left data set  4216  is the force-to-close curve  4192  and force-to-fire curve  4194  versus time (anonymous real time) recorded during the first firing  4172  of the lung tumor resection surgical procedure. The left data set  4216  shows that the force-to-fire peaked at 85 Lbs. and recorded at anonymous real time  4240  t 1a  (09:35:15). The right data set  4218  depicts the staple line visualization curve  4228  depicting leakage versus time. The right data set  4218  indicates that a “Vessel” tissue type  4244  having a thickness  4246  of 1.1 mm experienced a staple line  4180   a  seal failure  4242 . The staple line visualization curve  4228  depicts leakage volume (cc) versus time of the staple line  4180   a  seal. The staple line visualization curve  4228  shows that the leakage volume reached 0.5 cc, indicating a failed staple line  4180   a  seal of the bronchial vessel  4166   a , recorded at anonymous time  4248  (09:55:15). 
     The lower paired data set  4214  includes a left data set  4220  recorded by the instrument/device  235  during a firing linked  4226  to a right data set  4222  recorded at the time the staple line seal of the parenchyma tissue was evaluated. The left data set  4220  indicates a “Parenchyma” tissue type  4236  having a thickness  4238  of 2.1 mm. Also included in the left data set  4220  is the force-to-close curve  4230  and force-to-fire curve  4232  versus time (anonymous real time) recorded during the first firing of the liver tumor resection surgical procedure. The left data set  4220  shows that the force-to-fire peaked at 100 Lbs. and recorded at anonymous real time  4240  t 1b  (09:42:12). The right data set  4222  depicts the staple line visualization curve  4228  depicting leakage versus time. The right data set  4234  indicates that a “Parenchyma” tissue type  4244  having a thickness  4246  of 2.2 mm experienced a successful staple line seal. The staple line visualization curve  4234  depicts leakage volume (cc) versus time of the staple line seal. The staple line visualization curve  4234  shows that the leakage volume was 0.0 cc, indicating a successful staple line seal of the parenchyma tissue, recorded at anonymous time  4248  (10:02:12). 
     The paired date sets  4212 ,  4214  grouped by surgery are collected for many procedures and the data contained in the paired date sets  4212 ,  4214  is recorded and stored in the cloud  204  storage  205  anonymously to protect patient privacy, as described in connection with  FIGS.  62 - 69   . In one aspect, the paired date sets  4212 ,  4214  data are transmitted from the instrument/device  235 , or other modules coupled to the surgical hub  206 , to the surgical hub  206  and to the cloud  204  in the form of the self-describing packet  4100  as described in connection with  FIGS.  71  and  72    and surgical procedure examples described in connection with  FIGS.  72 - 76   . The paired date sets  4212 ,  4214  data stored in the cloud  204  storage  205  is analyzed in the cloud  204  to provide feedback to the instrument/device  235 , or other modules coupled to the surgical hub  206 , notifying a surgical robot coupled to the robot hub  222 , or the surgeon, that the conditions identified by the left data set ultimately lead to either a successful or failed seal. As described in connection with  FIG.  76   , the upper left data set  4216  led to a failed seal and the bottom left data set  4220  led to a successful seal. This is advantageous because the information provided in a paired data set grouped by surgery can be used to improve resection, transection, and creation of anastomosis in a variety of tissue types. The information can be used to avoid pitfalls that may lead to a failed seal. 
       FIG.  77    is a diagram of the right lung  4156  and  FIG.  78    is a diagram of the bronchial tree  4250  including the trachea  4252  and the bronchi  4254 ,  4256  of the lungs. As shown in  FIG.  77   , the right lung  4156  is composed of three lobes divided into the upper lobe  4162 , the middle lobe  4160 , and the lower lobe  4165  separated by the oblique fissure  4167  and horizontal fissure  4160 . The left lung is composed of only two smaller lobes due to the position of heart. As shown in  FIG.  78   , inside each lung, the right bronchus  4254  and the left bronchus  4256  divide into many smaller airways called bronchioles  4258 , greatly increasing surface area. Each bronchiole  4258  terminates with a cluster of air sacs called alveoli  4260 , where gas exchange with the bloodstream occurs. 
       FIG.  79    is a logic flow diagram  4300  of a process depicting a control program or a logic configuration for storing paired anonymous data sets grouped by surgery, according to one aspect of the present disclosure. With reference to  FIGS.  1 - 79   , in one aspect, the present disclosure provides a surgical hub  206  configured to communicate with a surgical instrument  235 . The surgical hub  206  comprises a processor  244  and a memory  249  coupled to the processor  244 . The memory  249  storing instructions executable by the processor  244  to receive  4302  a first data set from a first source, the first data set associated with a surgical procedure, receive  4304  a second data set from a second source, the second data set associated with the efficacy of the surgical procedure, anonymize  4306  the first and second data sets by removing information that identifies a patient, a surgery, or a scheduled time of the surgery, and store  4308  the first and second anonymized data sets to generate a data pair grouped by surgery. The first data set is generated at a first time, the second data set is generated at a second time, and the second time is separate and distinct from the first time. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to reconstruct a series of chronological events based on the data pair. In another aspect, the memory  249  stores instructions executable by the processor  244  to reconstruct a series of coupled but unconstrained data sets based on the data pair. In another aspect, the memory  249  stores instructions executable by the processor  244  to encrypt the data pair, define a backup format for the data pair, and mirror the data pair to a cloud  204  storage device  205 . 
     Determination of Data to Transmit to Cloud Based Medical Analytics 
     In one aspect, the present disclosure provides a communication hub and storage device for storing parameters and status of a surgical device what has the ability to determine when, how often, transmission rate, and type of data to be shared with a cloud based analytics system. The disclosure further provides techniques to determine where the analytics system communicates new operational parameters for the hub and surgical devices. 
     In a surgical hub environment, large amounts of data can be generated rather quickly and may cause storage and communication bottlenecks in the surgical hub network. One solution may include local determination of when and what data is transmitted for to the cloud-based medical analytics system for further processing and manipulation of surgical hub data. The timing and rate at which the surgical hub data is exported can be determined based on available local data storage capacity. User defined inclusion or exclusion of specific users, patients, or procedures enable data sets to be included for analysis or automatically deleted. The time of uploads or communications to the cloud-based medical analytics system may be determined based on detected surgical hub network down time or available capacity. 
     With reference to  FIGS.  1 - 79   , in one aspect, the present disclosure provides a surgical hub  206  comprising a storage device  248 , a processor  244  coupled to the storage device  248 , and a memory  249  coupled to the processor  244 . The memory  249  stores instructions executable by the processor  244  to receive data from a surgical instrument  235 , determine a rate at which to transfer the data to a remote cloud-based medical analytics network  204  based on available storage capacity of the storage device  248 , determine a frequency at which to transfer the data to the remote cloud-based medical analytics network  204  based on the available storage capacity of the storage device  248  or detected surgical hub network  206  down time, and determine a type of data to transfer the data to a remote cloud-based medical analytics network  204  based on inclusion or exclusion of data associated with a users, patient, or surgical procedure. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to receive new operational parameters for the surgical hub  206  or the surgical instrument  235 . 
     In various aspects, the present disclosure provides a control circuit to determine, rate, frequency and type of data to transfer the data to the remote cloud-based medical analytics network as described above. In various aspects, the present disclosure provides a non-transitory computer- readable medium storing computer readable instructions which, when executed, causes a machine to determine, rate, frequency and type of data to transfer to the remote cloud-based medical analytics network. 
     In one aspect, the surgical hub  206  is configured to determine what data to transmit to the cloud based analytics system  204 . For example, a surgical hub  206  modular device  235  that includes local processing capabilities may determine the rate, frequency, and type of data to be transmitted to the cloud based analytics system  204  for analysis and processing. 
     In one aspect, the surgical hub  206  comprises a modular communication hub  203  and storage device  248  for storing parameters and status of a device  235  that has the ability to determine when and how often data can be shared with a cloud based analytics system  204 , the transmission rate and the type of data that can be shared with the cloud based analytics system  204 . In another aspect, the cloud analytics system  204  communicates new operational parameters for the surgical hub  206  and surgical devices  235  coupled to the surgical hub  206 . A cloud based analytics system  204  is described in commonly-owned U.S. Provisional Pat. Application Serial No. 62/611,340, filed Dec. 28, 2017, and titled CLOUD-BASED MEDICAL ANALYTICS, which is incorporated herein by reference in its entirety. 
     In one aspect, a device  235  coupled to a local surgical hub  206  determines when and what data is transmitted to the cloud analytics system  204  for company analytic improvements. In one example, the available local data storage capacity remaining in the storage device  248  controls the timing and rate at which the data is exported. In another example, user defined inclusion or exclusion of specific users, patients, or procedures allows data sets to be included for analysis or automatically deleted. In yet another example, detected network down time or available capacity determines the time of uploads or communications. 
     In another aspect, transmission of data for diagnosis of failure modes is keyed by specific incidents. For example, user defined failure of a device, instrument, or tool within a procedure initiates archiving and transmission of data recorded with respect to that instrument for failure modes analysis. Further, when a failure event is identified, all the data surrounding the event is archived and packaged for sending back for predictive informatics (PI) analytics. Data that is part of a PI failure is flagged for storage and maintenance until either the hospital or the cloud based analytics system releases the hold on the data. 
     Catastrophic failures of instruments may initiate an automatic archive and submission of data for implications analysis. Detection of a counterfeit component or adapter on an original equipment manufacturer (OEM) device initiates documentation of the component and recording of the results and outcome of its use. 
       FIG.  80    is a logic flow diagram  4320  of a process depicting a control program or a logic configuration for determining rate, frequency, and type of data to transfer to a remote cloud-based analytics network, according to one aspect of the present disclosure. With reference to  FIGS.  1 - 80   , in one aspect, the present disclosure provides a surgical hub  206  comprising a storage device  248 , a processor  244  coupled to the storage device  248 , and a memory  249  coupled to the processor  244 . The memory  249  stores instructions executable by the processor  244  to receive  4322  data from a surgical instrument  235 , determine  4324  a rate at which to transfer the data to a remote cloud-based medical analytics network  204  based on available storage capacity of the storage device  248 . Optionally, the memory  249  stores instructions executable by the processor  244  to determine  4326  a frequency at which to transfer the data to the remote cloud-based medical analytics network  204  based on the available storage capacity of the storage device  248 . Optionally, the memory  249  stores instructions executable by the processor  244  to detect surgical hub network downtime and to determine  4326  a frequency at which to transfer the data to the remote cloud-based medical analytics network  204  based on the detected surgical hub network  206  down time. Optionally, the memory  249  stores instructions executable by the processor  244  to determine  4328  a type of data to transfer the data to a remote cloud-based medical analytics network  204  based on inclusion or exclusion of data associated with a users, patient, or surgical procedure. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to receive new operational parameters for the surgical hub  206  or the surgical instrument  235 . 
     In one aspect, the present disclosure provides a surgical hub, comprising: a processor; and a memory coupled to the processor, the memory storing instructions executable by the processor to: interrogate a surgical instrument, wherein the surgical instrument is a first source of patient data; retrieve a first data set from the surgical instrument, wherein the first data set is associated with a patient and a surgical procedure; interrogate a medical imaging device, wherein the medical imaging device is a second source of patient data; retrieve a second data set from the medical imaging device, wherein the second data set is associated with the patient and an outcome of the surgical procedure; associate the first and second data sets by a key; and transmit the associated first and second data sets to remote network outside of the surgical hub. The present disclosure further provides, a surgical hub wherein the memory stores instructions executable by the processor to: retrieve the first data set using the key; anonymize the first data set by removing its association with the patient; retrieve the second data set using the key; anonymize the second data set by removing its association with the patient; pair the anonymized first and second data sets; and determine success rates of surgical procedures grouped by the surgical procedure based on the anonymized paired first and second data sets. The present disclosure further provides a surgical hub, wherein the memory stores instructions executable by the processor to: retrieve the anonymized first data set; retrieve the anonymized second data set; and reintegrate the anonymized first and second data sets using the key. The present disclosure further provides a surgical hub, wherein the first and second data sets define first and second data payloads in respective first and second data packets. The present disclosure further provides a control circuit to perform any one of the above recited functions and/or a non-transitory computer readable medium storing computer readable instructions which, when executed, causes a machine to perform any one of the above recited functions. 
     In another aspect, the present disclosure provides a surgical hub, comprising: a processor; and a memory coupled to the processor, the memory storing instructions executable by the processor to: receive a first data packet from a first source, the first data packet comprising a first preamble, a first data payload, a source of the first data payload, and a first encryption certificate, wherein the first preamble defines the first data payload and the first encryption certificate verifies the authenticity of the first data packet; receive a second data packet from a second source, the second data packet comprising a second preamble, a second data payload, a source of the second data payload, and a second encryption certificate, wherein the second preamble defines the second data payload and the second encryption certificate verifies the authenticity of the second data packet; associate the first and second data packets; and generate a third data packet comprising the first and second data payloads. The present disclosure further provides a surgical hub, wherein the memory stores instructions executable by the processor to: determine that a data payload is from a new source; verify the new source of the data payload; and alter a data collection process at the surgical hub to receive subsequent data packets from the new source. The present disclosure further provides a surgical, wherein the memory stores instructions executable by the processor to associate the first and second data packets based on a key. The present disclosure further provides a surgical hub, wherein the memory stores instructions executable by the processor to anonymize the data payload of the third data packet. The present disclosure further provides a surgical hub, wherein the memory stores instructions executable by the processor to receive an anonymized third data packet and reintegrate the anonymized third data packet into the first and second data packets using the key. The present disclosure further provides a control circuit to perform any one of the above recited functions and/or a non-transitory computer readable medium storing computer readable instructions which, when executed, causes a machine to perform any one of the above recited functions. 
     In another aspect, the present disclosure provides a surgical hub configured to communicate with a surgical instrument, the surgical hub comprising: a processor; and a memory coupled to the processor, the memory storing instructions executable by the processor to: receive a first data set associated with a surgical procedure, wherein the first data set is generated at a first time; receive a second data set associated with the efficacy of the surgical procedure, wherein the second data set is generated at a second time, wherein the second time is separate and distinct from the first time; anonymize the first and second data sets by removing information that identifies a patient, a surgery, or a scheduled time of the surgery; and store the first and second anonymized data sets to generate a data pair grouped by surgery. The present disclosure further provides a surgical hub, wherein the memory stores instructions executable by the processor to reconstruct a series of chronological events based on the data pair. The present disclosure further provides a surgical hub, wherein the memory stores instructions executable by the processor to reconstruct a series of coupled but unconstrained data sets based on the data pair. The present disclosure further provides a surgical hub, wherein the memory stores instructions executable by the processor to: encrypt the data pair; define a backup format for the data pair; and mirror the data pair to a cloud storage device. The present disclosure further provides a control circuit to perform any one of the above recited functions and/or a non-transitory computer readable medium storing computer readable instructions which, when executed, causes a machine to perform any one of the above recited functions. 
     In another aspect, the present disclosure provides a surgical hub comprising: a storage device; a processor coupled to the storage device; and a memory coupled to the processor, the memory storing instructions executable by the processor to: receive data from a surgical instrument; determine a rate at which to transfer the data to a remote cloud-based medical analytics network based on available storage capacity of the storage device; determine a frequency at which to transfer the data to the remote cloud-based medical analytics network based on the available storage capacity of the storage device or detected surgical hub network down time; and determine a type of data to transfer the data to a remote cloud-based medical analytics network based on inclusion or exclusion of data associated with a users, patient, or surgical procedure. The present disclosure further provides a surgical hub, wherein the memory stores instructions executable by the processor to receive new operational parameters for the surgical hub or the surgical instrument. The present disclosure further provides a control circuit to perform any one of the above recited functions and/or a non-transitory computer readable medium storing computer readable instructions which, when executed, causes a machine to perform any one of the above recited functions. 
     In another aspect, the present disclosure provides a surgical hub comprising: a control configured to: receive data from a surgical instrument; determine a rate at which to transfer the data to a remote cloud-based medical analytics network based on available storage capacity of the storage device; determine a frequency at which to transfer the data to the remote cloud-based medical analytics network based on the available storage capacity of the storage device or detected surgical hub network down time; and determine a type of data to transfer the data to a remote cloud-based medical analytics network based on inclusion or exclusion of data associated with a users, patient, or surgical procedure. 
     Surgical Hub Situational Awareness 
     Although an “intelligent” device including control algorithms that respond to sensed data can be an improvement over a “dumb” device that operates without accounting for sensed data, some sensed data can be incomplete or inconclusive when considered in isolation, i.e., without the context of the type of surgical procedure being performed or the type of tissue that is being operated on. Without knowing the procedural context (e.g., knowing the type of tissue being operated on or the type of procedure being performed), the control algorithm may control the modular device incorrectly or suboptimally given the particular context-free sensed data. For example, the optimal manner for a control algorithm to control a surgical instrument in response to a particular sensed parameter can vary according to the particular tissue type being operated on. This is due to the fact that different tissue types have different properties (e.g., resistance to tearing) and thus respond differently to actions taken by surgical instruments. Therefore, it may be desirable for a surgical instrument to take different actions even when the same measurement for a particular parameter is sensed. As one specific example, the optimal manner in which to control a surgical stapling and cutting instrument in response to the instrument sensing an unexpectedly high force to close its end effector will vary depending upon whether the tissue type is susceptible or resistant to tearing. For tissues that are susceptible to tearing, such as lung tissue, the instrument’s control algorithm would optimally ramp down the motor in response to an unexpectedly high force to close to avoid tearing the tissue. For tissues that are resistant to tearing, such as stomach tissue, the instrument’s control algorithm would optimally ramp up the motor in response to an unexpectedly high force to close to ensure that the end effector is clamped properly on the tissue. Without knowing whether lung or stomach tissue has been clamped, the control algorithm may make a suboptimal decision. 
     One solution utilizes a surgical hub including a system that is configured to derive information about the surgical procedure being performed based on data received from various data sources and then control the paired modular devices accordingly. In other words, the surgical hub is configured to infer information about the surgical procedure from received data and then control the modular devices paired to the surgical hub based upon the inferred context of the surgical procedure.  FIG.  81    illustrates a diagram of a situationally aware surgical system  5100 , in accordance with at least one aspect of the present disclosure. In some exemplifications, the data sources  5126  include, for example, the modular devices  5102  (which can include sensors configured to detect parameters associated with the patient and/or the modular device itself), databases  5122  (e.g., an EMR database containing patient records), and patient monitoring devices  5124  (e.g., a blood pressure (BP) monitor and an electrocardiography (EKG) monitor). The surgical hub  5104  can be configured to derive the contextual information pertaining to the surgical procedure from the data based upon, for example, the particular combination(s) of received data or the particular order in which the data is received from the data sources  5126 . The contextual information inferred from the received data can include, for example, the type of surgical procedure being performed, the particular step of the surgical procedure that the surgeon is performing, the type of tissue being operated on, or the body cavity that is the subject of the procedure. This ability by some aspects of the surgical hub  5104  to derive or infer information related to the surgical procedure from received data can be referred to as “situational awareness.” In one exemplification, the surgical hub  5104  can incorporate a situational awareness system, which is the hardware and/or programming associated with the surgical hub  5104  that derives contextual information pertaining to the surgical procedure from the received data. 
     The situational awareness system of the surgical hub  5104  can be configured to derive the contextual information from the data received from the data sources  5126  in a variety of different ways. In one exemplification, the situational awareness system includes a pattern recognition system, or machine learning system (e.g., an artificial neural network), that has been trained on training data to correlate various inputs (e.g., data from databases  5122 , patient monitoring devices  5124 , and/or modular devices  5102 ) to corresponding contextual information regarding a surgical procedure. In other words, a machine learning system can be trained to accurately derive contextual information regarding a surgical procedure from the provided inputs. In another exemplification, the situational awareness system can include a lookup table storing pre-characterized contextual information regarding a surgical procedure in association with one or more inputs (or ranges of inputs) corresponding to the contextual information. In response to a query with one or more inputs, the lookup table can return the corresponding contextual information for the situational awareness system for controlling the modular devices  5102 . In one exemplification, the contextual information received by the situational awareness system of the surgical hub  5104  is associated with a particular control adjustment or set of control adjustments for one or more modular devices  5102 . In another exemplification, the situational awareness system includes a further machine learning system, lookup table, or other such system, which generates or retrieves one or more control adjustments for one or more modular devices  5102  when provided the contextual information as input. 
     A surgical hub  5104  incorporating a situational awareness system provides a number of benefits for the surgical system  5100 . One benefit includes improving the interpretation of sensed and collected data, which would in turn improve the processing accuracy and/or the usage of the data during the course of a surgical procedure. To return to a previous example, a situationally aware surgical hub  5104  could determine what type of tissue was being operated on; therefore, when an unexpectedly high force to close the surgical instrument’s end effector is detected, the situationally aware surgical hub  5104  could correctly ramp up or ramp down the motor of the surgical instrument for the type of tissue. 
     As another example, the type of tissue being operated can affect the adjustments that are made to the compression rate and load thresholds of a surgical stapling and cutting instrument for a particular tissue gap measurement. A situationally aware surgical hub  5104  could infer whether a surgical procedure being performed is a thoracic or an abdominal procedure, allowing the surgical hub  5104  to determine whether the tissue clamped by an end effector of the surgical stapling and cutting instrument is lung (for a thoracic procedure) or stomach (for an abdominal procedure) tissue. The surgical hub  5104  could then adjust the compression rate and load thresholds of the surgical stapling and cutting instrument appropriately for the type of tissue. 
     As yet another example, the type of body cavity being operated in during an insufflation procedure can affect the function of a smoke evacuator. A situationally aware surgical hub  5104  could determine whether the surgical site is under pressure (by determining that the surgical procedure is utilizing insufflation) and determine the procedure type. As a procedure type is generally performed in a specific body cavity, the surgical hub  5104  could then control the motor rate of the smoke evacuator appropriately for the body cavity being operated in. Thus, a situationally aware surgical hub  5104  could provide a consistent amount of smoke evacuation for both thoracic and abdominal procedures. 
     As yet another example, the type of procedure being performed can affect the optimal energy level for an ultrasonic surgical instrument or radio frequency (RF) electrosurgical instrument to operate at. Arthroscopic procedures, for example, require higher energy levels because the end effector of the ultrasonic surgical instrument or RF electrosurgical instrument is immersed in fluid. A situationally aware surgical hub  5104  could determine whether the surgical procedure is an arthroscopic procedure. The surgical hub  5104  could then adjust the RF power level or the ultrasonic amplitude of the generator (i.e., “energy level”) to compensate for the fluid filled environment. Relatedly, the type of tissue being operated on can affect the optimal energy level for an ultrasonic surgical instrument or RF electrosurgical instrument to operate at. A situationally aware surgical hub  5104  could determine what type of surgical procedure is being performed and then customize the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument, respectively, according to the expected tissue profile for the surgical procedure. Furthermore, a situationally aware surgical hub  5104  can be configured to adjust the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than just on a procedure-by-procedure basis. A situationally aware surgical hub  5104  could determine what step of the surgical procedure is being performed or will subsequently be performed and then update the control algorithms for the generator and/or ultrasonic surgical instrument or RF electrosurgical instrument to set the energy level at a value appropriate for the expected tissue type according to the surgical procedure step. 
     As yet another example, data can be drawn from additional data sources  5126  to improve the conclusions that the surgical hub  5104  draws from one data source  5126 . A situationally aware surgical hub  5104  could augment data that it receives from the modular devices  5102  with contextual information that it has built up regarding the surgical procedure from other data sources  5126 . For example, a situationally aware surgical hub  5104  can be configured to determine whether hemostasis has occurred (i.e., whether bleeding at a surgical site has stopped) according to video or image data received from a medical imaging device. However, in some cases the video or image data can be inconclusive. Therefore, in one exemplification, the surgical hub  5104  can be further configured to compare a physiologic measurement (e.g., blood pressure sensed by a BP monitor communicably connected to the surgical hub  5104 ) with the visual or image data of hemostasis (e.g., from a medical imaging device  124  ( FIG.  2   ) communicably coupled to the surgical hub  5104 ) to make a determination on the integrity of the staple line or tissue weld. In other words, the situational awareness system of the surgical hub  5104  can consider the physiological measurement data to provide additional context in analyzing the visualization data. The additional context can be useful when the visualization data may be inconclusive or incomplete on its own. 
     Another benefit includes proactively and automatically controlling the paired modular devices  5102  according to the particular step of the surgical procedure that is being performed to reduce the number of times that medical personnel are required to interact with or control the surgical system  5100  during the course of a surgical procedure. For example, a situationally aware surgical hub  5104  could proactively activate the generator to which an RF electrosurgical instrument is connected if it determines that a subsequent step of the procedure requires the use of the instrument. Proactively activating the energy source allows the instrument to be ready for use a soon as the preceding step of the procedure is completed. 
     As another example, a situationally aware surgical hub  5104  could determine whether the current or subsequent step of the surgical procedure requires a different view or degree of magnification on the display according to the feature(s) at the surgical site that the surgeon is expected to need to view. The surgical hub  5104  could then proactively change the displayed view (supplied by, e.g., a medical imaging device for the visualization system  108 ) accordingly so that the display automatically adjusts throughout the surgical procedure. 
     As yet another example, a situationally aware surgical hub  5104  could determine which step of the surgical procedure is being performed or will subsequently be performed and whether particular data or comparisons between data will be required for that step of the surgical procedure. The surgical hub  5104  can be configured to automatically call up data screens based upon the step of the surgical procedure being performed, without waiting for the surgeon to ask for the particular information. 
     Another benefit includes checking for errors during the setup of the surgical procedure or during the course of the surgical procedure. For example, a situationally aware surgical hub  5104  could determine whether the operating theater is setup properly or optimally for the surgical procedure to be performed. The surgical hub  5104  can be configured to determine the type of surgical procedure being performed, retrieve the corresponding checklists, product location, or setup needs (e.g., from a memory), and then compare the current operating theater layout to the standard layout for the type of surgical procedure that the surgical hub  5104  determines is being performed. In one exemplification, the surgical hub  5104  can be configured to compare the list of items for the procedure (scanned by the scanner  5132  depicted in  FIG.  85 B , for example) and/or a list of devices paired with the surgical hub  5104  to a recommended or anticipated manifest of items and/or devices for the given surgical procedure. If there are any discontinuities between the lists, the surgical hub  5104  can be configured to provide an alert indicating that a particular modular device  5102 , patient monitoring device  5124 , and/or other surgical item is missing. In one exemplification, the surgical hub  5104  can be configured to determine the relative distance or position of the modular devices  5102  and patient monitoring devices  5124  via proximity sensors, for example. The surgical hub  5104  can compare the relative positions of the devices to a recommended or anticipated layout for the particular surgical procedure. If there are any discontinuities between the layouts, the surgical hub  5104  can be configured to provide an alert indicating that the current layout for the surgical procedure deviates from the recommended layout. 
     As another example, a situationally aware surgical hub  5104  could determine whether the surgeon (or other medical personnel) was making an error or otherwise deviating from the expected course of action during the course of a surgical procedure. For example, the surgical hub  5104  can be configured to determine the type of surgical procedure being performed, retrieve the corresponding list of steps or order of equipment usage (e.g., from a memory), and then compare the steps being performed or the equipment being used during the course of the surgical procedure to the expected steps or equipment for the type of surgical procedure that the surgical hub  5104  determined is being performed. In one exemplification, the surgical hub  5104  can be configured to provide an alert indicating that an unexpected action is being performed or an unexpected device is being utilized at the particular step in the surgical procedure. 
     Overall, the situational awareness system for the surgical hub  5104  improves surgical procedure outcomes by adjusting the surgical instruments (and other modular devices  5102 ) for the particular context of each surgical procedure (such as adjusting to different tissue types) and validating actions during a surgical procedure. The situational awareness system also improves surgeons’ efficiency in performing surgical procedures by automatically suggesting next steps, providing data, and adjusting displays and other modular devices  5102  in the surgical theater according to the specific context of the procedure. 
       FIG.  82 A  illustrates a logic flow diagram of a process  5000   a  for controlling a modular device  5102  according to contextual information derived from received data, in accordance with at least one aspect of the present disclosure. In other words, a situationally aware surgical hub  5104  can execute the process  5000   a  to determine appropriate control adjustments for modular devices  5102  paired with the surgical hub  5104  before, during, or after a surgical procedure as dictated by the context of the surgical procedure. In the following description of the process  5000   a , reference should also be made to  FIG.  81   . In one exemplification, the process  5000   a  can be executed by a control circuit of a surgical hub  5104 , as depicted in  FIG.  10    (processor 244). In another exemplification, the process  5000   a  can be executed by a cloud computing system  104 , as depicted in  FIG.  1   . In yet another exemplification, the process  5000   a  can be executed by a distributed computing system including at least one of the aforementioned cloud computing system  104  and/or a control circuit of a surgical hub  5104  in combination with a control circuit of a modular device, such as the microcontroller  461  of the surgical instrument depicted in  FIG.  12   , the microcontroller  620  of the surgical instrument depicted in  FIG.  16   , the control circuit  710  of the robotic surgical instrument  700  depicted in  FIG.  17   , the control circuit  760  of the surgical instruments  750 ,  790  depicted in  FIGS.  18  and  19   , or the controller  838  of the generator  800  depicted in  FIG.  20   . For economy, the following description of the process  5000   a  will be described as being executed by the control circuit of a surgical hub  5104 ; however, it should be understood that the description of the process  5000   a  encompasses all of the aforementioned exemplifications. 
     The control circuit of the surgical hub  5104  executing the process  5000   a  receives  5004   a  data from one or more data sources  5126  to which the surgical hub  5104  is communicably connected. The data sources  5126  include, for example, databases  5122 , patient monitoring devices  5124 , and modular devices  5102 . In one exemplification, the databases  5122  can include a patient EMR database associated with the medical facility at which the surgical procedure is being performed. The data received  5004   a  from the data sources  5126  can include perioperative data, which includes preoperative data, intraoperative data, and/or postoperative data associated with the given surgical procedure. The data received  5004   a  from the databases  5122  can include the type of surgical procedure being performed or the patient’s medical history (e.g., medical conditions that may or may not be the subject of the present surgical procedure). In one exemplification depicted in  FIG.  83 A , the control circuit can receive  5004   a  the patient or surgical procedure data by querying the patient EMR database with a unique identifier associated with the patient. The surgical hub  5104  can receive the unique identifier from, for example, a scanner  5128  for scanning the patient’s wristband  5130  encoding the unique identifier associated with the patient when the patient enters the operating theater, as depicted in  FIG.  85 A . In one exemplification, the patient monitoring devices  5124  include BP monitors, EKG monitors, and other such devices that are configured to monitor one or more parameters associated with a patient. As with the modular devices  5102 , the patient monitoring devices  5124  can be paired with the surgical hub  5104  such that the surgical hub  5104  receives  5004   a  data therefrom. In one exemplification, the data received  5004   a  from the modular devices  5102  that are paired with (i.e., communicably coupled to) the surgical hub  5104  includes, for example, activation data (i.e., whether the device is powered on or in use), data of the internal state of the modular device  5102  (e.g., force to fire or force to close for a surgical cutting and stapling device, pressure differential for an insufflator or smoke evacuator, or energy level for an RF or ultrasonic surgical instrument), or patient data (e.g., tissue type, tissue thickness, tissue mechanical properties, respiration rate, or airway volume). 
     As the process  5000   a  continues, the control circuit of the surgical hub  5104  can derive  5006   a  contextual information from the data received  5004   a  from the data sources  5126 . The contextual information can include, for example, the type of procedure being performed, the particular step being performed in the surgical procedure, the patient’s state (e.g., whether the patient is under anesthesia or whether the patient is in the operating room), or the type of tissue being operated on. The control circuit can derive  5006   a  contextual information according to data from ether an individual data source  5126  or combinations of data sources  5126 . Further, the control circuit can derive  5006   a  contextual information according to, for example, the type(s) of data that it receives, the order in which the data is received, or particular measurements or values associated with the data. For example, if the control circuit receives data from an RF generator indicating that the RF generator has been activated, the control circuit could thus infer that the RF electrosurgical instrument is now in use and that the surgeon is or will be performing a step of the surgical procedure utilizing the particular instrument. As another example, if the control circuit receives data indicating that a laparoscope imaging device has been activated and an ultrasonic generator is subsequently activated, the control circuit can infer that the surgeon is on a laparoscopic dissection step of the surgical procedure due to the order in which the events occurred. As yet another example, if the control circuit receives data from a ventilator indicating that the patient’s respiration is below a particular rate, then the control circuit can determine that the patient is under anesthesia. 
     The control circuit can then determine  5008   a  what control adjustments are necessary (if any) for one or more modular devices  5102  according to the derived  5006   a  contextual information. After determining  5008   a  the control adjustments, the control circuit of the surgical hub  5104  can then control  5010   a  the modular devices according to the control adjustments (if the control circuit determined  5008   a  that any were necessary). For example, if the control circuit determines that an arthroscopic procedure is being performed and that the next step in the procedure utilizes an RF or ultrasonic surgical instrument in a liquid environment, the control circuit can determine  5008   a  that a control adjustment for the generator of the RF or ultrasonic surgical instrument is necessary to preemptively increase the energy output of the instrument (because such instruments require increased energy in liquid environments to maintain their effectiveness). The control circuit can then control  5010   a  the generator and/or the RF or ultrasonic surgical instrument accordingly by causing the generator to increase its output and/or causing the RF or ultrasonic surgical instrument to increase the energy drawn from the generator. The control circuit can control  5010   a  the modular devices  5102  according to the determined  5008   a  control adjustment by, for example, transmitting the control adjustments to the particular modular device to update the modular device’s  5102  programming. In another exemplification wherein the modular device(s)  5102  and the surgical hub  5104  are executing a distributed computing architecture, the control circuit can control  5010   a  the modular device  5102  according to the determined  5008   a  control adjustments by updating the distributed program. 
       FIGS.  82 B-D  illustrate representative implementations of the process  5000   a  depicted in  FIG.  82 A . As with the process  5000   a  depicted in  FIG.  82 A , the processes illustrated in  FIGS.  82 B-D  can, in one exemplification, be executed by a control circuit of the surgical hub  5104 .  FIG.  82 B  illustrates a logic flow diagram of a process  5000   b  for controlling a second modular device according to contextual information derived from perioperative data received from a first modular device, in accordance with at least one aspect of the present disclosure. In the illustrated exemplification, the control circuit of the surgical hub  5104  receives  5004   b  perioperative data from a first modular device. The perioperative data can include, for example, data regarding the modular device  5102  itself (e.g., pressure differential, motor current, internal forces, or motor torque) or data regarding the patient with which the modular device  5102  is being utilized (e.g., tissue properties, respiration rate, airway volume, or laparoscopic image data). After receiving  5004   b  the perioperative data, the control circuit of the surgical hub  5104  derives  5006   b  contextual information from the perioperative data. The contextual information can include, for example, the procedure type, the step of the procedure being performed, or the status of the patient. The control circuit of the surgical hub  5104  then determines  5008   b  control adjustments for a second modular device based upon the derived  5006   b  contextual information and then controls  5010   b  the second modular device accordingly. For example, the surgical hub  5104  can receive  5004   b  perioperative data from a ventilator indicating that the patient’s lung has been deflated, derive  5006   b  the contextual information therefrom that the subsequent step in the particular procedure type utilizes a medical imaging device (e.g., a scope), determine  5008   b  that the medical imaging device should be activated and set to a particular magnification, and then control  5010   b  the medical imaging device accordingly. 
       FIG.  82 C  illustrates a logic flow diagram of a process  5000   c  for controlling a second modular device according to contextual information derived from perioperative data received from a first modular device and the second modular device. In the illustrated exemplification, the control circuit of the surgical hub  5104  receives  5002   c  perioperative data from a first modular device and receives  5004   c  perioperative data from a second modular device. After receiving  5002   c ,  5004   c  the perioperative data, the control circuit of the surgical hub  5104  derives  5006   c  contextual information from the perioperative data. The control circuit of the surgical hub  5104  then determines  5008   c  control adjustments for the second modular device based upon the derived  5006   c  contextual information and then controls  5010   c  the second modular device accordingly. For example, the surgical hub  5104  can receive  5002   c  perioperative data from a RF electrosurgical instrument indicating that the instrument has been fired, receive  5004   c  perioperative data from a surgical stapling instrument indicating that the instrument has been fired, derive  5006   c  the contextual information therefrom that the subsequent step in the particular procedure type requires that the surgical stapling instrument be fired with a particular force (because the optimal force to fire can vary according to the tissue type being operated on), determine  5008   c  the particular force thresholds that should be applied to the surgical stapling instrument, and then control  5010   c  the surgical stapling instrument accordingly. 
       FIG.  82 D  illustrates a logic flow diagram of a process  5000   d  for controlling a third modular device according to contextual information derived from perioperative data received from a first modular device and a second modular device. In the illustrated exemplification, the control circuit of the surgical hub  5104  receives  5002   d  perioperative data from a first modular device and receives  5004   d  perioperative data from a second modular device. After receiving  5002   d ,  5004   d  the perioperative data, the control circuit of the surgical hub  5104  derives  5006   d  contextual information from the perioperative data. The control circuit of the surgical hub  5104  then determines  5008   d  control adjustments for a third modular device based upon the derived  5006   d  contextual information and then controls  5010   d  the third modular device accordingly. For example, the surgical hub  5104  can receive  5002   d ,  5004   d  perioperative data from an insufflator and a medical imaging device indicating that both devices have been activated and paired to the surgical hub  5104 , derive  5006   d  the contextual information therefrom that a video-assisted thoracoscopic surgery (VATS) procedure is being performed, determine  5008   d  that the displays connected to the surgical hub  5104  should be set to display particular views or information associated with the procedure type, and then control  5010   d  the displays accordingly. 
       FIG.  83 A  illustrates a diagram of a surgical system  5100  including a surgical hub  5104  communicably coupled to a particular set of data sources  5126 . A surgical hub  5104  including a situational awareness system can utilize the data received from the data sources  5126  to derive contextual information regarding the surgical procedure that the surgical hub  5104 , the modular devices  5102  paired to the surgical hub  5104 , and the patient monitoring devices  5124  paired to the surgical hub  5104  are being utilized in connection with. The inferences (i.e., contextual information) that one exemplification of the situational awareness system can derive from the particular set of data sources  5126  are depicted in dashed boxes extending from the data source(s)  5126  from which they are derived. The contextual information derived from the data sources  5126  can include, for example, what step of the surgical procedure is being performed, whether and how a particular modular device  5102  is being used, and the patient’s condition. 
     In the example illustrated in  FIG.  83 A , the data sources  5126  include a database  5122 , a variety of modular devices  5102 , and a variety of patient monitoring devices  5124 . The surgical hub  5104  can be connected to various databases  5122  to retrieve therefrom data regarding the surgical procedure that is being performed or is to be performed. In one exemplification of the surgical system  5100 , the databases  5122  include an EMR database of a hospital. The data that can be received by the situational awareness system of the surgical hub  5104  from the databases  5122  can include, for example, start (or setup) time or operational information regarding the procedure (e.g., a segmentectomy in the upper right portion of the thoracic cavity). The surgical hub  5104  can derive contextual information regarding the surgical procedure from this data alone or from the combination of this data and data from other data sources  5126 . 
     The surgical hub  5104  can also be connected to (i.e., paired with) a variety of patient monitoring devices  5124 . In one exemplification of the surgical system  5100 , the patient monitoring devices  5124  that can be paired with the surgical hub  5104  can include a pulse oximeter (SpO 2  monitor)  5114 , a BP monitor  5116 , and an EKG monitor  5120 . The perioperative data that can be received by the situational awareness system of the surgical hub  5104  from the patient monitoring devices  5124  can include, for example, the patient’s oxygen saturation, blood pressure, heart rate, and other physiological parameters. The contextual information that can be derived by the surgical hub  5104  from the perioperative data transmitted by the patient monitoring devices  5124  can include, for example, whether the patient is located in the operating theater or under anesthesia. The surgical hub  5104  can derive these inferences from data from the patient monitoring devices  5124  alone or in combination with data from other data sources  5126  (e.g., the ventilator  5118 ). 
     The surgical hub  5104  can also be connected to (i.e., paired with) a variety of modular devices  5102 . In one exemplification of the surgical system  5100 , the modular devices  5102  that can be paired with the surgical hub  5104  can include a smoke evacuator  5106 , a medical imaging device  5108 , an insufflator  5110 , a combined energy generator  5112  (for powering an ultrasonic surgical instrument and/or an RF electrosurgical instrument), and a ventilator  5118 . 
     The medical imaging device  5108  includes an optical component and an image sensor that generates image data. The optical component includes a lens or a light source, for example. The image sensor includes a charge-coupled device (CCD) or a complementary metal-oxide-semiconductor (CMOS), for example. In various exemplifications, the medical imaging device  5108  includes an endoscope, a laparoscope, a thoracoscope, and other such imaging devices. Various additional components of the medical imaging device  5108  are described above. The perioperative data that can be received by the surgical hub  5104  from the medical imaging device  5108  can include, for example, whether the medical imaging device  5108  is activated and a video or image feed. The contextual information that can be derived by the surgical hub  5104  from the perioperative data transmitted by the medical imaging device  5108  can include, for example, whether the procedure is a VATS procedure (based on whether the medical imaging device  5108  is activated or paired to the surgical hub  5104  at the beginning or during the course of the procedure). Furthermore, the image or video data from the medical imaging device  5108  (or the data stream representing the video for a digital medical imaging device  5108 ) can processed by a pattern recognition system or a machine learning system to recognize features (e.g., organs or tissue types) in the field of view (FOV) of the medical imaging device  5108 , for example. The contextual information that can be derived by the surgical hub  5104  from the recognized features can include, for example, what type of surgical procedure (or step thereof) is being performed, what organ is being operated on, or what body cavity is being operated in. 
     In one exemplification depicted in  FIG.  83 B , the smoke evacuator  5106  includes a first pressure sensor P 1  configured to detect the ambient pressure in the operating theater, a second pressure sensor P 2  configured to detect the internal downstream pressure (i.e., the pressure downstream from the inlet), and a third pressure sensor P 3  configured to detect the internal upstream pressure. In one exemplification, the first pressure sensor P 1  can be a separate component from the smoke evacuator  5106  or otherwise located externally to the smoke evacuator  5106 . The perioperative data that can be received by the surgical hub  5104  from the smoke evacuator  5106  can include, for example, whether the smoke evacuator  5106  is activated, pressure readings from each of the sensors P 1 , P 2 , P 3 , and pressure differentials between pairs of the sensors P 1 , P 2 , P 3 . The perioperative data can also include, for example, the type of tissue being operated on (based upon the chemical composition of the smoke being evacuated) and the amount of tissue being cut. The contextual information that can be derived by the surgical hub  5104  from the perioperative data transmitted by the smoke evacuator  5106  can include, for example, whether the procedure being performed is utilizing insufflation. The smoke evacuator  5106  perioperative data can indicate whether the procedure is utilizing insufflation according to the pressure differential between P 3  and P 1 . If the pressure sensed by P 3  is greater than the pressure sensed by P 1  (i.e., P 3  - P 1  &gt; 0), then the body cavity to which the smoke evacuator  5106  is connected is insufflated. If the pressure sensed by P 3  is equal to the pressure sensed by P 1  (i.e., P 3  - P1 = 0), then the body cavity is not insufflated. When the body cavity is not insufflated, the procedure may be an open type of procedure. 
     The insufflator  5110  can include, for example, pressure sensors and current sensors configured to detect internal parameters of the insufflator  5110 . The perioperative data that can be received by the surgical hub  5104  from the insufflator can include, for example, whether the insufflator  5110  is activated and the electrical current drawn by the insufflator’s  5110  pump. The surgical hub  5104  can determine whether the insufflator  5110  is activated by, for example, directly detecting whether the device is powered on, detecting whether there is a pressure differential between an ambient pressure sensor and a pressure sensor internal to the surgical site, or detecting whether the pressure valves of the insufflator  5110  are pressurized (activated) or non-pressurized (deactivated). The contextual information that can be derived by the surgical hub  5104  from the perioperative data transmitted by the insufflator  5110  can include, for example, the type of procedure being performed (e.g., insufflation is utilized in laparoscopic procedures, but not arthroscopic procedures) and what body cavity is being operated in (e.g., insufflation is utilized in the abdominal cavity, but not in the thoracic cavity). In some exemplifications, the inferences derived from the perioperative data received from different modular devices  5102  can be utilized to confirm and/or increase the confidence of prior inferences. For example, if the surgical hub  5104  determines that the procedure is utilizing insufflation because the insufflator  5110  is activated, the surgical hub  5104  can then confirm that inference by detecting whether the perioperative data from the smoke evacuator  5106  likewise indicates that the body cavity is insufflated. 
     The combined energy generator  5112  supplies energy to one or more ultrasonic surgical instruments or RF electrosurgical instruments connected thereto. The perioperative data that can be received by the surgical hub  5104  from the combined energy generator  5112  can include, for example, the mode that the combined energy generator  5112  is set to (e.g., a vessel sealing mode or a cutting/coagulation mode). The contextual information that can be derived by the surgical hub  5104  from the perioperative data transmitted by the combined energy generator  5112  can include, for example, the surgical procedural type (based on the number and types of surgical instruments that are connected to the energy generator  5112 ) and the procedural step that is being performed (because the particular surgical instrument being utilized or the particular order in which the surgical instruments are utilized corresponds to different steps of the surgical procedure). Further, the inferences derived by the surgical hub  5104  can depend upon inferences and/or perioperative data previously received by the surgical hub  5104 . Once the surgical hub  5104  has determined the general category or specific type of surgical procedure being performed, the surgical hub  5104  can determine or retrieve an expected sequence of steps for the surgical procedure and then track the surgeon’s progression through the surgical procedure by comparing the detected sequence in which the surgical instruments are utilized relative to the expected sequence. 
     The perioperative data that can be received by the surgical hub  5104  from the ventilator  5118  can include, for example, the respiration rate and airway volume of the patient. The contextual information that can be derived by the surgical hub  5104  from the perioperative data transmitted by the ventilator  5118  can include, for example, whether the patient is under anesthesia and whether the patient’s lung is deflated. In some exemplifications, certain contextual information can be inferred by the surgical hub  5104  based on combinations of perioperative data from multiple data sources  5126 . For example, the situational awareness system of the surgical hub  5104  can be configured to infer that the patient is under anesthesia when the respiration rate detected by the ventilator  5118 , the blood pressure detected by the BP monitor  5116 , and the heart rate detected by the EKG monitor  5120  fall below particular thresholds. For certain contextual information, the surgical hub  5104  can be configured to only derive a particular inference when the perioperative data from a certain number or all of the relevant data sources  5126  satisfy the conditions for the inference. 
     As can be seen from the particular exemplified surgical system  5100 , the situational awareness system of a surgical hub  5104  can derive a variety of contextual information regarding the surgical procedure being performed from the data sources  5126 . The surgical hub  5104  can utilize the derived contextual information to control the modular devices  5102  and make further inferences about the surgical procedure in combination with data from other data sources  5126 . It should be noted that the inferences depicted in  FIG.  83 A  and described in connection with the depicted surgical system  5100  are merely exemplary and should not be interpreted as limiting in any way. Furthermore, the surgical hub  5104  can be configured to derive a variety of other inferences from the same (or different) modular devices  5102  and/or patient monitoring devices  5124 . In other exemplifications, a variety of other modular devices  5102  and/or patient monitoring devices  5124  can be paired to the surgical hub  5104  in the operating theater and data received from those additional modular devices  5102  and/or patient monitoring devices  5124  can be utilized by the surgical hub  5104  to derive the same or different contextual information about the particular surgical procedure being performed. 
       FIGS.  84 A-J  depict logic flow diagrams for processes for deriving  5008   a ,  5008   b ,  5008   c ,  5008   d  contextual information from various modular devices, as discussed above with respect to the processes  5000   a ,  5000   b ,  5000   c ,  5000   d  depicted in  FIGS.  82 A-D . The derived contextual information in  FIGS.  84 A-C  is the procedure type. The procedure type can correspond to techniques utilized during the surgical procedure (e.g., a segmentectomy), the category of the surgical procedure (e.g., a laparoscopic procedure), the organ, tissue, or other structure being operated on, and other characteristics to identify the particular surgical procedure (e.g., the procedure utilizes insufflation). The derived contextual information in  FIGS.  84 D-G  is the particular step of the surgical procedure that is being performed. The derived contextual information in  FIGS.  84 H-J  is the patient’s status. It can be noted that the patient’s status can also correspond to the particular step of the surgical procedure that is being performed (e.g., determining that the patient’s status has changed from not being under anesthesia to being under anesthesia can indicate that the step of the surgical procedure of placing the patient under anesthesia was carried out by the surgical staff). As with the process  5000   a  depicted in  FIG.  82 A , the processes illustrated in  FIGS.  84 A-J  can, in one exemplification, be executed by a control circuit of the surgical hub  5104 . In the following descriptions of the processes illustrated in  FIGS.  84 A-J , reference should also be made to  FIG.  83 A . 
       FIG.  84 A  illustrates a logic flow diagram of a process  5111  for determining a procedure type according to smoke evacuator  5106  perioperative data. In this exemplification, the control circuit of the surgical hub  5104  executing the process  5111  receives  5113  perioperative data from the smoke evacuator  5106  and then determines  5115  whether the smoke evacuator  5106  is activated based thereon. If the smoke evacuator  5106  is not activated, then the process  5111  continues along the NO branch and the control circuit of the surgical hub  5104  continues monitoring for the receipt of smoke evacuator  5106  perioperative data. If the smoke evacuator  5106  is activated, then the process  5111  continues along the YES branch and the control circuit of the surgical hub  5104  determines  5117  whether there is a pressure differential between an internal upstream pressure sensor P 3  ( FIG.  83 B ) and an external or ambient pressure sensor Pi ( FIG.  83 B ). If there is a pressure differential (i.e., the internal upstream pressure of the smoke evacuator  5106  is greater then the ambient pressure of the operating theater), then the process  5111  continues along the YES branch and the control circuit determines  5119  that the surgical procedure is an insufflation-utilizing procedure. If there is not a pressure differential, then the process  5111  continues along the NO branch and the control circuit determines  5121  that the surgical procedure is not an insufflation-utilizing procedure. 
       FIG.  84 B  illustrates a logic flow diagram of a process  5123  for determining a procedure type according to smoke evacuator  5106 , insufflator  5110 , and medical imaging device  5108  perioperative data. In this exemplification, the control circuit of the surgical hub  5104  executing the process  5123  receives  5125 ,  5127 ,  5129  perioperative data from the smoke evacuator  5106 , insufflator  5110 , and medical imaging device  5108  and then determines  5131  whether all of the devices are activated or paired with the surgical hub  5104 . If all of these devices are not activated or paired with the surgical hub  5104 , then the process  5123  continues along the NO branch and the control circuit determines  5133  that the surgical procedure is not a VATS procedure. If all of the aforementioned devices are activated or paired with the surgical hub  5104 , then the process  5123  continues along the YES branch and the control circuit determines  5135  that the surgical procedure is a VATS procedure. The control circuit can make this determination based upon the fact that al of these devices are required for a VATS procedure; therefore, if not all of these devices are being utilized in the surgical procedure, it cannot be a VATS procedure. 
       FIG.  84 C  illustrates a logic flow diagram of a process  5137  for determining a procedure type according to medical imaging device  5108  perioperative data. In this exemplification, the control circuit of the surgical hub  5104  executing the process  5137  receives  5139  perioperative data from the medical imaging device 5108 and then determines  5141  whether the medical imaging device  5108  is transmitting an image or video feed. If the medical imaging device  5108  is not transmitting an image or video feed, then the process  5137  continues along the NO branch and the control circuit determines  5143  that the surgical procedure is not a VATS procedure. If the medical imaging device  5108  is not transmitting an image or video feed, then the process  5137  continues along the YES branch and the control circuit determines  5145  that the surgical procedure is a VATS procedure. In one exemplification, the control circuit of the surgical hub  5104  can execute the process  5137  depicted in  FIG.  84 C  in combination with the process  5123  depicted in  FIG.  84 B  in order to confirm or increase the confidence in the contextual information derived by both processes  5123 ,  5137 . If there is a discontinuity between the determinations of the processes  5123 ,  5137  (e.g., the medical imaging device  5108  is transmitting a feed, but not all of the requisite devices are paired with the surgical hub  5104 ), then the surgical hub  5104  can execute additional processes to come to a final determination that resolves the discontinuities between the processes  5123 ,  5137  or display an alert or feedback to the surgical staff as to the discontinuity. 
       FIG.  84 D  illustrates a logic flow diagram of a process  5147  for determining a procedural step according to insufflator  5110  perioperative data. In this exemplification, the control circuit of the surgical hub  5104  executing the process  5147  receives  5149  perioperative data from the insufflator  5110  and then determines  5151  whether there is a pressure differential between the surgical site and the ambient environment of the operating theater. In one exemplification, the insufflator  5110  perioperative data can include a surgical site pressure (e.g., the intra-abdominal pressure) sensed by a first pressure sensor associated with the insufflator  5110 , which can be compared against a pressure sensed by a second pressure sensor configured to detect the ambient pressure. The first pressure sensor can be configured to detect an intra-abdominal pressure between 0-10 mmHg, for example. If there is a pressure differential, then the process  5147  continues along the YES branch and the control circuit determines  5153  that an insufflation-utilizing step of the surgical procedure is being performed. If there is not a pressure differential, then the process  5147  continues along the NO branch and the control circuit determines  5155  that an insufflation-utilizing step of the surgical procedure is not being performed. 
       FIG.  84 E  illustrates a logic flow diagram of a process  5157  for determining a procedural step according to energy generator  5112  perioperative data. In this exemplification, the control circuit of the surgical hub  5104  executing the process  5157  receives  5159  perioperative data from the energy generator  5112  and then determines  5161  whether the energy generator  5112  is in the sealing mode. In various exemplifications, the energy generator  5112  can include two modes: a sealing mode corresponding to a first energy level and a cut/coagulation mode corresponding to a second energy level. If the energy generator  5112  is not in the sealing mode, then the process  5157  proceeds along the NO branch and the control circuit determines  5163  that a dissection step of the surgical procedure is being performed. The control circuit can make this determination  5163  because if the energy generator  5112  is not on the sealing mode, then it must thus be on the cut/coagulation mode for energy generators  5112  having two modes of operation. The cut/coagulation mode of the energy generator  5112  corresponds to a dissection procedural step because it provides an appropriate degree of energy to the ultrasonic surgical instrument or RF electrosurgical instrument to dissect tissue. If the energy generator  5112  is in the sealing mode, then the process  5157  proceeds along the YES branch and the control circuit determines  5165  that a ligation step of the surgical procedure is being performed. The sealing mode of the energy generator  5112  corresponds to a ligation procedural step because it provides an appropriate degree of energy to the ultrasonic surgical instrument or RF electrosurgical instrument to ligate vessels. 
       FIG.  84 F  illustrates a logic flow diagram of a process  5167  for determining a procedural step according to energy generator  5112  perioperative data. In various aspects, previously received perioperative data and/or previously derived contextual information can also be considered by processes in deriving subsequent contextual information. This allows the situational awareness system of the surgical hub  5104  to derive additional and/or increasingly detailed contextual information about the surgical procedure as the procedure is performed. In this exemplification, the process  5167  determines  5169  that a segmentectomy procedure is being performed. This contextual information can be derived by this process  5167  or other processes based upon other received perioperative data and/or retrieved from a memory. Subsequently, the control circuit receives  5171  perioperative data from the energy generator  5112  indicating that a surgical instrument is being fired and then determines  5173  whether the energy generator  5112  was utilized in a previous step of the procedure to fire the surgical instrument. The control circuit can determine  5173  whether the energy generator  5112  was previously utilized in a prior step of the procedure by retrieving a list of the steps that have been performed in the current surgical procedure from a memory, for example. In such exemplifications, when the surgical hub  5104  determines that a step of the surgical procedure has been performed or completed by the surgical staff, the surgical hub  5104  can update a list of the procedural steps that have been performed, which can then be subsequently retrieved by the control circuit of the surgical hub  5104 . In one exemplification, the surgical hub  5104  can distinguish between sequences of firings of the surgical instrument as corresponding to separate steps of the surgical procedure according to the time delay between the sequences of firings, whether any intervening actions were taken or modular devices  5102  were utilized by the surgical staff, or other factors that the situational awareness system can detect. If the energy generator  5112  has not been previously utilized during the course of the segmentectomy procedure, the process  5167  proceeds along the NO branch and the control circuit determines  5175  that the step of dissecting tissue to mobilize the patient’s lungs is being performed by the surgical staff. If the energy generator  5112  has been previously utilized during the course of the segmentectomy procedure, the process  5167  proceeds along the YES branch and the control circuit determines  5177  that the step of dissecting nodes is being performed by the surgical staff. An ultrasonic surgical instrument or RF electrosurgical instrument is utilized twice during the course of an example of a segmentectomy procedure (e.g.,  FIG.  86   ); therefore, the situational awareness system of the surgical hub  5104  executing the process  5167  can distinguish between which step the utilization of the energy generator  5112  indicates is currently being performed based upon whether the energy generator  5112  was previously utilized. 
       FIG.  84 G  illustrates a logic flow diagram of a process  5179  for determining a procedural step according to stapler perioperative data. As described above with respect to the process  5167  illustrated in  FIG.  84 F , the process  5179  utilizes previously received perioperative data and/or previously derived contextual information in deriving subsequent contextual information. In this exemplification, the process  5179  determines  5181  that a segmentectomy procedure is being performed. This contextual information can be derived by this process  5179  or other processes based upon other received perioperative data and/or retrieved from a memory. Subsequently, the control circuit receives  5183  perioperative data from the surgical stapling instrument (i.e., stapler) indicating that the surgical stapling instrument is being fired and then determines  5185  whether the surgical stapling instrument was utilized in a previous step of the surgical procedure. As described above, the control circuit can determine  5185  whether the surgical stapling instrument was previously utilized in a prior step of the procedure by retrieving a list of the steps that have been performed in the current surgical procedure from a memory, for example. If the surgical stapling instrument has not been utilized previously, then the process  5179  proceeds along the NO branch and the control circuit determines  5187  that the step of ligating arteries and veins is being performed by the surgical staff. If the surgical stapling instrument has been previously utilized during the course of the segmentectomy procedure, the process  5179  proceeds along the YES branch and the control circuit determines  5189  that the step of transecting parenchyma is being performed by the surgical staff. A surgical stapling instrument is utilized twice during the course of an example of a segmentectomy procedure (e.g.,  FIG.  86   ); therefore, the situational awareness system of the surgical hub  5104  executing the process  5179  can distinguish between which step the utilization of the surgical stapling instrument indicates is currently being performed based upon whether the surgical stapling instrument was previously utilized. 
       FIG.  84 H  illustrates a logic flow diagram of a process  5191  for determining a patient status according to ventilator  5110 , pulse oximeter  5114 , BP monitor  5116 , and/or EKG monitor  5120  perioperative data. In this exemplification, the control circuit of the surgical hub  5104  executing the process  5191  receives  5193 ,  5195 ,  5197 ,  5199  perioperative data from each of the ventilator  5110 , pulse oximeter  5114 , BP monitor  5116 , and/or EKG monitor  5120  and then determines whether one or more values of the physiological parameters sensed by each of the devices fall below a threshold for each of the physiological parameters. The threshold for each physiological parameter can correspond to a value that corresponds to a patient being under anesthesia. In other words, the control circuit determines  5201  whether the patient’s respiration rate, oxygen saturation, blood pressure, and/or heart rate indicate that the patient is under anesthesia according data sensed by the respective modular device  5102  and/or patient monitoring devices  5124 . In one exemplification, if the all of the values from the perioperative data are below their respective thresholds, then the process  5191  proceeds along the YES branch and the control circuit determines  5203  that the patient is under anesthesia. In another exemplification, the control circuit can determine  5203  that the patient is under anesthesia if a particular number or ratio of the monitored physiological parameters indicate that the patient is under anesthesia. Otherwise, the process  5191  proceeds along the NO branch and the control circuit determines  5205  that the patient is not under anesthesia. 
       FIG.  84 I  illustrates a logic flow diagram of a process  5207  for determining a patient status according to pulse oximeter  5114 , BP monitor  5116 , and/or EKG monitor  5120  perioperative data. In this exemplification, the control circuit of the surgical hub  5104  executing the process  5207  receives  5209 ,  5211 ,  5213  (or attempts to receive) perioperative data the pulse oximeter  5114 , BP monitor  5116 , and/or EKG monitor  5120  and then determines  5215  whether at least one of the devices is paired with the surgical hub  5104  or the surgical hub  5104  is otherwise receiving data therefrom. If the control circuit is receiving data from at least one of these patient monitoring devices  5124 , the process  5207  proceeds along the YES branch and the control circuit determines  5217  that the patient is in the operating theater. The control circuit can make this determination because the patient monitoring devices  5214  connected to the surgical hub  5104  must be in the operating theater and thus the patient must likewise be in the operating theater. If the control circuit is not receiving data from at least one of these patient monitoring devices  5124 , the process  5207  proceeds along the NO branch and the control circuit determines  5219  that the patient is not in the operating theater. 
       FIG.  84 J  illustrates a logic flow diagram of a process  5221  for determining a patient status according to ventilator  5110  perioperative data. In this exemplification, the control circuit of the surgical hub  5104  executing the process  5221  receives  5223  perioperative data from the ventilator  5110  and then determines  5225  whether the patient’s airway volume has decreased or is decreasing. In one exemplification, the control circuit determines  5225  whether the patient’s airway volume falls below a particular threshold value indicative of a lung having collapsed or been deflated. In another exemplification, the control circuit determines  5225  whether the patient’s airway volume falls below an average or baseline level by a threshold amount. If the patient’s airway volume has not decreased sufficiently, the process  5221  proceeds along the NO branch and the control circuit determines  5227  that the patient’s lung is not deflated. If the patient’s airway volume has decreased sufficiently, the process  5221  proceeds along the YES branch and the control circuit determines  5229  that the patient’s lung is not deflated. 
     In one exemplification, the surgical system  5100  can further include various scanners that can be paired with the surgical hub  5104  to detect and record objects and individuals that enter and exit the operating theater.  FIG.  85 A  illustrates a scanner  5128  paired with a surgical hub  5104  that is configured to scan a patient wristband  5130 . In one aspect, the scanner  5128  includes, for example, a barcode reader or a radio-frequency identification (RFID) reader that is able to read patient information from the patient wristband  5130  and then transmit that information to the surgical hub  5104 . The patient information can include the surgical procedure to be performed or identifying information that can be cross-referenced with the hospital’s EMR database  5122  by the surgical hub  5104 , for example.  FIG.  85 B  illustrates a scanner  5132  paired with a surgical hub  5104  that is configured to scan a product list  5134  for a surgical procedure. The surgical hub  5104  can utilize data from the scanner  5132  regarding the number, type, and mix of items to be used in the surgical procedure to identify the type of surgical procedure being performed. In one exemplification, the scanner  5132  includes a product scanner (e.g., a barcode reader or an RFID reader) that is able to read the product information (e.g., name and quantity) from the product itself or the product packaging as the products are brought into the operating theater and then transmit that information to the surgical hub  5104 . In another exemplification, the scanner  5132  includes a camera (or other visualization device) and associated optical character recognition software that is able to read the product information from a product list  5134 . The surgical hub  5104  can be configured to cross-reference the list of items indicated by the received data with a lookup table or database of items utilized for various types of surgical procedures in order to infer the particular surgical procedure that is to be (or was) performed. As shown in  FIG.  85 B , the illustrative product list  5134  includes ring forceps, rib spreaders, a powered vascular stapler (PVS), and a thoracic wound protector. In this example, the surgical hub  5104  can infer that the surgical procedure is a thoracic procedure from this data since these products are only utilized in thoracic procedures. In sum, the scanner(s)  5128 ,  5132  can provide serial numbers, product lists, and patient information to the surgical hub  5104 . Based on this data regarding what devices and instruments are being utilized and the patient’s medical information, the surgical hub  5104  can determine additional contextual information regarding the surgical procedure. 
     In order to assist in the understanding of the process  5000   a  illustrated in  FIG.  82 A  and the other concepts discussed above,  FIG.  86    illustrates a timeline  5200  of an illustrative surgical procedure and the contextual information that a surgical hub  5104  can derive from the data received from the data sources  5126  at each step in the surgical procedure. In the following description of the timeline  5200  illustrated in  FIG.  86   , reference should also be made to  FIG.  81   . The timeline  5200  depicts the typical steps that would be taken by the nurses, surgeons, and other medical personnel during the course of a lung segmentectomy procedure, beginning with setting up the operating theater and ending with transferring the patient to a post-operative recovery room. The situationally aware surgical hub  5104  receives data from the data sources  5126  throughout the course of the surgical procedure, including data generated each time medical personnel utilize a modular device  5102  that is paired with the surgical hub  5104 . The surgical hub  5104  can receive this data from the paired modular devices  5102  and other data sources  5126  and continually derive inferences (i.e., contextual information) about the ongoing procedure as new data is received, such as which step of the procedure is being performed at any given time. The situational awareness system of the surgical hub  5104  is able to, for example, record data pertaining to the procedure for generating reports (e.g., see  FIGS.  90 - 101   ), verify the steps being taken by the medical personnel, provide data or prompts (e.g., via a display screen) that may be pertinent for the particular procedural step, adjust modular devices  5102  based on the context (e.g., activate monitors, adjust the FOV of the medical imaging device, or change the energy level of an ultrasonic surgical instrument or RF electrosurgical instrument), and take any other such action described above. 
     As the first step  5202  in this illustrative procedure, the hospital staff members retrieve the patient’s EMR from the hospital’s EMR database. Based on select patient data in the EMR, the surgical hub  5104  determines that the procedure to be performed is a thoracic procedure. Second  5204 , the staff members scan the incoming medical supplies for the procedure. The surgical hub  5104  cross-references the scanned supplies with a list of supplies that are utilized in various types of procedures and confirms that the mix of supplies corresponds to a thoracic procedure (e.g., as depicted in  FIG.  85 B ). Further, the surgical hub  5104  is also able to determine that the procedure is not a wedge procedure (because the incoming supplies either lack certain supplies that are necessary for a thoracic wedge procedure or do not otherwise correspond to a thoracic wedge procedure). Third  5206 , the medical personnel scan the patient band (e.g., as depicted in  FIG.  85 A ) via a scanner  5128  that is communicably connected to the surgical hub  5104 . The surgical hub  5104  can then confirm the patient’s identity based on the scanned data. Fourth  5208 , the medical staff turns on the auxiliary equipment. The auxiliary equipment being utilized can vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, insufflator, and medical imaging device. When activated, the auxiliary equipment that are modular devices  5102  can automatically pair with the surgical hub  5104  that is located within a particular vicinity of the modular devices  5102  as part of their initialization process. The surgical hub  5104  can then derive contextual information about the surgical procedure by detecting the types of modular devices  5102  that pair with it during this pre-operative or initialization phase. In this particular example, the surgical hub  5104  determines that the surgical procedure is a VATS procedure based on this particular combination of paired modular devices  5102 . Based on the combination of the data from the patient’s EMR, the list of medical supplies to be used in the procedure, and the type of modular devices  5102  that connect to the hub, the surgical hub  5104  can generally infer the specific procedure that the surgical team will be performing. Once the surgical hub  5104  knows what specific procedure is being performed, the surgical hub  5104  can then retrieve the steps of that procedure from a memory or from the cloud and then cross-reference the data it subsequently receives from the connected data sources  5126  (e.g., modular devices  5102  and patient monitoring devices  5124 ) to infer what step of the surgical procedure the surgical team is performing. Fifth  5210 , the staff members attach the EKG electrodes and other patient monitoring devices  5124  to the patient. The EKG electrodes and other patient monitoring devices  5124  are able to pair with the surgical hub  5104 . As the surgical hub  5104  begins receiving data from the patient monitoring devices  5124 , the surgical hub  5104  thus confirms that the patient is in the operating theater, as described in the process  5207  depicted in  FIG.  84 I , for example. Sixth  5212 , the medical personnel induce anesthesia in the patient. The surgical hub  5104  can infer that the patient is under anesthesia based on data from the modular devices  5102  and/or patient monitoring devices  5124 , including EKG data, blood pressure data, ventilator data, or combinations thereof, as described in the process  5191  depicted in  FIG.  84 H , for example. Upon completion of the sixth step  5212 , the pre-operative portion of the lung segmentectomy procedure is completed and the operative portion begins. 
     Seventh  5214 , the patient’s lung that is being operated on is collapsed (while ventilation is switched to the contralateral lung). The surgical hub  5104  can infer from the ventilator data that the patient’s lung has been collapsed, as described in the process  5221  depicted in  FIG.  84 J , for example. The surgical hub  5104  can infer that the operative portion of the procedure has commenced as it can compare the detection of the patient’s lung collapsing to the expected steps of the procedure (which can be accessed or retrieved previously) and thereby determine that collapsing the lung is the first operative step in this particular procedure. Eighth  5216 , the medical imaging device  5108  (e.g., a scope) is inserted and video from the medical imaging device is initiated. The surgical hub  5104  receives the medical imaging device data (i.e., video or image data) through its connection to the medical imaging device. Upon receipt of the medical imaging device data, the surgical hub  5104  can determine that the laparoscopic portion of the surgical procedure has commenced. Further, the surgical hub  5104  can determine that the particular procedure being performed is a segmentectomy, as opposed to a lobectomy (note that a wedge procedure has already been discounted by the surgical hub  5104  based on data received at the second step  5204  of the procedure). The data from the medical imaging device  124  ( FIG.  2   ) can be utilized to determine contextual information regarding the type of procedure being performed in a number of different ways, including by determining the angle at which the medical imaging device is oriented with respect to the visualization of the patient’s anatomy, monitoring the number or medical imaging devices being utilized (i.e., that are activated and paired with the surgical hub  5104 ), and monitoring the types of visualization devices utilized. For example, one technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient’s chest cavity above the diaphragm, whereas one technique for performing a VATS segmentectomy places the camera in an anterior intercostal position relative to the segmental fissure. Using pattern recognition or machine learning techniques, for example, the situational awareness system can be trained to recognize the positioning of the medical imaging device according to the visualization of the patient’s anatomy. As another example, one technique for performing a VATS lobectomy utilizes a single medical imaging device, whereas another technique for performing a VATS segmentectomy utilizes multiple cameras. As yet another example, one technique for performing a VATS segmentectomy utilizes an infrared light source (which can be communicably coupled to the surgical hub as part of the visualization system) to visualize the segmental fissure, which is not utilized in a VATS lobectomy. By tracking any or all of this data from the medical imaging device  5108 , the surgical hub 5104 can thereby determine the specific type of surgical procedure being performed and/or the technique being used for a particular type of surgical procedure. 
     Ninth  5218 , the surgical team begins the dissection step of the procedure. The surgical hub  5104  can infer that the surgeon is in the process of dissecting to mobilize the patient’s lung because it receives data from the RF or ultrasonic generator indicating that an energy instrument is being fired. The surgical hub  5104  can cross-reference the received data with the retrieved steps of the surgical procedure to determine that an energy instrument being fired at this point in the process (i.e., after the completion of the previously discussed steps of the procedure) corresponds to the dissection step. Tenth  5220 , the surgical team proceeds to the ligation step of the procedure. The surgical hub  5104  can infer that the surgeon is ligating arteries and veins because it receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similarly to the prior step, the surgical hub  5104  can derive this inference by cross-referencing the receipt of data from the surgical stapling and cutting instrument with the retrieved steps in the process. Eleventh  5222 , the segmentectomy portion of the procedure is performed. The surgical hub  5104  can infer that the surgeon is transecting the parenchyma based on data from the surgical stapling and cutting instrument, including data from its cartridge. The cartridge data can correspond to the size or type of staple being fired by the instrument, for example. As different types of staples are utilized for different types of tissues, the cartridge data can thus indicate the type of tissue being stapled and/or transected. In this case, the type of staple being fired is utilized for parenchyma (or other similar tissue types), which allows the surgical hub  5104  to infer that the segmentectomy portion of the procedure is being performed. Twelfth  5224 , the node dissection step is then performed. The surgical hub  5104  can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator indicating that an RF or ultrasonic instrument is being fired. For this particular procedure, an RF or ultrasonic instrument being utilized after parenchyma was transected corresponds to the node dissection step, which allows the surgical hub  5104  to make this inference. It should be noted that surgeons regularly switch back and forth between surgical stapling/cutting instruments and surgical energy (i.e., RF or ultrasonic) instruments depending upon the particular step in the procedure because different instruments are better adapted for particular tasks. Therefore, the particular sequence in which the stapling/cutting instruments and surgical energy instruments are used can indicate what step of the procedure the surgeon is performing. Upon completion of the twelfth step  5224 , the incisions and closed up and the post-operative portion of the procedure begins. 
     Thirteenth  5226 , the patient’s anesthesia is reversed. The surgical hub  5104  can infer that the patient is emerging from the anesthesia based on the ventilator data (i.e., the patient’s breathing rate begins increasing), for example. Lastly, the fourteenth step  5228  is that the medical personnel remove the various patient monitoring devices  5124  from the patient. The surgical hub  5104  can thus infer that the patient is being transferred to a recovery room when the hub loses EKG, BP, and other data from the patient monitoring devices  5124 . As can be seen from the description of this illustrative procedure, the surgical hub  5104  can determine or infer when each step of a given surgical procedure is taking place according to data received from the various data sources  5126  that are communicably coupled to the surgical hub  5104 . 
     In addition to utilizing the patient data from EMR database(s) to infer the type of surgical procedure that is to be performed, as illustrated in the first step  5202  of the timeline  5200  depicted in  FIG.  86   , the patient data can also be utilized by a situationally aware surgical hub  5104  to generate control adjustments for the paired modular devices  5102 .  FIG.  87 A  illustrates a flow diagram depicting the process  5240  of importing patient data stored in an EMR database  5250  and deriving inferences  5256  therefrom, in accordance with at least one aspect of the present disclosure. Further,  FIG.  87 B  illustrates a flow diagram depicting the process  5242  of determining control adjustments  5264  corresponding to the derived inferences  5256  from  FIG.  87 A , in accordance with at least one aspect of the present disclosure. In the following description of the processes  5240 ,  5242 , reference should also be made to  FIG.  81   . 
     As shown in  FIG.  87 A , the surgical hub  5104  retrieves the patient information (e.g., EMR) stored in a database  5250  to which the surgical hub  5104  is communicably connected. The unredacted portion of the patient data is removed  5252  from the surgical hub  5104 , leaving anonymized, stripped patient data  5254  related to the patient’s condition and/or the surgical procedure to be performed. The unredacted patient data is removed  5252  in order to maintain patient anonymity for the processing of the data (including if the data is uploaded to the cloud for processing and/or data tracking for reports). The stripped patient data  5254  can include any medical conditions that the patient is suffering from, the patient’s medical history (including previous treatments or procedures), medication that the patient is taking, and other such medically relevant details. The control circuit of the surgical hub  5104  can then derive various inferences  5256  from the stripped patient data  5254 , which can in turn be utilized by the surgical hub  5104  to derive various control adjustments for the paired modular devices  5102 . The derived inferences  5256  can be based upon individual pieces of data or combinations of pieces of data. Further, the derived inferences  5256  may, in some cases, be redundant with each other as some data may lead to the same inference. By integrating each patient’s stripped patient data  5254  into the situational awareness system, the surgical hub  5104  is thus able to generate pre-procedure adjustments to optimally control each of the modular devices  5102  based on the unique circumstances associated with each individual patient. In the illustrated example, the stripped patient data  5254  includes that (i) the patient is suffering from emphysema, (ii) has high blood pressure, (iii) is suffering from a small cell lung cancer, (iv) is taking warfarin (or another blood thinner), and/or (v) has received radiation pretreatment. In the illustrated example, the inferences  5256  derived from the stripped patient data  5254  include that (i) the lung tissue will be more fragile than normal lung tissue, (ii) hemostasis issues are more likely, (iii) the patient is suffering from a relatively aggressive cancer, (iv) hemostasis issues are more likely, and (v) the lung tissue will be stiffer and more prone to fracture, respectively. 
     After the control circuit of the surgical hub  5104  receives or identifies the implications  5256  that are derived from anonymized patient data, the control circuit of the surgical hub  5104  is configured to execute a process  5242  to control the modular devices  5102  in a manner consistent with the derived implications  5256 . In the example shown in  FIG.  87 B , the control circuit of the surgical hub  5104  interprets how the derived implications  5256  impacts the modular devices  5102  and then communicates corresponding control adjustments to each of the modular devices  5102 . In the example shown in  FIG.  87 B , the control adjustments include (i) adjusting the compression rate threshold parameter of the surgical stapling and cutting instrument, (ii) adjusting the visualization threshold value of the surgical hub  5104  to quantify bleeding via the visualization system  108  ( FIG.  2   ) (this adjustment can apply to the visualization system  108  itself or as an internal parameter of the surgical hub  5104 ), (iii) adjusts the power and control algorithms of the combo generator module  140  ( FIG.  3   ) for the lung tissue and vessel tissue types, (iv) adjusts the margin ranges of the medical imaging device  124  ( FIG.  2   ) to account for the aggressive cancer type, (v) notifies the surgical stapling and cutting instrument of the margin parameter adjustment needed (the margin parameter corresponds to the distance or amount of tissue around the cancer that will be excised), and (vi) notifies the surgical stapling and cutting instrument that the tissue is potentially fragile, which causes the control algorithm of the surgical stapling and cutting instrument to adjust accordingly. Furthermore, the data regarding the implications  5256  derived from the anonymized patient data  5254  is considered by the situational awareness system to infer contextual information  5260  regarding the surgical procedure being performed. In the example shown in  FIG.  87 B , the situational awareness system further infers that the procedure is a thoracic lung resection  5262 , e.g., segmentectomy. 
     Determining where inefficiencies or ineffectiveness may reside in a medical facility’s practice can be challenging because medical personnel’s efficiency in completing a surgical procedure, correlating positive patient outcomes with particular surgical teams or particular techniques in performing a type of surgical procedure, and other performance measures are not easily quantified using legacy systems. As one solution, the surgical hubs can be employed to track and store data pertaining to the surgical procedures that the surgical hubs are being utilized in connection with and generate reports or recommendations related to the tracked data. The tracked data can include, for example, the length of time spent during a particular procedure, the length of time spent on a particular step of a particular procedure, the length of downtime between procedures, modular device(s) (e.g., surgical instruments) utilized during the course of a procedure, and the number and type of surgical items consumed during a procedure (or step thereof). Further, the tracked data can include, for example, the operating theater in which the surgical hub is located, the medical personnel associated with the particular event (e.g., the surgeon or surgical team performing the surgical procedure), the day and time at which the particular event(s) occurred, and patient outcomes. This data can be utilized to create performance metrics, which can be utilized to detect and then ultimately address inefficiencies or ineffectiveness within a medical facility’s practice. In one exemplification, the surgical hub includes a situational awareness system, as described above, that is configured to infer or determine information regarding a particular event (e.g., when a particular step of a surgical procedure is being performed and/or how long the step took to complete) based on data received from data sources connected to the surgical hub (e.g., paired modular devices). The surgical hub can then store this tracked data to provide reports or recommendations to users. 
     Aggregation and Reporting of Surgical Hub Data 
       FIG.  88    illustrates a block diagram of a computer-implemented interactive surgical system  5700 , in accordance with at least one aspect of the present disclosure. The system  5700  includes a number of surgical hubs  5706  that, as described above, are able to detect and track data related to surgical procedures that the surgical hubs  5706  (and the modular devices paired to the surgical hubs  5706 ) are utilized in connection with. In one exemplification, the surgical hubs  5706  are connected to form local networks such that the data being tracked by the surgical hubs  5706  is aggregated together across the network. The networks of surgical hubs  5706  can be associated with a medical facility, for example. The data aggregated from the network of surgical hubs  5706  can be analyzed to provide reports on data trends or recommendations. For example, the surgical hubs  5706  of a first medical facility  5704   a  are communicably connected to a first local database  5708   a  and the surgical hubs  5706  of a second medical facility  5704   b  are communicably connected to a second local database  5708   b . The network of surgical hubs  5706  associated with the first medical facility  5704   a  can be distinct from the network of surgical hubs  5706  associated with the second medical facility  5704   b , such that the aggregated data from each network of surgical hubs  5706  corresponds to each medical facility  5704   a ,  5704   b  individually. A surgical hub  5706  or another computer terminal communicably connected to the database  5708   a ,  5708   b  can be configured to provide reports or recommendations based on the aggregated data associated with the respective medical facility  5704   a ,  5704   b . In this exemplification, the data tracked by the surgical hubs  5706  can be utilized to, for example, report whether a particular incidence of a surgical procedure deviated from the average in-network time to complete the particular procedure type. 
     In another exemplification, each surgical hub  5706  is configured to upload the tracked data to the cloud  5702 , which then processes and aggregates the tracked data across multiple surgical hubs  5706 , networks of surgical hubs  5706 , and/or medical facilities  5704   a ,  5704   b  that are connected to the cloud  5702 . Each surgical hub  5706  can then be utilized to provide reports or recommendations based on the aggregated data. In this exemplification, the data tracked by the surgical hubs  5706  can be utilized to, for example, report whether a particular incidence of a surgical procedure deviated from the average global time to complete the particular procedure type. 
     In another exemplification, each surgical hub  5706  can further be configured to access the cloud  5702  to compare locally tracked data to global data aggregated from all of the surgical hubs  5706  that are communicably connected to the cloud  5702 . Each surgical hub  5706  can be configured to provide reports or recommendations based on the comparison between the tracked local data relative to local (i.e., in-network) or global norms. In this exemplification, the data tracked by the surgical hubs  5706  can be utilized to, for example, report whether a particular incidence of a surgical procedure deviated from either the average in-network time or the average global time to complete the particular procedure type. 
     In one exemplification, each surgical hub  5706  or another computer system local to the surgical hub  5706  is configured to locally aggregate the data tracked by the surgical hubs  5706 , store the tracked data, and generate reports and/or recommendations according to the tracked data in response to queries. In cases where the surgical hub  5706  is connected to a medical facility network (which may include additional surgical hubs  5706 ), the surgical hub  5706  can be configured to compare the tracked data with the bulk medical facility data. The bulk medical facility data can include EMR data and aggregated data from the local network of surgical hubs  5706 . In another exemplification, the cloud  5702  is configured to aggregate the data tracked by the surgical hubs  5706 , store the tracked data, and generate reports and/or recommendations according to the tracked data in response to queries. 
     Each surgical hub  5706  can provide reports regarding trends in the data and/or provide recommendations on improving the efficiency or effectiveness of the surgical procedures being performed. In various exemplifications, the data trends and recommendations can be based on data tracked by the surgical hub  5706  itself, data tracked across a local medical facility network containing multiple surgical hubs  5706 , or data tracked across a number of surgical hubs  5706  communicably connected to a cloud  5702 . The recommendations provided by the surgical hub  5706  can describe, for example, particular surgical instruments or product mixes to utilize for particular surgical procedures based on correlations between the surgical instruments/product mixes and patient outcomes and procedural efficiency. The reports provided by the surgical hub  5706  can describe, for example, whether a particular surgical procedure was performed efficiently relative to local or global norms, whether a particular type of surgical procedure being performed at the medical facility is being performed efficiently relative to global norms, and the average time taken to complete a particular surgical procedure or step of a surgical procedure for a particular surgical team. 
     In one exemplification, each surgical hub  5706  is configured to determine when operating theater events occur (e.g., via a situational awareness system) and then track the length of time spent on each event. An operating theater event is an event that a surgical hub  5706  can detect or infer the occurrence of. An operating theater event can include, for example, a particular surgical procedure, a step or portion of a surgical procedure, or downtime between surgical procedures. The operating theater events can be categorized according to an event type, such as a type of surgical procedure being performed, so that the data from individual procedures can be aggregated together to form searchable data sets.  FIG.  90    illustrates an example of a diagram  5400  depicting the data tracked by the surgical hubs  5706  being parsed to provide increasingly detailed metrics related to surgical procedures or the use of the surgical hub  5706  (as depicted further in  FIGS.  91 - 95   ) for an illustrative data set. In one exemplification, the surgical hub  5706  is configured to determine whether a surgical procedure is being performed and then track both the length of time spent between procedures (i.e., downtime) and the time spent on the procedures themselves. The surgical hub  5706  can further be configured to determine and track the time spent on each of the individual steps taken by the medical personnel (e.g., surgeons, nurses, orderlies) either between or during the surgical procedures. The surgical hub can determine when surgical procedures or different steps of surgical procedures are being performed via a situational awareness system, which is described in further detail above. 
       FIG.  89    illustrates a logic flow diagram of a process  5300  for tracking data associated with an operating theater event. In the following description, description of the process  5300 , reference should also be made to  FIG.  88   . In one exemplification, the process  5300  can be executed by a control circuit of a surgical hub  206 , as depicted in  FIG.  10    (processor  244 ). In yet another exemplification, the process  5300  can be executed by a distributed computing system including a control circuit of a surgical hub  206  in combination with a control circuit of a modular device, such as the microcontroller  461  of the surgical instrument depicted  FIG.  12   , the microcontroller  620  of the surgical instrument depicted in  FIG.  16   , the control circuit  710  of the robotic surgical instrument  700  depicted in  FIG.  17   , the control circuit  760  of the surgical instruments  750 ,  790  depicted in  FIGS.  18  and  19   , or the controller  838  of the generator  800  depicted in  FIG.  20   . For economy, the following description of the process  5300  will be described as being executed by the control circuit of a surgical hub  5706 ; however, it should be understood that the description of the process  5300  encompasses all of the aforementioned exemplifications. 
     The control circuit of the surgical hub  5706  executing the process  5300  receives  5302  perioperative data from the modular devices and other data sources (e.g., databases and patient monitoring devices) that are communicably coupled to the surgical hub  5706 . The control circuit then determines  5304  whether an event has occurred via, for example, a situational awareness system that derives contextual information from the received  5302  data. The event can be associated with an operating theater in which the surgical hub  5706  in being used. The event can include, for example, a surgical procedure, a step or portion of a surgical procedure, or downtime between surgical procedures or steps of a surgical procedure. Furthermore, the control circuit tracks data associated with the particular event, such as the length of time of the event, the surgical instruments and/or other medical products utilized during the course of the event, and the medical personnel associated with the event. The surgical hub  5706  can further determine this information regarding the event via, for example, the situational awareness system. 
     For example, the control circuit of a situationally aware surgical hub  5706  could determine that anesthesia is being induced in a patient through data received from one or more modular devices  5102  ( FIG.  81   ) and/or patient monitoring devices  5124  ( FIG.  81   ). The control circuit could then determine that the operative portion of the surgical procedure has begun upon detecting that an ultrasonic surgical instrument or RF electrosurgical instrument has been activated. The control circuit could thus determine the length of time for the anesthesia inducement step according to the difference in time between the beginning of that particular step and the beginning of the first step in the operative portion of the surgical procedure. Likewise, the control circuit could determine how long the particular operative step in the surgical procedure took according to when the control circuit detects the subsequent step in the procedure begins. Further, the control circuit could determine how long the overall operative portion of the surgical procedure took according to when the control circuit detects that the final operative step in the procedure ends. The control circuit can also determine what surgical instruments (and other modular devices  5102 ) are being utilized during the course of each step in the surgical procedure by tracking the activation and/or use of the instruments during each of the steps. The control circuit can also detect the completion of the surgical procedure by, for example, detecting when the patient monitoring devices  5124  have been removed from the patient (as in step fourteen  5228  of  FIG.  86   ). The control circuit can then track the downtime between procedures according to when the control circuit infers that the subsequent surgical procedure has begun. 
     The control circuit executing the process  5300  then aggregates  5306  the data associated with the event according to the event type. In one exemplification, the aggregated  5306  data can be stored in a memory  249  ( FIG.  10   ) of the surgical hub  5706 . In another exemplification, the control circuit is configured to upload the data associated with the event to the cloud  5702 , whereupon the data is aggregated  5306  according to the event type for all of the data uploaded by each of the surgical hubs  5706  connected to the cloud  5702 . In yet another exemplification, the control circuit is configured to upload the data associated with the event to a database associated with a local network of the surgical hubs  5706 , whereupon the data is aggregated  5306  according to the event type for all of the data uploaded across the local network of surgical hubs  5706 . 
     In one exemplification, the control circuit is further configured to compare the data associated with the event type to baseline data associated with the event type. The baseline data can correspond to, for example, average values associated with the particular event type for a particular hospital, network of hospitals, or across the entirety of the cloud  5702 . The baseline data can be stored on the surgical hub  5706  or retrieved by the surgical  5706  as the perioperative data is received  5302  thereby. 
     Aggregating  5306  the data from each of the events according to the event type allows individual incidents of the event type to thereafter be compared against the historical or aggregated data to determine when deviations from the norm for an event type occur. The control circuit further determines  5308  whether it has received a query. If the control circuit does not receive a query, then the process  5300  continues along the NO branch and loops back to continue receiving  5302  data from the data sources. If the control circuit does receive a query for a particular event type, the process  5300  continues along the YES branch and the control circuit then retrieves the aggregated data for the particular event type and displays  5310  the appropriate aggregated data corresponding to the query. In various exemplifications, the control circuit can retrieve the appropriate aggregated data from the memory of the surgical hub  5706 , the cloud  5702 , or a local database  5708   a ,  5708   b . 
     In one example, the surgical hub  5706  is configured to determine a length of time for a particular procedure via the aforementioned situational awareness system according to data received from one or more modular devices utilized in the performance of the surgical procedure (and other data sources). Each time a surgical procedure is completed, the surgical hub  5706  uploads or stores the length of time required to complete the particular type of surgical procedure, which is then aggregated with the data from every other instance of the type of procedure. In some aspects, the surgical hub  5706 , cloud  5702 , and/or local database  5708   a ,  5708   b  can then determine an average or expected procedure length for the particular type of procedure from the aggregated data. When the surgical hub  5706  receives a query as to the particular type of procedure thereafter, the surgical hub  5706  can then provide feedback as to the average (or expected) procedure length or compare an individual incidence of the procedure type to the average procedure length to determine whether the particular incidence deviates therefrom. 
     In some aspects, the surgical hub  5706  can be configured to automatically compare each incidence of an event type to average or expected norms for the event type and then provide feedback (e.g., display a report) when a particular incidence of the event type deviates from the norm. For example, the surgical hub  5706  can be configured to provide feedback whenever a surgical procedure (or a step of the surgical procedure) deviates from the expected length of time to complete the surgical procedure (or the step of the surgical procedure) by more than a set amount. 
     Referring back to  FIG.  90   , the surgical hub  5706  could be configured to track, store, and display data regarding the number of patients operated on (or procedures completed) per day per operating theater (bar graph  5402  depicted further in  FIG.  91   ), for example. The surgical hub  5706  could be configured to further parse the number of patients operated on (or procedures completed) per day per operating theater and can be further parsed according to the downtime between the procedures on a given day (bar graph  5404  depicted further in  FIG.  92   ) or the average procedure length on a given day (bar graph  5408  depicted further in  FIG.  94   ). The surgical hub  5706  can be further configured to provide a detailed breakdown of the downtime between procedures according to, for example, the number and length of the downtime time periods and the subcategories of the actions or steps during each time period (bar graph  5406  depicted further in  FIG.  93   ). The surgical hub  5706  can be further configured to provide a detailed breakdown of the average procedure length on a given day according to each individual procedure and the subcategory of actions or steps during each procedure (bar graph  5410  depicted further in  FIG.  95   ). The various graphs shown in  FIGS.  90 - 95    can represent data tracked by the surgical hub  5706  and can further be generated automatically or displayed by the surgical hub  5706  in response to queries submitted by users. 
       FIG.  91    illustrates an example bar graph  5402  depicting the number of patients  5420  operated on relative to the days of the week  5422  for different operating rooms  5424 ,  5426 . The surgical hub  5706  can be configured to provide (e.g., via a display) the number of patients  5420  operated on or procedures that are completed in connection with each surgical hub  5706 , which can be tracked through a situational awareness system or accessing the hospital’s EMR database, for example. In one exemplification, the surgical hub  5706  can further be configured to collate this data from different surgical hubs  5706  within the medical facility that are communicably connected together, which allows each individual surgical hub to present the aggregated data of the medical facility on a hub-by-hub or operating theater-by-theater basis. In one exemplification, the surgical hub  5706  can be configured to compare one or more tracked metrics to a threshold value (which may be unique to each tracked metric). When at least one of the tracked metrics exceeds the threshold value (i.e., either increases above or drops below the threshold value, as appropriate for the particular tracked metric), then the surgical hub  5706  provides a visual, audible, or tactile alert to notify a user of such. For example, the surgical hub  5706  can be configured to indicate when the number of patients or procedures deviates from an expected, average, or threshold value. For example,  FIG.  91    depicts the number of patients on Tuesday  5428  and Thursday  5430  for a first operating theater  5424  as being highlighted for being below expectation. Conversely, no days are highlighted for a second operating theater  5426  for this particular week, which means in this context that the number of patients for each day falls within expectations. 
       FIG.  92    illustrates a bar graph  5404  depicting the total downtime between procedures  5432  relative to the days of a week  5434  for a particular operating room. The surgical hub  5706  can be configured to track the length of downtime between surgical procedures through a situational awareness system, for example. The situational awareness system can detect or infer when each particular downtime instance is occurring and then track the length of time for each instance of downtime. The surgical hub  5706  can thereby determine the total downtime  5432  for each day of the week  5434  by summing the downtime instances for each particular day. In one exemplification, the surgical hub  5706  can be configured to provide an alert when the total length of downtime on a given day (or another unit of time) deviates from an expected, average, or threshold value. For example,  FIG.  92    depicts the total downtime  5432  on Tuesday  5436  and Friday  5438  as being highlighted for deviating from an expected length of time. 
       FIG.  93    illustrates a bar graph  5406  depicting the total downtime  5432  per day of the week  5434  as depicted in  FIG.  92    broken down according to each individual downtime instance. The number of downtime instances and the length of time for each downtime instance can be represented within each day’s total downtime. For example, on Tuesday in the first operating theater (OR 1 ) there were four instances of downtime between procedures and the magnitude of the first downtime instance indicates that it was longer than the other three instances. In one exemplification, the surgical hub  5706  is configured to further indicate the particular actions or steps taken during a selected downtime instance. For example, in  FIG.  93   , Thursday’s second downtime instance  5440  has been selected, which then causes a callout  5442  to be displayed indicating that this particular downtime instance consisted of performing the initial set-up of the operating theater, administering anesthesia, and prepping the patient. As with the downtime instances themselves, the relative size or length of the actions or steps within the callout  5442  can correspond to the length of time for each particular action or step. The detail views for the downtime instances can be displayed when a user selects the particular instance, for example. 
       FIG.  94    illustrates a bar graph  5408  depicting the average procedure length  5444  relative to the days of a week  5446  for a particular operating theater. The surgical hub  5706  can be configured to track the average procedure length through a situational awareness system, for example. The situational awareness system can detect or infer when each particular step of a surgical procedure is occurring (see  FIG.  86   , for example) and then track the length of time for each of the steps. The surgical hub  5706  can thereby determine the total downtime  5432  for each day of the week  5434  by summing the lengths of the downtime instances for the particular day. In one exemplification, the surgical hub  5706  can be configured to indicate when the average procedure length deviates from an expected value. For example,  FIG.  94    depicts Thursday’s average procedure length  5448  for the first operating room (OR 1 ) as being highlighted for deviating from an expected length of time. 
       FIG.  95    illustrates a bar graph  5410  depicting the procedure lengths  5450  relative to procedure types  5452 . The depicted procedure lengths  5450  can either represent the average procedure lengths for particular types of procedures or the procedure lengths for each individual procedure performed on a given day in a given operating theater. The procedure lengths  5450  for different procedure types  5452  can then be compared. Further, the average lengths for the steps in a procedure type  5452  or the length for each particular step in a particular procedure can be displayed when a procedure is selected. Further, the procedure types  5452  can be tagged with various identifiers for parsing and comparing different data sets. For example, in  FIG.  95    the first procedure  5454  corresponds to a colorectal procedure (specifically, a low anterior resection) where there was a preoperative identification of abdominal adhesions. The second procedure  5456  corresponds to a thoracic procedure (specifically, a segmentectomy). It should be noted again that the procedures depicted in  FIG.  95    can represent the lengths of time for individual procedures or the average lengths of time for all of the procedures for the given procedure types. Each of the procedures can further be broken down according to the length of time for each step in the procedure. For example,  FIG.  95    depicts the second procedure  5456  (a thoracic segmentectomy) as including an icon or graphical representation  5458  of the length of time spent on the dissect vessels, ligate (the vessels), nodal dissection, and closing steps of the surgical procedure. As with the procedure lengths themselves, the relative size or length of the steps within the graphical representation  5442  can correspond to the length of time for each particular step of the surgical procedure. The detail views for the steps of the surgical procedures can be displayed when a user selects the particular procedure, for example. In one exemplification, the surgical hub  5706  can be configured to identify when a length of time to complete a given step in the procedure deviates from an expected length of time. For example,  FIG.  95    depicts the nodal dissection step as being highlighted for deviating from an expected length of time. 
     In one exemplification, an analytics package of the surgical hub  5706  can be configured to provide the user with usage data and results correlations related to the surgical procedures (or downtime between procedures). For example, the surgical hub  5706  can be configured to display methods or suggestions to improve the efficiency or effectiveness of a surgical procedure. As another example, the surgical hub  5706  can be configured to display methods to improve cost allocation.  FIGS.  96 - 101    depict examples of various metrics that can be tracked by the surgical hub  5706 , which can then be utilized to provide medical facility personnel suggestions for inventory utilization or technique outcomes. For example, a surgical hub  5706  could provide a surgeon with a suggestion pertaining to a particular technique outcome prior to or at the beginning of a surgical procedure based on the metrics tracked by the surgical hub  5706 . 
       FIG.  96    illustrates a bar graph  5460  depicting the average completion time  5462  for particular procedural steps  5464  for different types of thoracic procedures. The surgical hub  5706  can be configured to track and store historical data for different types of procedures and calculate the average time to complete the procedure (or an individual step thereof). For example,  FIG.  96    depicts the average completion time  5462  for thoracic segmentectomy  5466 , wedge  5468 , and lobectomy  5470  procedures. For each type of procedure, the surgical hub  5706  can track the average time to complete each step thereof. In this particular example, the dissection, vessel transection, and node dissection steps are indicated for each type of procedure. In addition to tracking and providing the average time for the steps of the procedure types, the surgical hub 5706 can additionally track other metrics or historical data, such as the complication rate for each procedure type (i.e., the rate of procedures having at least one complication as defined by the surgical hub  5706  or the surgeon). Additional tracked metrics for each procedure type, such as the complication rate, can also be depicted for comparison between the different procedure types. 
       FIG.  97    illustrates a bar graph  5472  depicting the procedure time  5474  relative to procedure types  5476 . The surgical hub  5706  can be configured to track and store historical data or metrics for different procedure types  5476  or classes, which can encompass multiple subtypes of procedures. For example,  FIG.  97    depicts the procedure time  5474  for surgical procedures classified as a thoracic  5478 , bariatric  5480 , or colorectal  5482  procedure. In various exemplifications, the surgical hub  5706  can output the procedure time  5474  for the procedure classifications expressed in terms of either the total length of time or the average time spent on the given procedure types  5476 . The analytics package of the surgical hub  5706  can, for example, provide this data to the surgeons, hospital officials, or medical personnel to track the efficiency of the queried procedures. For example,  FIG.  97    depicts bariatric procedures  5480  as taking a lower average time (i.e., being more time efficient) than either thoracic procedures  5478  or colorectal procedures  5482 . 
       FIG.  98    illustrates a bar graph  5484  depicting operating room downtime  5486  relative to the time of day  5488 . Relatedly,  FIG.  99    illustrates a bar graph  5494  depicting operating room downtime  5496  relative to the day of the week  5498 . Operating room downtime  5486 ,  5496  can be expressed in, for example, a length of a unit of time or relative utilization (i.e., percentage of time that the operating room is in use). The operating room downtime data can encompass an individual operating room or an aggregation of multiple operating rooms at a medical facility. As discussed above, a surgical hub  5706  can be configured to track whether a surgical procedure is being performed in the operating theater associated with the surgical hub  5706  (including the length of time that a surgical procedure is or is not being performed) utilizing a situational awareness system, for example. As shown in  FIGS.  98  and  99   , the surgical hub  5706  can provide an output (e.g., bar graphs  5484 ,  5494  or other graphical representations of data) depicting the tracked data pertaining to when the operating room is being utilized (i.e., when a surgical procedure is being performed) and/or when there is downtime between procedures. Such data can be utilized to identify ineffectiveness or inefficiencies in performing surgical procedures, cleaning or preparing operating theaters for surgery, scheduling, and other metrics associated with operating theater use. For example,  FIG.  98    depicts a comparative increase in operating room downtime  5486  at a first instance  5490  from 11:00 a.m.-12:00 p.m. and a second instance  5492  from 3:00-4:00 p.m. As another example,  FIG.  99    depicts a comparative increase in operating room downtime  5496  on Mondays  5500  and Fridays  5502 . In various exemplifications, the surgical hub  5706  can provide operating theater downtime data for a particular instance (i.e., a specific time, day, week, etc.) or an average operating theater downtime data for a category of instances (i.e., aggregated data for a day, time, week, etc.). Hospital officials or other medical personnel thus could use this data to identify specific instances where an inefficiency may have occurred or identify trends in particular days and/or times of day where there may be inefficiencies. From such data, the hospital officials or other medical personnel could then investigate to identify the specific reasons for these increased downtimes and take corrective action to address the identified reason. 
     In various exemplifications, the surgical hub  5706  can be configured to display data in response to queries in a variety of different formats (e.g., bar graphs, pie graphs, infographics).  FIG.  100    illustrates a pair of pie charts depicting the percentage of time that the operating theater is utilized. The operating theater utilization percentage can encompass an individual operating theater or an aggregation of multiple operating theaters (e.g., the operating rooms at a medical facility or every operating room for all medical facilities having surgical hubs  5706  connected to the cloud  5702 ). As discussed above, a surgical hub  5706  can be configured to determine when a surgical procedure is or is not being performed (i.e., whether the operating theater associated with the surgical hub  5706  is being utilized) using a situational awareness system, for example. In addition to expressing operating theater utilization in terms of an average or absolute amount for different time periods (as depicted in  FIGS.  98 - 99   ), the surgical hub  5706  can additionally express operating theater utilization in terms of a percentage or relative amount compared to a maximum possible utilization. As above, the operating theater utilization can be parsed for particular time periods, including the overall utilization (i.e., the total historical percentage of time in use) for the particular operating theater (or groups of operating theaters) or the utilization over the span of a particular time period. As shown in  FIG.  100   , a first pie chart  5504  depicts the overall operating theater utilization  5508  (85%) and a second pie chart  5506  depicts the operating theater utilization for the prior week  5510  (75%). Hospital officials and other medical personnel could use this data to identify that there may have been some inefficiency that occurred in the prior week that caused the particular operating theater (or group of operating theaters) to be utilized less efficiently compared to the historical average so that further investigations can be carried out to identify the specific reasons for this decreased utilization. 
     In some exemplifications, the surgical hub  5706  is configured to track detect and track the number of surgical items that are utilized during the course of a surgical procedure. This data can then be aggregated and displayed (either automatically or in response to a query) according to, for example, a particular time period (e.g., per day or per week) or for a particular surgical procedure type (e.g., thoracic procedures or abdominal procedures).  FIG.  101    illustrates a bar graph  5512  depicting consumed and unused surgical items  5514  relative to procedure type  5516 . The surgical hub  5706  can be configured to determine or infer what surgical items are being consumed during the course of each surgical procedure via a situational awareness system. The situational awareness system can determine or receive the list of surgical items to be used in a procedure (e.g., see  FIG.  85 B ), determine or infer when each procedure (and steps thereof) begins and ends, and determine when a particular surgical item is being utilized according to the procedural step being performed. The inventory of surgical items that are consumed or unused during the course of a surgical procedure can be represented in terms of the total number of surgical items or the average number of surgical items per procedure type  5516 , for example. The consumed surgical items can include non-reusable items that are utilized during the course of a surgical procedure. The unused surgical items can include additional items that are not utilized during the procedure(s) or scrap items. The procedure type can correspond to broad classifications of procedures or a specific procedure type or technique for performing a procedure type. For example, in  FIG.  101    the procedure types  5516  being compared are thoracic, colorectal, and bariatric procedures. For each of these procedure types  5516 , the average number of consumed and unused surgical items  5514  are both provided. In one aspect, the surgical hub  5706  can be configured to further parse the consumed and/or unused surgical items  5514  by the specific item type. In one exemplification, the surgical hub  5706  can provide a detailed breakdown of the surgical items  5514  making up each item category for each surgical procedure type  5516  and graphically represent the different categories of surgical items  5514 . For example, in  FIG.  101   , the unused surgical items are depicted in dashed lines and the consumed surgical items are depicted in solid lines. In one exemplification, the surgical hub  5706  is configured to further indicate the specific within a category for a particular procedure type  5516 . For example, in  FIG.  93   , the consumed items category for the thoracic procedure type has been selected, which then causes a callout  5520  to be displayed listing the particular surgical items in the category: stapler cartridges, sponges, saline, fibrin sealants, surgical sutures, and stapler buttress material. Furthermore, the callout  5520  can be configured to provide the quantities of the listed items in the category, which may be the average or absolute quantities of the items (either consumed or unused) for the particular procedure type. 
     In one exemplification, the surgical hub  5706  can be configured to aggregate tracked data in a redacted format (i.e., with any patient-identifying information stripped out). Such bulk data can be utilized for academic or business analysis purposes. Further, the surgical hub  5706  can be configured to upload the redacted or anonymized data to a local database of the medical facility in which the surgical hub  5706  is located, an external database system, or the cloud  5702 , whereupon the anonymized data can be accessed by user/client applications on demand. The anonymized data can be utilized to compare outcomes and efficiencies within a hospital or between geographic regions, for example. 
     The process  5300  depicted in  FIG.  89    improves scheduling efficiency by allowing the surgical hubs  5706  to automatically store and provide granular detail on correlations between lengths of time required for various procedures according to particular days, particular types of procedures, particular hospital staff members, and other such metrics. This process  5300  also reduces surgical item waste by allowing the surgical hubs  5706  to provide alerts when the amount of surgical items being consumed, either on a per-procedure basis or as a category, are deviating from the expected amounts. Such alerts can be provided either automatically or in response to receiving a query. 
       FIG.  102    illustrates a logic flow diagram of a process  5350  for storing data from the modular devices and patient information database for comparison. In the following description, description of the process  5350 , reference should also be made to  FIG.  88   . In one exemplification, the process  5350  can be executed by a control circuit of a surgical hub  206 , as depicted in  FIG.  10    (processor  244 ). In yet another exemplification, the process  5350  can be executed by a distributed computing system including a control circuit of a surgical hub  206  in combination with a control circuit of a modular device, such as the microcontroller  461  of the surgical instrument depicted  FIG.  12   , the microcontroller  620  of the surgical instrument depicted in  FIG.  16   , the control circuit  710  of the robotic surgical instrument  700  depicted in  FIG.  17   , the control circuit  760  of the surgical instruments  750 ,  790  depicted in  FIGS.  18  and  19   , or the controller  838  of the generator  800  depicted in  FIG.  20   . For economy, the following description of the process  5350  will be described as being executed by the control circuit of a surgical hub  5706 ; however, it should be understood that the description of the process  5350  encompasses all of the aforementioned exemplifications. 
     The control circuit executing the process  5350  receives data from the data sources, such as the modular device(s) and the patient information database(s) (e.g., EMR databases) that are communicably coupled to the surgical hub  5706 . The data from the modular devices can include, for example, usage data (e.g., data pertaining to how often the modular device has been utilized, what procedures the modular device has been utilized in connection with, and who utilized the modular devices) and performance data (e.g., data pertaining to the internal state of the modular device and the tissue being operated on). The data from the patient information databases can include, for example, patient data (e.g., data pertaining to the patient’s age, sex, and medical history) and patient outcome data (e.g., data pertaining to the outcomes from the surgical procedure). In some exemplifications, the control circuit can continuously receive  5352  data from the data sources before, during, or after a surgical procedure. 
     As the data is received  5352 , the control circuit aggregates  5354  the data in comparison groups of types of data. In other words, the control circuit causes a first type of data to be stored in association with a second type of data. However, more than two different types of data can be aggregated  5354  together into a comparison group. For example, the control circuit could store a particular type of performance data for a particular type of modular device (e.g., the force to fire for a surgical cutting and stapling instrument or the characterization of the energy expended by an RF or ultrasonic surgical instrument) in association with patient data, such as sex, age (or age range), a condition (e.g., emphysema) associated with the patient. In one exemplification, when the data is aggregated  5354  into comparison groups, the data is anonymized such that all patient-identifying information is removed from the data. This allows the data aggregated  5354  into comparison groups to be utilized for studies, without compromising confidential patient information. The various types of data can be aggregated  5354  and stored in association with each other in lookup tables, arrays, and other such formats. In one exemplification, the received  5352  data is automatically aggregated  5354  into comparison groups. Automatically aggregating  5354  and storing the data allows the surgical hub  5706  to quickly return results for queries and the groups of data to be exported for analysis according to specifically desired data types. 
     When the control circuit receives  5356  a query for a comparison between two or more of the tracked data types, the process  5350  proceeds along the YES branch. The control circuit then retrieves the particular combination of the data types stored in association with each other and then displays  5358  a comparison (e.g., a graph or other graphical representation of the data) between the subject data types. If the control circuit does not receive  5356  a query, the process  5350  continues along the NO branch and the control circuit continues receiving  5352  data from the data sources. 
     In one exemplification, the control circuit can be configured to automatically quantify a correlation between the received  5352  data types. In such aspects, the control circuit can calculate a correlation coefficient (e.g., the Pearson’s coefficient) between pairs of data types. In one aspect, the control circuit can be configured to automatically display a report providing suggestions or other feedback if the quantified correlation exceeds a particular threshold value. In one aspect, the control circuit of the surgical hub  5706  can be configured to display a report on quantified correlations exceeding a particular threshold value upon receiving a query or request from a user. 
     In one exemplification, a surgical hub  5706  can compile information on procedures that the surgical hub  5706  was utilized in the performance of, communicate with other surgical hubs  5706  within its network (e.g., a local network of a medical facility or a number of surgical hubs  5706  connected by the cloud  5702 ), and compare results between type of surgical procedures or particular operating theaters, doctors, or departments. Each surgical hub  5706  can calculate and analyze utilization, efficiency, and comparative results (relative to all surgical hubs  5706  across a hospital network, a region, etc.). For example, the surgical hub  5706  can display efficiency and comparative data, including operating theater downtime, operating theater clean-up and recycle time, step-by-step completion timing for procedures (including highlighting which procedural steps take the longest, for example), average times for surgeons to complete procedures (including parsing the completion times on a procedure-by-procedure basis), historical completion times (e.g., for completing classes of procedures, specific procedures, or specific steps within a procedure), and/or operating theater utilization efficiency (i.e., the time efficiency from a procedure to a subsequent procedure). The data that is accessed and shared across networks by the surgical hubs  5706  can include the anonymized data aggregated into comparison groups, as discussed above. 
     For example, the surgical hub  5706  can be utilized to perform studies of performance by instrument type or cartridge type for various procedures. As another example, the surgical hub  5706  can be utilized to perform studies on the performance of individual surgeons. As yet another example, the surgical hub  5706  can be utilized to perform studies on the effectiveness of different surgical procedures according to patients’ characteristics or disease states. 
     In another exemplification, a surgical hub  5706  can provide suggestions on streamlining processes based on tracked data. For example, the surgical hub  5706  can suggest different product mixes according to the length of certain procedures or steps within a procedure (e.g., suggest a particular item that is more appropriate for long procedure steps), suggest more cost effective product mixes based on the utilization of items, and/or suggest kitting or pre-grouping certain items to lower set-up time. In another exemplification, a surgical hub  5706  can compare operating theater utilization across different surgical groups in order to better balance high volume surgical groups with surgical groups that have more flexible bandwidth. In yet another aspect, the surgical hub  5706  could be put in a forecasting mode that would allow the surgical hub  5706  to monitor upcoming procedure preparation and scheduling, then notify the administration or department of upcoming bottlenecks or allow them to plan for scalable staffing. The forecasting mode can be based on, for example, the anticipated future steps of the current surgical procedure that is being performed using the surgical hub  5706 , which can be determined by a situational awareness system. 
     In another exemplification, a surgical hub  5706  can be utilized as a training tool to allow users to compare their procedure timing to other types of individuals or specific individuals within their department (e.g., a resident could compare his or her timing to a particular specialist or the average time for a specialist within the hospital) or the department average times. For example, users could identify what steps of a surgical procedure they are spending an inordinate amount of time on and, thus, what steps of the surgical procedure that they need to improve upon. 
     In one exemplification, all processing of stored data is performed locally on each surgical hub  5706 . In another exemplification, each surgical hub  5706  is part of a distributed computing network, wherein each individual surgical hub  5706  compiles and analyzes its stored data and then communicates the data to the requesting surgical hub  5706 . A distributed computing network could permit fast parallel processing. In another exemplification, each surgical hub  5706  is communicably connected to a cloud  5702 , which can be configured to receive the data from each surgical hub  5706  and then perform the necessary processing (data aggregation, calculations, and so on) on the data. 
     The process  5350  depicted in  FIG.  102    improves the ability to determine when procedures are being performed inefficiently by allowing the surgical hubs  5706  to provide alerts when particular procedures, either on a per-procedure basis or as category, are deviating from the expected times to complete the procedures. Such alerts can be provided either automatically or in response to receiving a query. This process  5350  also improves the ability to perform studies on what surgical instruments and surgical procedure techniques provide the best patient outcomes by automatically tracking and indexing such data in easily-retrievable and reportable formats. 
     Some systems described herein offload the data processing that controls the modular devices (e.g., surgical instruments) from the modular devices themselves to an external computing system (e.g., a surgical hub) and/or a cloud. However in some exemplifications, some modular devices can sample data (e.g., from the sensors of the surgical instruments) at a faster rate that the rate at which the data can be transmitted to and processed by a surgical hub. As one solution, the surgical hub and the surgical instruments (or other modular devices) can utilize a distributed computing system where at least a portion of the data processing is performed locally on the surgical instrument. This can avoid data or communication bottlenecks between the instrument and the surgical hub by allowing the onboard processor of the surgical instrument to handle at least some of the data processing when the data sampling rate is exceeding the rate at which the data can be transmitted to the surgical hub. In some exemplifications, the distributed computing system can cease distributing the processing between the surgical hub and the surgical instrument and instead have the processing be executed solely onboard the surgical instrument. The processing can be executed solely by the surgical instrument in situations where, for example, the surgical hub needs to allocate its processing capabilities to other tasks or the surgical instrument is sampling data at a very high rate and it has the capabilities to execute all of the data processing itself. 
     Similarly, the data processing for controlling the modular devices, such as surgical instruments, can be taxing for an individual surgical hub to perform. If the surgical hub’s processing of the control algorithms for the modular devices cannot keep pace with the use of the modular devices, then the modular devices will not perform adequately because their control algorithms will either not be updated as needed or the updates to the control algorithms will lag behind the actual use of the instrument. As one solution, the surgical hubs can be configured to utilize a distributed computing system where at least a portion of the processing is performed across multiple separate surgical hubs. This can avoid data or communication bottlenecks between the modular devices and the surgical hub by allowing each surgical hub to utilize the networked processing power of multiple surgical hubs, which can increase the rate at which the data is processed and thus the rate at which the control algorithm adjustments can be transmitted by the surgical hub to the paired modular devices. In addition to distributing the computing associated with controlling the various modular devices connected to the surgical hubs, a distributed computing system can also dynamically shift computing resources between multiple surgical hubs in order to analyze tracked data in response to queries from users and perform other such functions. The distributed computing system for the surgical hubs can further be configured to dynamically shift data processing resources between the surgical hubs when any particular surgical hub becomes overtaxed. 
     The modular devices that are communicably connectable to the surgical hub can include sensors, memories, and processors that are coupled to the memories and configured to receive and analyze data sensed by the sensors. The surgical hub can further include a processor coupled to a memory that is configured to receive (through the connection between the modular device and the surgical hub) and analyze the data sensed by the sensors of the modular device. In one exemplification, the data sensed by the modular device is processed externally to the modular device (e.g., external to a handle assembly of a surgical instrument) by a computer that is communicably coupled to the modular device. For example, the advanced energy algorithms for controlling the operation of a surgical instrument can be processed by an external computing system, rather than on a controller embedded in the surgical instrument (such as instrument using an Advanced RISC Machine (ARM) processor). The external computer system processing the data sensed by the modular devices can include the surgical hub to which the modular devices are paired and/or a cloud computing system. In one exemplification, data sampled at a particular rate (e.g., 20 Ms/sec) and a particular resolution (e.g., 12 bits resolution) by a surgical instrument is decimated and then transmitted over a link to the surgical hub to which the surgical instrument is paired. Based on this received data, the control circuit of the surgical hub then determines the appropriate control adjustments for the surgical instrument, such as controlling power for an ultrasonic surgical instrument or RF electrosurgical instrument, setting motor termination points for a motor-driven surgical instrument, and so on. The control adjustments are then transmitted to the surgical instrument for application thereon. 
     Distributed Processing 
       FIG.  103    illustrates a diagram of a distributed computing system  5600 . The distributed computing system  5600  includes a set of nodes  5602   a ,  5602   b ,  5602   c  that are communicably coupled by a distributed multi-party communication protocol such that they execute a shared or distributed computer program by passing messages therebetween. Although three nodes  5602   a ,  5602   b ,  5602   c  are depicted, the distributed computing system  5600  can include any number of nodes  5602   a ,  5602   b ,  5602   c  that are communicably connected together. Each of the nodes  5602   a ,  5602   b ,  5602   c  comprises a respective memory  5606   a ,  5606   b ,  5606   c  and processor  5604   a ,  5604   b ,  5604   c  coupled thereto. The processors  5604   a ,  5604   b ,  5604   c  execute the distributed multi-party communication protocol, which is stored at least partially in the memories  5606   a ,  5606   b ,  5606   c . Each node  5602   a ,  5602   b ,  5602   c  can represent either a modular device or a surgical hub. Therefore, the depicted diagram represents aspects wherein various combinations of surgical hubs and/or modular devices are communicably coupled. In various exemplifications, the distributed computing system  5600  can be configured to distribute the computing associated with controlling the modular device(s) (e.g., advanced energy algorithms) over the modular device(s) and/or the surgical hub(s) to which the modular device(s) are connected. In other words, the distributed computing system  5600  embodies a distributed control system for controlling the modular device(s) and/or surgical hub(s). 
     In some exemplifications, the modular device(s) and surgical hub(s) utilize data compression for their communication protocols. Wireless data transmission over sensor networks can consume a significant amount of energy and/or processing resources compared to data computation on the device itself. Thus data compression can be utilized to reduce the data size at the cost of extra processing time on the device. In one exemplification, the distributed computing system  5600  utilizes temporal correlation for sensing data, data transformation from one dimension to two dimension, and data separation (e.g., upper 8 bit and lower 8 bit data). In another exemplification, the distributed computing system  5600  utilizes a collection tree protocol for data collection from different nodes  5602   a ,  5602   b ,  5602   c  having sensors (e.g., modular devices) to a root node. In yet another aspect, the distributed computing system  5600  utilizes first-order prediction coding to compress the data collected by the nodes  5602   a ,  5602   b ,  5602   c  having sensors (e.g., modular devices), which can minimize the amount of redundant information and greatly reduce the amount of data transmission between the nodes  5602   a ,  5602   b ,  5602   c  of the network. In yet another exemplification, the distributed computing system  5600  is configured to transmit only the electroencephalogram (EEG) features. In still yet another exemplification, the distributed computing system  5600  can be configured to transmit only the complex data features that are pertinent to the surgical instrument detection, which can save significant power in wireless transmission. Various other exemplifications can utilize combinations of the aforementioned data compression techniques and/or additional techniques of data compression. 
       FIG.  104    illustrates a logic flow diagram of a process  5650  for shifting distributed computing resources. In the following description of the  5650 , reference should also be made to  FIG.  103   . In one exemplification, the process  5650  can be executed by a distributed computing system including a control circuit of a surgical hub  206 , as depicted in  FIG.  10    (processor  244 ), in combination with a control circuit of a second surgical hub  206  and/or a control circuit of a modular device, such as the microcontroller  461  of the surgical instrument depicted  FIG.  12   , the microcontroller  620  of the surgical instrument depicted in  FIG.  16   , the control circuit  710  of the robotic surgical instrument  700  depicted in  FIG.  17   , the control circuit  760  of the surgical instruments  750 ,  790  depicted in  FIGS.  18  and  19   , or the controller  838  of the generator  800  depicted in  FIG.  20   . For economy, the following description of the process  5650  will be described as being executed by the control circuits of one or more nodes; however, it should be understood that the description of the process  5650  encompasses all of the aforementioned exemplifications. 
     The control circuits of each node execute  5652  a distributed control program in synchrony. As the distributed control program is being executed across the network of nodes, at least one of the control circuits monitors for a command instructing the distributed computing system to shift from a first mode, wherein the distributed computing program is executed across the network of nodes, to a second mode, wherein the control program is executed by a single node. In one exemplification, the command can be transmitted by a surgical hub in response to the surgical hub’s resources being needed for an alternative computing task. In another exemplification, the command can be transmitted by a modular device in response to the rate at which the data is sampled by the modular device outpacing the rate at which the sampled data can be communicated to the other nodes in the network. If a control circuit determines that an appropriate command has been received  5654 , the process  5650  continues along the YES branch and the distributed computing system  5600  shifts to a single node executing  5656  the program. For example, the distributed computing system  5600  shifts the distributed computing program from being executed by both a modular device and a surgical hub to being executed solely by the modular device. As another example, the distributed computing system  5600  shifts the distributed computing program from being executed by both a first surgical hub and a second surgical hub to being executed solely by the first surgical hub. If no control circuit determines that an appropriate command has been received  5654 , the process continues along the NO branch and the control circuits of the network of nodes continues executing  5652  the distributed computing program across the network of nodes. 
     In the event that the program has been shifted to being executed  5656  by a single node, the control circuit of the particular node solely executing the distributed program and/or a control circuit of another node within the network (which previously was executing the distributed program) monitors for a command instructing the node to re-distribute the processing of the program across the distributed computing system. In other words, the node monitors for a command to re-initiate the distributed computing system. In one exemplification, the command to re-distribute the processing across the network can be generated when the sampling rate of the sensor is less than the data communication rate between the modular device and the surgical hub. If a control circuit receives  5658  an appropriate command to re-distribute the processing, then the process  5650  proceeds along the YES branch and the program is once again executed  5652  across the node network. If a control circuit has not received  5658  an appropriate command, then the node continues singularly executing  5656  the program. 
     The process  5650  depicted in  FIG.  104    eliminates data or communication bottlenecks in controlling modular devices by utilizing a distributed computing architecture that can shift computing resources either between the modular devices and surgical hubs or between the surgical hubs as needed. This process  5650  also improves the modular devices’ data processing speed by allowing the processing of the modular devices’ control adjustments to be executed at least in part by the modular devices themselves. This process  5650  also improves the surgical hubs’ data processing speed by allowing the surgical hubs to shift computing resources between themselves as necessary. 
     It can be difficult during video-assisted surgical procedures, such as laparoscopic procedures, to accurately measure sizes or dimensions of features being viewed through a medical imaging device due to distortive effects caused by the device’s lens. Being able to accurately measure sizes and dimensions during video-assisted procedures could assist a situational awareness system for a surgical hub by allowing the surgical hub to accurately identify organs and other structures during video-assisted surgical procedures. As one solution, a surgical hub could be configured to automatically calculate sizes or dimensions of structures (or distances between structures) during a surgical procedure by comparing the structures to markings affixed to devices that are intended to be placed within the FOV of the medical imaging device during a surgical procedure. The markings can represent a known scale, which can then be utilized to make measurements by comparing the unknown measured length to the known scale. 
     In one exemplification, the surgical hub is configured to receive image or video data from a medical imaging device paired with the surgical hub. When a surgical instrument bearing a calibration scale is within the FOV of the medical imaging device, the surgical hub is able to measure organs and other structures that are likewise within the medical imaging device’s FOV by comparing the structures to the calibration scale. The calibration scale can be positioned on, for example, the distal end of a surgical instrument. 
       FIG.  105    illustrates a diagram of an imaging system  5800  and a surgical instrument  5806  bearing a calibration scale  5808 . The imaging system  5800  includes a medical imaging device  5804  that is paired with a surgical hub  5802 . The surgical hub  5802  can include a pattern recognition system or a machine learning system configured to recognize features in the FOV from image or video data received from the medical imaging device  5804 . In one exemplification, a surgical instrument  5806  (e.g., a surgical cutting and stapling instrument) that is intended to enter the FOV of the medical imaging device  5804  during a surgical procedure includes a calibration scale  5808  affixed thereon. The calibration scale  5808  can be positioned on the exterior surface of the surgical instrument  5806 , for example. In aspects wherein the surgical instrument  5806  is a surgical cutting and stapling instrument, the calibration scale  5808  can be positioned along the exterior surface of the anvil. The calibration scale  5808  can include a series of graphical markings separated at fixed and/or known intervals. The distance between the end or terminal markings of the calibration scale  5808  can likewise be a set distance L (e.g., 35 mm). In one exemplification, the end markings (e.g., the most proximal marking and the most distal marking) of the calibration scale  5808  are differentiated from the intermediate markings in size, shape, color, or another such fashion. This allows the image recognition system of the surgical hub  5802  to identify the end markings separately from the intermediate markings. The distance(s) between the markings can be stored in a memory or otherwise retrieved by the surgical hub  5802 . The surgical hub  5802  can thus measure lengths or sizes of structures relative to the provided calibration scale  5808 . In  FIG.  105   , for example, the surgical hub  5802  can calculate that the artery  5810   a  has a diameter or width of D 1  (e.g., 17.0 mm), the vein  5810   b  has a diameter or width of D 2  (e.g., 17.5 mm), and the distance between the vessels is D 3  (e.g., 20 mm) by comparing the visualizations of these distances D 1 , D 2 , D 3  to the known length L of the calibration scale  5808  positioned on the surgical instrument  5806  within the FOV of the medical imaging device  5804 . The surgical hub  5802  can recognize the presence of the vessels  5810   a ,  5810   b  via an image recognition system. In some exemplifications, the surgical hub  5802  can be configured to automatically measure and display the size or dimension of detected features within the FOV of the medical imaging device  5804 . In some exemplifications, the surgical hub  5802  can be configured to calculate the distance between various points selected by a user on an interactive display that is paired with the surgical hub  5802 . 
     The imaging system  5800  configured to detect and measure sizes according to a calibration scale  5808  affixed to surgical instruments  5806  provides the ability to accurately measure sizes and distances during video-assisted procedures. This can make it easier for surgeons to precisely perform video-assisted procedures by compensating for the optically distortive effects inherent in such procedures. 
     User Feedback Methods 
     The present disclosure provides user feedback techniques. In one aspect, the present disclosure provides a display of images through a medical imaging device (e.g., laparoscope, endoscope, thoracoscope, and the like). A medical imaging device comprises an optical component and an image sensor. The optical component may comprise a lens and a light source, for example. The image sensor may be implemented as a charge coupled device (CCD) or complementary oxide semiconductor (CMOS). The image sensor provides image data to electronic components in the surgical hub. The data representing the images may be transmitted by wired or wireless communication to display instrument status, feedback data, imaging data, and highlight tissue irregularities and underlining structures. In another aspect, the present disclosure provides wired or wireless communication techniques for communicating user feedback from a device (e.g., instrument, robot, or tool) to the surgical hub. In another aspect, the present disclosure provides identification and usage recording and enabling. Finally, in another aspect, the surgical hub may have a direct interface control between the device and the surgical hub. 
     Through Laparoscope Monitor Display of Data 
     In various aspects, the present disclosure provides through laparoscope monitor display of data. The through laparoscope monitor display of data may comprise displaying a current instrument alignment to adjacent previous operations, cooperation between local instrument displays and paired laparoscope display, and display of instrument specific data needed for efficient use of an end-effector portion of a surgical instrument. Each of these techniques is described hereinbelow. 
     Display of Current Instrument Alignment to Adjacent Previous Operations 
     In one aspect, the present disclosure provides alignment guidance display elements that provide the user information about the location of a previous firing or actuation and allow them to align the next instrument use to the proper position without the need for seeing the instrument directly. In another aspect, the first device and second device and are separate; the first device is within the sterile field and the second is used from outside the sterile field. 
     During a colorectal transection using a double-stapling technique it is difficult to align the location of an anvil trocar of a circular stapler with the center of an overlapping staple line. During the procedure, the anvil trocar of the circular stapler is inserted in the rectum below the staple line and a laparoscope is inserted in the peritoneal cavity above the staple line. Because the staple line seals off the colon, there is no light of sight to align the anvil trocar using the laparoscope to optically align the anvil trocar insertion location relative to the center of the staple line overlap. 
     One solution provides a non-contact sensor located on the anvil trocar of the circular stapler and a target located at the distal end of the laparoscope. Another solution provides a non-contact sensor located at the distal end of the laparoscope and a target located on the anvil trocar of the circular stapler. 
     A surgical hub computer processor receives signals from the non-contact sensor and displays a centering tool on a screen indicating the alignment of the anvil trocar of the circular stapler and the overlap portion at the center of staple line. The screen displays a first image of the target staple line with a radius around the staple line overlap portion and a second image of the projected anvil trocar location. The anvil trocar and the overlap portion at the center of staple line are aligned when the first and second images overlap. 
     In one aspect, the present disclosure provides a surgical hub for aligning a surgical instrument. The surgical hub comprises a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to receive image data from an image sensor, generate a first image based on the image data, display the first image on a monitor coupled to the processor, receive a signal from a non-contact sensor, generate a second image based on the position of the surgical device, and display the second image on the monitor. The first image data represents a center of a staple line seal. The first image represents a target corresponding to the center of the staple line. The signal is indicative of a position of a surgical device relative to the center of the staple line. The second image represents the position of the surgical device along a projected path of the surgical device toward the center of the staple line. 
     In one aspect, the center of the staple line is a double-staple overlap portion zone. In another aspect, the image sensor receives an image from a laparoscope. In another aspect, the surgical device is a circular stapler comprising an anvil trocar and the non-contact sensor is configured to detect the location of the anvil trocar relative to the center of the staple line seal. In another aspect, the non-contact sensor is an inductive sensor. In another aspect, the non-contact sensor is a capacitive sensor. 
     In various aspects, the present disclosure provides a control circuit to align the surgical instrument as described above. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, causes a machine to align the surgical instrument as described above. 
     This technique provides better alignment of a surgical instrument such as a circular stapler about the overlap portion of the staple line to produce a better seal and cut after the circular stapler is fired. 
     In one aspect, the present disclosure provides a system for displaying the current instrument alignment relative to prior adjacent operations. The instrument alignment information may be displayed on a monitor or any suitable electronic device suitable for the visual presentation of data whether located locally on the instrument or remotely from the instrument through the modular communication hub. The system may display the current alignment of a circular staple cartridge to an overlapping staple line, display the current alignment of a circular staple cartridge relative to a prior linear staple line, and/or show the existing staple line of the linear transection and an alignment circle indicating an appropriately centered circular staple cartridge. Each of these techniques is described hereinbelow. 
     In one aspect, the present disclosure provides alignment guidance display elements that provide the user information about the location of a previous firing or actuation of a surgical instrument (e.g., surgical stapler) and allows the user to align the next instrument use (e.g., firing or actuation of the surgical stapler) to the proper position without the need for seeing the instrument directly. In another aspect, the present disclosure provides a first device and a second device that is separate from the first device. The first device is located within a sterile field and the second is located outside the sterile field. The techniques described herein may be applied to surgical staplers, ultrasonic instruments, electrosurgical instruments, combination ultrasonic/electrosurgical instruments, and/or combination surgical stapler/electrosurgical instruments. 
       FIG.  106    illustrates a diagram  6000  of a surgical instrument  6002  centered on a staple line  6003  using the benefit of centering tools and techniques described in connection with  FIGS.  23 - 33   , according to one aspect of the present disclosure. As used in the following description of  FIGS.  107 - 117    a staple line may include multiple rows of staggered staples and typically includes two or three rows of staggered staples, without limitation. The staple line may be a double staple line  6004  formed using a double-stapling technique as described in connection with  FIGS.  107 - 111    or may be a linear staple line  6052  formed using a linear transection technique as described in connection with  FIGS.  112 - 117   . The centering tools and techniques described herein can be used to align the instrument  6002  located in one part of the anatomy with either the staple line  6003  or with another instrument located in another part of the anatomy without the benefit of a line of sight. The centering tools and techniques include displaying the current alignment of the instrument  6002  adjacent to previous operations. The centering tool is useful, for example, during laparoscopic-assisted rectal surgery that employ a double-stapling technique, also referred to as an overlapping stapling technique. In the illustrated example, during a laparoscopic-assisted rectal surgical procedure, a circular stapler  6002  is positioned in the rectum  6006  of a patient within the pelvic cavity  6008  and a laparoscope is positioned in the peritoneal cavity. 
     During the laparoscopic-assisted rectal surgery, the colon is transected and sealed by the staple line  6003  having a length “1.” The double-stapling technique uses the circular stapler  6002  to create an end-to-end anastomosis and is currently used widely in laparoscopic-assisted rectal surgery. For a successful formation of an anastomosis using a circular stapler  6002 , the anvil trocar  6010  of the circular stapler  6002  should be aligned with the center “½” of the staple line  6003  transection before puncturing through the center “½” of the staple line  6003  and/or fully clamping on the tissue before firing the circular stapler  6002  to cut out the staple overlap portion  6012  and forming the anastomosis. Misalignment of the anvil trocar  6010  to the center of the staple line  6003  transection may result in a high rate of anastomotic failures. This technique may be applied to ultrasonic instruments, electrosurgical instruments, combination ultrasonic/electrosurgical instruments, and/or combination surgical stapler/electrosurgical instruments. Several techniques are now described for aligning the anvil trocar  6010  of the circular stapler  6002  to the center “½” of the staple line  6003 . 
     In one aspect, as described in  FIGS.  107 - 109    and with reference also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , the present disclosure provides an apparatus and method for detecting the overlapping portion of the double staple line  6004  in a laparoscopic-assisted rectal surgery colorectal transection using a double stapling technique. The overlapping portion of the double staple line  6004  is detected and the current location of the anvil trocar  6010  of the circular stapler  6002  is displayed on a surgical hub display  215  coupled to the surgical hub  206 . The surgical hub display  215  displays the alignment of a circular stapler  6002  cartridge relative to the overlapping portion of the double staple line  6004 , which is located at the center of the double staple line  6004 . The surgical hub display  215  displays a circular image centered around the overlapping double staple line  6004  region to ensure that the overlapping portion of the double staple line  6004  is contained within the knife of the circular stapler  6002  and therefore removed following the circular firing. Using the display, the surgeon aligns the anvil trocar  6010  with the center of the double staple line  6004  before puncturing through the center of the double staple line  6004  and/or fully clamping on the tissue before firing the circular stapler  6002  to cut out the staple overlap portion  6012  and form the anastomosis. 
       FIGS.  107 - 109    illustrate a process of aligning an anvil trocar  6010  of a circular stapler  6022  to a staple overlap portion  6012  of a double staple line  6004  created by a double-stapling technique, according to one aspect of the present disclosure. The staple overlap portion  6012  is centered on the double staple line  6004  formed by a double-stapling technique. The circular stapler  6002  is inserted into the colon  6020  below the double staple line  6004  and a laparoscope  6014  is inserted through the abdomen above the double staple line  6004 . A laparoscope  6014  and a non-contact sensor  6022  are used to determine an anvil trocar  6010  location relative to the staple overlap portion  6012  of the double staple line  6004 . The laparoscope  6014  includes an image sensor to generate an image of the double staple line  6004 . The image sensor image is transmitted to the surgical hub  206  via the imaging module  238 . The sensor  6022  generates a signal  6024  that detects the metal staples using inductive or capacitive metal sensing technology. The signal  6024  varies based on the position of the anvil trocar  6010  relative to the staple overlap portion  6004 . A centering tool  6030  presents an image  6038  of the double staple line  6004  and a target alignment ring  6032  circumscribing the image  6038  of the double staple line  6004  centered about an image  6040  of the staple overlap portion  6012  on the surgical hub display  215 . The centering tool  6030  also presents a projected cut path  6034  of an anvil knife of the circular stapler  6002 . The alignment process includes displaying an image  6038  of the double staple line  6004  and a target alignment ring  6032  circumscribing the image  6038  of the double staple line  6004  centered on the image  6040  of the staple overlap portion  6012  to be cut out by the circular knife of the circular stapler  6002 . Also displayed is an image of a crosshair  6036  (X) relative to the image  6040  of the staple overlap portion  6012 . 
       FIG.  107    illustrates an anvil trocar  6010  of a circular stapler  6002  that is not aligned with a staple overlap portion  6012  of a double staple line  6004  created by a double-stapling technique. The double staple line  6004  has a length “1” and the staple overlap portion  6012  is located midway along the double staple line  6004  at “½.” As shown in  FIG.  107   , the circular stapler  6002  is inserted into a section of the colon  6020  and is positioned just below the double staple line  6004  transection. A laparoscope  6014  is positioned above the double staple line  6004  transection and feeds an image of the double staple line  6004  and staple overlap portion  6012  within the field of view  6016  of the laparoscope  6014  to the surgical hub display  215 . The position of the anvil trocar  6010  relative to the staple overlap portion  6012  is detected by a sensor  6022  located on the circular stapler  6002 . The sensor  6022  also provides the position of the anvil trocar  6010  relative to the staple overlap portion  6012  to the surgical hub display  215 . 
     As shown in In  FIG.  107   , the projected path  6018  of the anvil trocar  6010  is shown along a broken line to a position marked by an X. As shown in  FIG.  107   , the projected path  6018  of the anvil trocar  6010  is not aligned with the staple overlap portion  6012 . Puncturing the anvil trocar  6010  through the double staple line  6004  at a point off the staple overlap portion  6012  could lead to an anastomotic failure. Using the anvil trocar  6010  centering tool  6030  described in  FIG.  109   , the surgeon can align the anvil trocar  6010  with the staple overlap portion  6012  using the images displayed by the centering tool  6030 . For example, in one implementation, the sensor  6022  is an inductive sensor. Since the staple overlap portion  6012  contains more metal than the rest of the lateral portions of the double staple line  6004 , the signal  6024  is maximum when the sensor  6022  is aligned with and proximate to the staple overlap portion  6012 . The sensor  6022  provides a signal to the surgical hub  206  that indicates the location of the anvil trocar  6010  relative to the staple overlap portion  6012 . The output signal is converted to a visualization of the location of the anvil trocar  6010  relative to the staple overlap portion  6012  that is displayed on the surgical hub display  215 . 
     As shown in  FIG.  108   , the anvil trocar  6010  is aligned with the staple overlap portion  6012  at the center of the double staple line  6004  created by a double-stapling technique. The surgeon can now puncture the anvil trocar  6010  through the staple overlap portion  6012  of the double staple line  6004  and/or fully clamp on the tissue before firing the circular stapler  6002  to cut out the staple overlap portion  6012  and form an anastomosis. 
       FIG.  109    illustrates a centering tool  6030  displayed on a surgical hub display  215 , the centering tool providing a display of a staple overlap portion  6012  of a double staple line  6004  created by a double-staling technique, where the anvil trocar  6010  is not aligned with the staple overlap portion  6012  of the double staple line  6004  as shown in  FIG.  107   . The centering tool  6030  presents an image  6038  on the surgical hub display  215  of the double staple line  6004  and an image  6040  of the staple overlap portion  6012  received from the laparoscope  6014 . A target alignment ring  6032  centered about the image  6040  of the staple overlap portion  6012  circumscribes the image  6038  of the double staple line  6004  to ensure that the staple overlap portion  6012  is located within the circumference of the projected cut path  6034  of the circular stapler  6002  knife when the projected cut path  6034  is aligned to the target alignment ring  6032 . The crosshair  6036  (X) represents the location of the anvil trocar  6010  relative to the staple overlap portion  6012 . The crosshair  6036  (X) indicates the point through the double staple line  6004  where the anvil trocar  6010  would puncture if it were advanced from its current location. 
     As shown in  FIG.  109   , the anvil trocar  6010  is not aligned with the desired puncture through location designated by the image  6040  of the staple overlap portion  6012 . To align the anvil trocar  6010  with the staple overlap portion  6012  the surgeon manipulates the circular stapler  6002  until the projected cut path  6034  overlaps the target alignment ring  6032  and the crosshair  6036  (X) is centered on the image  6040  of the staple overlap portion  6012 . Once alignment is complete, the surgeon punctures the anvil trocar  6010  through the staple overlap portion  6012  of the double staple line  6004  and/or fully clamps on the tissue before firing the circular stapler  6002  to cut out the staple overlap portion  6012  and form the anastomosis. 
     As discussed above, the sensor  6022  is configured to detect the position of the anvil trocar  6010  relative to the staple overlap portion  6012 . Accordingly, the location of the crosshair  6036  (X) presented on the surgical hub display  215  is determined by the surgical stapler sensor  6022 . In another aspect, the sensor  6022  may be located on the laparoscope  6014 , where the sensor  6022  is configured to detect the tip of the anvil trocar  6010 . In other aspects, the sensor  6022  may be located either on the circular stapler  6022  or the laparoscope  6014 , or both, to determine the location of the anvil trocar  6010  relative to the staple overlap portion  6012  and provide the information to the surgical hub display  215  via the surgical hub  206 . 
       FIGS.  110  and  111    illustrate a before image  6042  and an after image  6043  of a centering tool  6030 , according to one aspect of the present disclosure.  FIG.  110    illustrates an image of a projected cut path  6034  of an anvil trocar  6010  and circular knife before alignment with the target alignment ring  6032  circumscribing the image  6038  of the double staple line  6004  over the image  6040  of the staple overlap portion  6040  presented on a surgical hub display  215 .  FIG.  111    illustrates an image of a projected cut path  6034  of an anvil trocar  6010  and circular knife after alignment with the target alignment ring  6032  circumscribing the image  6038  of the double staple line  6004  over the image  6040  of the staple overlap portion  6040  presented on a surgical hub display  215 . The current location of the anvil trocar  6010  is marked by the crosshair  6036  (X), which as shown in  FIG.  110   , is positioned below and to the left of center of the image  6040  of the staple overlap portion  6040 . As shown in  FIG.  111   , as the surgeon moves the anvil trocar  6010  of the along the projected path  6046 , the projected cut path  6034  aligns with the target alignment ring  6032 . The target alignment ring  6032  may be displayed as a greyed out alignment circle overlaid over the current position of the anvil trocar  6010  relative to the center of the double staple line  6004 , for example. The image may include indication marks to assist the alignment process by indication which direction to move the anvil trocar  6010 . The target alignment ring  6032  may be shown in bold, change color or may be highlighted when it is located within a predetermined distance of center within acceptable limits. 
     In another aspect, the sensor  6022  may be configured to detect the beginning and end of a linear staple line in a colorectal transection and to provide the position of the current location of the anvil trocar  6010  of the circular stapler  6002 . In another aspect, the present disclosure provides a surgical hub display  215  to present the circular stapler  6002  centered on the linear staple line, which would create even dog ears, and to provide the current position of the anvil trocar  6010  to allow the surgeon to center or align the anvil trocar  6010  as desired before puncturing and/or fully clamping on tissue prior to firing the circular stapler  6002 . 
     In another aspect, as described in  FIGS.  112 - 114    and with reference also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , in a laparoscopic-assisted rectal surgery colorectal transection using a linear stapling technique, the beginning and end of the linear staple line  6052  is detected and the current location of the anvil trocar  6010  of the circular stapler  6002  is displayed on a surgical hub display  215  coupled to the surgical hub  206 . The surgical hub display  215  displays a circular image centered on the double staple line  6004 , which would create even dog ears and the current position of the anvil trocar  6002  is displayed to allow the surgeon to center or align the anvil trocar  6010  before puncturing through the linear staple line  6052  and/or fully clamping on the tissue before firing the circular stapler  6002  to cut out the center  6050  of the linear staple line  6052  to form an anastomosis. 
       FIGS.  112 - 114    illustrate a process of aligning an anvil trocar  6010  of a circular stapler  6022  to a center  6050  of a linear staple line  6052  created by a linear stapling technique, according to one aspect of the present disclosure.  FIGS.  112  and  113    illustrate a laparoscope  6014  and a sensor  6022  located on the circular stapler  6022  to determine the location of the anvil trocar  6010  relative to the center  6050  of the linear staple line  6052 . The anvil trocar  6010  and the sensor  6022  is inserted into the colon  6020  below the linear staple line  6052  and the laparoscope  6014  is inserted through the abdomen above the linear staple line  6052 . 
       FIG.  112    illustrates the anvil trocar  6010  out of alignment with the center  6050  of the linear staple line  6052  and  FIG.  113    illustrates the anvil trocar  6010  in alignment with the center  6050  of the linear staple line  6052 . The sensor  6022  is used to detect the center  6050  of the linear staple line  6052  to align the anvil trocar  6010  with the center of the staple line  6052 . In one aspect, the center  6050  of the linear staple line  6052  may be located by moving the circular stapler  6002  until one end of the linear staple line  6052  is detected. An end may be detected when there are no more staples in the path of the sensor  6022 . Once one of the ends is reached, the circular stapler  6002  is moved along the linear staple line  6053  until the opposite end is detected and the length “1” of the linear staple line  6052  is determined by measurement or by counting individual staples by the sensor  6022 . Once the length of the linear staple line  6052  is determined, the center  6050  of the linear staple line  6052  can be determined by dividing the length by two “½.” 
       FIG.  114    illustrates a centering tool  6054  displayed on a surgical hub display  215 , the centering tool providing a display of a linear staple line  6052 , where the anvil trocar  6010  is not aligned with the staple overlap portion  6012  of the double staple line  6004  as shown in  FIG.  112   . The surgical hub display  215  presents a standard reticle field of view  6056  of the laparoscopic field of view  6016  of the linear staple line  6052  and a portion of the colon  6020 . The surgical hub display  215  also presents a target ring  6062  circumscribing the image center of the linear staple line and a projected cut path  6064  of the anvil trocar and circular knife. The crosshair  6066  (X) represents the location of the anvil trocar  6010  relative to the center  6050  of the linear staple line  6052 . The crosshair  6036  (X) indicates the point through the linear staple line  6052  where the anvil trocar  6010  would puncture if it were advanced from its current location. 
     As shown in  FIG.  114   , the anvil trocar  6010  is not aligned with the desired puncture through location designated by the offset between the target ring  6062  and the projected cut path  6064 . To align the anvil trocar  6010  with the center  6050  of the linear staple line  6052  the surgeon manipulates the circular stapler  6002  until the projected cut path  6064  overlaps the target alignment ring  6062  and the crosshair  6066  (X) is centered on the image  6040  of the staple overlap portion  6012 . Once alignment is complete, the surgeon punctures the anvil trocar  6010  through the center  6050  of the linear staple line  6052  and/or fully clamps on the tissue before firing the circular stapler  6002  to cut out the staple overlap portion  6012  and forming the anastomosis. 
     In one aspect, the present disclosure provides an apparatus and method for displaying an image of an linear staple line  6052  using a linear transection technique and an alignment ring or bullseye positioned as if the anvil trocar  6010  of the circular stapler  6022  were centered appropriately along the linear staple line  6052 . The apparatus displays a greyed out alignment ring overlaid over the current position of the anvil trocar  6010  relative to the center  6050  of the linear staple line  6052 . The image may include indication marks to assist the alignment process by indication which direction to move the anvil trocar  6010 . The alignment ring may be bold, change color or highlight when it is located within a predetermined distance of centered. 
     With reference now to  FIGS.  112 - 115   ,  FIG.  115    is an image  6080  of a standard reticle field view  6080  of a linear staple line  6052  transection of a surgical as viewed through a laparoscope  6014  displayed on the surgical hub display  215 , according to one aspect of the present disclosure. In a standard reticle view  6080 , it is difficult to see the linear staple line  6052  in the standard reticle field of view  6056 . Further, there are no alignment aids to assist with alignment and introduction of the anvil trocar  6010  to the center  6050  of the linear staple line. This view does not show an alignment circle or alignment mark to indicate if the circular stapler is centered appropriately and does not show the projected trocar path. In this view it also difficult to see the staples because there is no contrast with the background image. 
     With reference now to  FIGS.  112 - 116   ,  FIG.  116    is an image  6082  of a laser-assisted reticle field of view  6072  of the surgical site shown in  FIG.  115    before the anvil trocar  6010  and circular knife of the circular stapler  6002  are aligned to the center  6050  of the linear staple line  6052 , according to one aspect of the present disclosure. The laser-assisted reticle field of view  6072  provides an alignment mark or crosshair  6066  (X), currently positioned below and to the left of center of the linear staple line  6052  showing the projected path of the anvil trocar  6010  to assist positioning of the anvil trocar  6010 . In addition to the projected path marked by the crosshair  6066  (X) of the anvil trocar  6010 , the image  6082  displays the staples of the linear staple line  6052  in a contrast color to make them more visible against the background. The linear staple line  6052  is highlighted and a bullseye target  6070  is displayed over the center  6050  of the linear staple line  6052 . Outside of the laser-assisted reticle field of view  6072 , the image  6082  displays a status warning box  6068 , a suggestion box  6074 , a target ring  6062 , and the current alignment position of the anvil trocar  6010  marked by the crosshair  6066  (X) relative to the center  6050  of the linear staple line  6052 . As shown in  FIG.  116   , the status warning box  6068  indicates that the trocar is “MISALIGNED” and the suggestion box  6074  states “Adjust trocar to center staple line.” 
     With reference now to  FIGS.  112 - 117   ,  FIG.  117    is an image  6084  of a laser-assisted reticle field of view  6072  of the surgical site shown in  FIG.  116    after the anvil trocar  6010  and circular knife of the circular stapler  6002  are aligned to the center  6050  of the linear staple line  6052 , according to one aspect of the present disclosure. The laser-assisted reticle field of view  6072  provides an alignment mark or crosshair  6066  (X), currently positioned below and to the left of center of the linear staple line  6052  showing the projected path of the anvil trocar  6010  to assist positioning of the anvil trocar  6010 . In addition to the projected path marked by the crosshair  6066  (X) of the anvil trocar  6010 , the image  6082  displays the staples of the linear staple line  6052  in a contrast color to make them more visible against the background. The linear staple line  6052  is highlighted and a bullseye target  6070  is displayed over the center  6050  of the linear staple line  6052 . Outside of the laser-assisted reticle field of view  6072 , the image  6082  displays a status warning box  6068 , a suggestion box  6074 , a target ring  6062 , and the current alignment position of the anvil trocar  6010  marked by the crosshair  6066  (X) relative to the center  6050  of the linear staple line  6052 . As shown in  FIG.  116   , the status warning box  6068  indicates that the trocar is “MISALIGNED” and the suggestion box  6074  states “Adjust trocar to center staple line.” 
       FIG.  117    is a laser assisted view of the surgical site shown in  FIG.  116    after the anvil trocar  6010  and circular knife are aligned to the center of the staple line  6052 . In this view, inside the field of view  6072  of the laser-assisted reticle, the alignment mark crosshair  6066  (X) is positioned over the center of the staple line  6052  and the highlighted bullseye target to indicate alignment of the trocar to the center of the staple line. Outside the field of view  6072  of the laser-assisted reticle, the status warning box indicates that the trocar is “ALIGNED” and the suggestion is “Proceed trocar introduction.” 
       FIG.  118    illustrates a non-contact inductive sensor  6090  implementation of the non-contact sensor  6022  to determine an anvil trocar  6010  location relative to the center of a staple line transection (the staple overlap portion  6012  of the double staple line  6004  shown in  FIGS.   107 - 108    or the center  6050  of the linear staple line  6052  shown in  FIGS.  112 - 113   , for example), according to one aspect of the present disclosure. The non-contact inductive sensor  6090  includes an oscillator  6092  that drives an inductive coil  6094  to generate an electromagnetic field  6096 . As a metal target  6098 , such as a metal staple, is introduced into the electromagnetic field  6096 , eddy currents  6100  induced in the target  6098  oppose the electromagnetic field  6096  and the reluctance shifts and the amplitude of the oscillator voltage  6102  drops. An amplifier  6104  amplifies the oscillator voltage  6102  amplitude as it changes. 
     With reference now to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206  and also to  FIGS.  106 - 117   , the inductive sensor  6090  is a non-contact electronic sensor. It can be used for positioning and detecting metal objects such as the metal staples in the staple lines  6003 ,  6004 ,  6052  described above. The sensing range of the inductive sensor  6090  is dependent on the type of metal being detected. Because the inductive sensor  6090  is a non-contact sensor, it can detect metal objects across a stapled tissue barrier. The inductive sensor  6090  can be located either on the circular stapler  6002  to detect staples in the staple lines  6003 ,  6004 ,  6052 , detect the location of the distal end of the laparoscope  6014 , or it may be located on the laparoscope  6014  to detect the location of the anvil trocar  6010 . A processor or control circuit located either in the circular stapler  6002 , laparoscope  6014 , or coupled to the surgical hub  206  receives signals from the inductive sensors  6090  and can be employed to display the centering tool on the surgical hub display  215  to determine the location of the anvil trocar  6010  relative to either staple overlap portion  6012  of a double staple line  6004  or the center  6050  of a linear staple line  6052 . 
     In one aspect, the distal end of the laparoscope  6014  may be detected by the inductive sensor  6090  located on the circular stapler  6002 . The inductive sensor  6090  may detect a metal target  6098  positioned on the distal end of the laparoscope  6014 . Once the  laparoscope   6014  is aligned with the center  6050  of the linear staple line  6052  or the staple overlap portion  6012  of the double staple line  6004 , a signal from the inductive sensor  6090  is transmitted to circuits that convert the signals from the inductive sensor  6090  to present an image of the relative alignment of the laparoscope  6014  with the anvil trocar  6010  of the circular stapler  6002 . 
       FIGS.  119 A and  119 B  illustrate one aspect of a non-contact capacitive sensor  6110  implementation of the non-contact sensor  6022  to determine an anvil trocar  6010  location relative to the center of a staple line transection (the staple overlap portion  6012  of the double staple line  6004  shown in  FIGS.  107 - 108    or the center  6050  of the linear staple line  6052  shown in  FIGS.  112 - 113   , for example), according to one aspect of the present disclosure.  FIG.  119 A  shows the non-contact capacitive sensor  6110  without a nearby metal target and  FIG.  119 B  shows the non-contact capacitive sensor  6110  near a metal target  6112 . The non-contact capacitive sensor  6110  includes capacitor plates  6114 ,  6116  housed in a sensing head and establishes field lines  6118  when energized by an oscillator waveform to define a sensing zone.  FIG.  119 A  shows the field lines  6118  when no target is present proximal to the capacitor plates  6114 ,  6116 .  FIG.  119 B  shows a ferrous or nonferrous metal target  6120  in the sensing zone. As the metal target  6120  enters the sensing zone, the capacitance increases causing the natural frequency to shift towards the oscillation frequency causing amplitude gain. Because the capacitive sensor  6110  is a non-contact sensor, it can detect metal objects across a stapled tissue barrier. The capacitive sensor  6110  can be located either on the circular stapler  6002  to detect the staple lines  6004 ,  6052  or the location of the distal end of the laparoscope  6014  or the capacitive sensor  6110  may be located on the laparoscope  6014  to detect the location of the anvil trocar  6010 . A processor or control circuit located either in the circular stapler  6002 , the laparoscope  6014 , or coupled to the surgical hub  206  receives signals from the capacitive sensor  6110  to present an image of the relative alignment of the laparoscope  6014  with the anvil trocar  6010  of the circular stapler  6002 . 
       FIG.  120    is a logic flow diagram  6130  of a process depicting a control program or a logic configuration for aligning a surgical instrument, according to one aspect of the present disclosure. With reference to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206  and also to  FIGS.  106 - 119   , the surgical hub  206  comprises a processor  244  and a memory  249  coupled to the processor  244 . The memory  249  stores instructions executable by the processor  244  to receive  6132  image data from a laparoscope image sensor, generate  6134  a first image based on the image data, display  6136  the first image on a surgical hub display  215  coupled to the processor  244 , receive  6138  a signal from a non-contact sensor  6022 , the signal indicative of a position of a surgical device, generate a second image based on the signal indicative of the position of the surgical device, e.g., the anvil trocar  6010  and display  6140  the second image on the surgical hub display  215 . The first image data represents a center  6044 ,  6050  of a staple line  6004 ,  6052  seal. The first image represents a target corresponding to the center  6044 ,  6050  of the staple line  6004 ,  6052  seal. The signal is indicative of a position of a surgical device, e.g., an anvil trocar  6010 , relative to the center  6044 ,  6050  of the staple line  6004 ,  6052  seal. The second image represents the position of the surgical device, e.g., an anvil trocar  6010 , along a projected path  6018  of the surgical device, e.g., an anvil trocar  6010 , toward the center  6044 ,  6050  of the staple line  6004 ,  6052  seal. 
     In one aspect, the center  6044  of the double staple line  6004  seal defines a staple overlap portion  6012 . In another aspect, an image sensor receives an image from a medical imaging device. In another aspect, the surgical device is a circular stapler  6002  comprising an anvil trocar  6010  and the non-contact sensor  6022  is configured to detect the location of the anvil trocar  6010  relative to the center  6044  of the double staple line  6004  seal. In another aspect, the non-contact sensor  6022  is an inductive sensor  6090 . In another aspect, the non-contact sensor  6022  is a capacitive sensor  6110 . In one aspect, the staple line may be a linear staple line  6052  formed using a linear transection technique. 
     Cooperation Between Local Instrument Displays and Paired Imaging Device Display 
     In one aspect, the present disclosure provides an instrument including a local display, a hub having an operating room (OR), or operating theater, display separate from the instrument display. When the instrument is linked to the surgical hub, the secondary display on the device reconfigures to display different information than when it is independent of the surgical hub connection. In another aspect, some portion of the information on the secondary display of the instrument is then displayed on the primary display of the surgical hub. In another aspect, image fusion allowing the overlay of the status of a device, the integration landmarks being used to interlock several images and at least one guidance feature are provided on the surgical hub and/or instrument display. Techniques for overlaying or augmenting images and/or text from multiple image/text sources to present composite images on a single display are described hereinbelow in connection with  FIGS.  129 - 137    and  FIGS.  147 - 151   . 
     In another aspect, the present disclosure provides cooperation between local instrument displays and a paired laparoscope display. In one aspect, the behavior of a local display of an instrument changes when it senses the connectable presence of a global display coupled to the surgical hub. In another aspect, the present disclosure provides 360° composite top visual field of view of a surgical site to avoid collateral structures. Each of these techniques is described hereinbelow. 
     During a surgical procedure, the surgical site is displayed on a remote “primary” surgical hub display. During a surgical procedure, surgical devices track and record surgical data and variables (e.g., surgical parameters) that are stored in the instrument (see  FIGS.  12 - 19    for instrument architectures comprising processors, memory, control circuits, storage, etc.). The surgical parameters include force-to-fire (FTF), force-to-close (FTC), firing progress, tissue gap, power level, impedance, tissue compression stability (creep), and the like. Using conventional techniques during the procedure the surgeon needs to watch two separate displays. Providing image/text overlay is thus advantageous because during the procedure the surgeon can watch a single display presenting the overlaid image/text information. 
     One solution detects when the surgical device (e.g., instrument) is connected to the surgical hub and then display a composite image on the primary display that includes a field of view of the surgical site received from a first instrument (e.g., medical imaging device such as, e.g., laparoscope, endoscope, thoracoscope, and the like) augmented by surgical data and variables received from a second instrument (e.g., a surgical stapler) to provide pertinent images and data on the primary display. 
     During a surgical procedure the surgical site is displayed as a narrow field of view of a medical imaging device on the primary surgical hub display. Items outside the current field of view, collateral structures, cannot be viewed without moving the medical imaging device. 
     One solution provides a narrow field of view of the surgical site in a first window of the display augmented by a wide field of view of the surgical site in a separate window of the display. This provides a composite over head field of view mapped using two or more imaging arrays to provide an augmented image of multiple perspective views of the surgical site. 
     In one aspect, the present disclosure provides a surgical hub, comprising a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to detect a surgical device connection to the surgical hub, transmit a control signal to the detected surgical device to transmit to the surgical hub surgical parameter data associated with the detected device, receive the surgical parameter data, receive image data from an image sensor, and display, on a display coupled to the surgical hub, an image received from the image sensor in conjunction with the surgical parameter data received from the surgical device. 
     In another aspect, the present disclosure provides a surgical hub, comprising a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to receive first image data from a first image sensor, receive second image data from a second image sensor, and display, on a display coupled to the surgical hub, a first image corresponding to the first field of view and a second image corresponding to the second field of view. The first image data represents a first field of view and the second image data represents a second field of view. 
     In one aspect, the first field of view is a narrow angle field of view and the second field of view is a wide angle field of view. In another aspect, the memory stores instructions executable by the processor to augment the first image with the second image on the display. In another aspect, the memory stores instructions executable by the processor to fuse the first image and the second image into a third image and display a fused image on the display. In another aspect, the fused image data comprises status information associated with a surgical device, an image data integration landmark to interlock a plurality of images, and at least one guidance parameter. In another aspect, the first image sensor is the same as the same image sensor and wherein the first image data is captured as a first time and the second image data is captured at a second time. 
     In another aspect, the memory stores instructions executable by the processor to receive third image data from a third image sensor, wherein the third image data represents a third field of view, generate composite image data comprising the second and third image data, display the first image in a first window of the display, wherein the first image corresponds to the first image data, and display a third image in a second window of the display, wherein the third image corresponds to the composite image data. 
     In another aspect, the memory stores instructions executable by the processor to receive third image data from a third image sensor, wherein the third image data represents a third field of view, fuse the second and third image data to generate fused image data, display the first image in a first window of the display, wherein the first image corresponds to the first image data, and display a third image in a second window of the display, wherein the third image corresponds to the fused image data. 
     In various aspects, the present disclosure provides a control circuit to perform the functions described above. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions, which when executed, causes a machine to perform the functions described above. 
     By displaying endoscope images augmented with surgical device images on one primary surgical hub display, enables the surgeon to focus on one display to obtain a field of view of the surgical site augmented with surgical device data associated with the surgical procedure such as force-to-fire, force-to-close, firing progress, tissue gap, power level, impedance, tissue compression stability (creep), and the like. 
     Displaying a narrow field of view image in a first window of a display and a composite image of several other perspectives such as wider fields of view enables the surgeon to view a magnified image of the surgical site simultaneously with wider fields of view of the surgical site without moving the scope. 
     In one aspect, the present disclosure provides both global and local display of a device, e.g., a surgical instrument, coupled to the surgical hub. The device displays all of its relevant menus and displays on a local display until it senses a connection to the surgical hub at which point a sub-set of the information is displayed only on the monitor through the surgical hub and that information is either mirrored on the device display or is no longer accessible on the device detonated screen. This technique frees up the device display to show different information or display larger font information on the surgical hub display. 
     In one aspect, the present disclosure provides an instrument having a local display, a surgical hub having an operating theater (e.g., operating room or OR) display that is separate from the instrument display. When the instrument is linked to the surgical hub, the instrument local display becomes a secondary display and the instrument reconfigures to display different information than when it is operating independent of the surgical hub connection. In another aspect, some portion of the information on the secondary display is then displayed on the primary display in the operating theater through the surgical hub. 
       FIG.  121    illustrates a primary display  6200  of the surgical hub  206  comprising a global display  6202  and a local instrument display  6204 , according to one aspect of the present disclosure. With continued reference to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206  and  FIGS.  12 - 21    for surgical hub connected instruments together with  FIG.  121   , the local instrument display  6204  behavior is displayed when the instrument  235  senses the connectable presence of a global display  6202  through the surgical hub  206 . The global display  6202  shows a field of view  6206  of a surgical site  6208 , as viewed through a medical imaging device such as, for example, a laparoscope/endoscope  219  coupled to an imaging module  238 , at the center of the surgical hub display  215 , referred to herein also as a monitor, for example. The end effector  6218  portion of the connected instrument  235  is shown in the field of view  6206  of the surgical site  6208  in the global display  6202 . The images shown on the display  237  located on an instrument  235  coupled to the surgical hub  206  is shown, or mirrored, on the local instrument display  6204  located in the lower right corner of the monitor  6200  as shown in  FIG.  121   , for example. During operation, all relevant instrument and information and menus are displayed on the display  237  located on the instrument  235  until the instrument  235  senses a connection of the instrument  235  to the surgical hub  206  at which point all or some sub-set of the information presented on the instrument display  237  is displayed only on the local instrument display  6204  portion of the surgical hub display  6200  through the surgical hub  206 . The information displayed on the local instrument display  6204  may be mirrored on the display  237  located on the instrument  235  or may be no longer accessible on the instrument display  237  detonated screen. This technique frees up the instrument  235  to show different information or to show larger font information on the surgical hub display  6200 . Several techniques for overlaying or augmenting images and/or text from multiple image/text sources to present composite images on a single display are described hereinbelow in connection with  FIGS.  129 - 137    and  FIGS.  147 - 151   . 
     The surgical hub display  6200  provides perioperative visualization of the surgical site  6208 . Advanced imaging identifies and visually highlights  6222  critical structures such as the ureter  6220  (or nerves, etc.) and also tracks instrument proximity displays  6210  and shown on the left side of the display  6200 . In the illustrated example, the instrument proximity displays  6210  show instrument specific settings. For example the top instrument proximity display  6212  shows settings for a monopolar instrument, the middle instrument proximity display  6214  shows settings for a bipolar instrument, and the bottom instrument proximity display  6212  shows settings for an ultrasonic instrument. 
     In another aspect, independent secondary displays or dedicated local displays can be linked to the surgical hub  206  to provide both an interaction portal via a touchscreen display and/or a secondary screen that can display any number of surgical hub  206  tracked data feeds to provide a clear non-confusing status. The secondary screen may display force to fire (FTF), tissue gap, power level, impedance, tissue compression stability (creep), etc., while the primary screen may display only key variables to keep the feed free of clutter. The interactive display may be used to move the display of specific information to the primary display to a desired location, size, color, etc. In the illustrated example, the secondary screen displays the instrument proximity displays  6210  on the left side of the display  6200  and the local instrument display  6204  on the bottom right side of the display  6200 . The local instrument display  6204  presented on the surgical hub display  6200  displays an icon of the end effector  6218 , such as the icon of a staple cartridge  6224  currently in use, the size  6226  of the staple cartridge  6224  (e.g., 60 mm), and an icon of the current position of the knife  6228  of the end effector. 
     In another aspect, the display  237  located on the instrument  235  displays the wireless or wired attachment of the instrument  235  to the surgical hub  206  and the instrument’s communication/recording on the surgical hub  206 . A setting may be provided on the instrument  235  to enable the user to select mirroring or extending the display to both monitoring devices. The instrument controls may be used to interact with the surgical hub display of the information being sourced on the instrument. As previously discussed, the instrument  235  may comprise wireless communication circuits to communicate wirelessly with the surgical hub  206 . 
     In another aspect, a first instrument coupled to the surgical hub  206  can pair to a screen of a second instrument coupled to the surgical hub  206  allowing both instruments to display some hybrid combination of information from the two devices of both becoming mirrors of portions of the primary display. In yet another aspect, the primary display  6200  of the surgical hub  206  provides a 360° composite top visual view of the surgical site  6208  to avoid collateral structures. For example, a secondary display of the end-effector surgical stapler may be provided within the primary display  6200  of the surgical hub  206  or on another display in order to provide better perspective around the areas within a current the field of view  6206 . These aspects are described hereinbelow in connection with  FIGS.  122 - 124   . 
       FIGS.  122 - 124    illustrate a composite overhead views of an end-effector  6234  portion of a surgical stapler mapped using two or more imaging arrays or one array and time to provide multiple perspective views of the end-effector  6234  to enable the composite imaging of an overhead field of view. The techniques described herein may be applied to ultrasonic instruments, electrosurgical instruments, combination ultrasonic/electrosurgical instruments, and/or combination surgical stapler/electrosurgical instruments. Several techniques for overlaying or augmenting images and/or text from multiple image/text sources to present composite images on a single display are described hereinbelow in connection with  FIGS.  129 - 137    and  FIGS.  147 - 151   . 
       FIG.  122    illustrates a primary display  6200  of the surgical hub  206 , according to one aspect of the present disclosure. A primary window  6230  is located at the center of the screen shows a magnified or exploded narrow angle view of a surgical field of view  6232 . The primary window  6230  located in the center of the screen shows a magnified or narrow angle view of an end-effector  6234  of the surgical stapler grasping a vessel  6236 . The primary window  6230  displays knitted images to produce a composite image that enables visualization of structures adjacent to the surgical field of view  6232 . A second window  6240  is shown in the lower left corner of the primary display  6200 . The second window  6240  displays a knitted image in a wide angle view at standard focus of the image shown in the primary window  6230  in an overhead view. The overhead view provided in the second window  6240  enables the viewer to easily see items that are out of the narrow field surgical field of view  6232  without moving the laparoscope, or other imaging device  239  coupled to the imaging module  238  of the surgical hub  206 . A third window  6242  is shown in the lower right corner of the primary display  6200  shows an icon  6244  representative of the staple cartridge of the end-effector  6234  (e.g., a staple cartridge in this instance) and additional information such as “4 Row” indicating the number of staple rows  6246  and “35 mm” indicating the distance  6248  traversed by the knife along the length of the staple cartridge. Below the third window  6242  is displayed an icon  6258  of a frame of the current state of a clamp stabilization sequence  6250  ( FIG.  123   ) that indicates clamp stabilization. 
       FIG.  123    illustrates a clamp stabilization sequence  6250  over a five second period, according to one aspect of the present disclosure. The clamp stabilization sequence  6250  is shown over a five second period with intermittent displays  6252 ,  6254 ,  6256 ,  6258 ,  6260  spaced apart at one second intervals  6268  in addition to providing the real time  6266  (e.g., 09:35:10), which may be a pseudo real time to preserve anonymity of the patient. The intermittent displays  6252 ,  6254 ,  6256 ,  6258 ,  6260  show elapsed by filling in the circle until the clamp stabilization period is complete. At that point, the last display  6260  is shown in solid color. Clamp stabilization after the end effector  6234  clamps the vessel  6236  enables the formation of a better seal. 
       FIG.  124    illustrates a diagram  6270  of four separate wide angle view images  6272 ,  6274 ,  6276 ,  6278  of a surgical site at four separate times during the procedure, according to one aspect of the present disclosure. The sequence of images shows the creation of an overhead composite image in wide and narrow focus over time. A first image  6272  is a wide angle view of the end-effector  6234  clamping the vessel  6236  taken at an earlier time t o  (e.g., 09:35:09). A second image  6274  is another wide angle view of the end-effector  6234  clamping the vessel  6236  taken at the present time t 1  (e.g., 09:35:13). A third image  6276  is a composite image of an overhead view of the end-effector  6234  clamping the vessel  6236  taken at present time ti. The third image  6276  is displayed in the second window  6240  of the primary display  6200  of the surgical hub  206  as shown in  FIG.  122   . A fourth image  6278  is a narrow angle view of the end-effector  6234  clamping the vessel  6236  at present time ti (e.g., 09:35:13). The fourth image  6278  is the narrow angle view of the surgical site shown in the primary window  6230  of the primary display  6200  of the surgical hub  206  as shown in  FIG.  122   . 
     Display of Instrument Specific Data Needed For Efficient Use of the End-Effector 
     In one aspect, the present disclosure provide a surgical hub display of instrument specific data needed for efficient use of a surgical instrument, such as a surgical stapler. The techniques described herein may be applied to ultrasonic instruments, electrosurgical instruments, combination ultrasonic/electrosurgical instruments, and/or combination surgical stapler/electrosurgical instruments. In one aspect, a clamp time indicator based on tissue properties is shown on the display. In another aspect, a 360° composite top visual view is shown on the display to avoid collateral structures as shown and described in connection with  FIGS.  121 - 124    is incorporated herein by reference and, for conciseness and clarity of disclosure, the description of  FIGS.  121 - 124    will not be repeated here. 
     In one aspect, the present disclosure provides a display of tissue creep to provide the user with in-tissue compression/tissue stability data and to guide the user making an appropriate choice of when to conduct the next instrument action. In one aspect, an algorithm calculates a constant advancement of a progressive time based feedback system related to the viscoelastic response of tissue. These and other aspects are described hereinbelow. 
       FIG.  125    is a graph  6280  of tissue creep clamp stabilization curves  6282 ,  6284  for two tissue types, according to one aspect of the present disclosure. The clamp stabilization curves  6284 ,  6284  are plotted as force-to-close (FTC) as a function of time, where FTC (N) is displayed along the vertical axis and Time, t, (Sec) is displayed along the horizontal axis. The FTC is the amount of force exerted to close the clamp arm on the tissue. The first clamp stabilization curve  6282  represents stomach tissue and the second clamp stabilization curve  6284  represents lung tissue. In one aspect, the FTC along the vertical axis is scaled from 0-180 N. and the horizontal axis is scaled from 0-5 Sec. As shown, the FTC as a different profile over a five second clamp stabilization period (e.g., as shown in  FIG.  123   ). 
     With reference to the first clamp stabilization curve 6282, as the stomach tissue is clamped by the end-effector 6234, the force-to-close (FTC) applied by the end-effector 6234 increases from 0 N to a peak force-to-close of ~180 N after ~1 Sec. While the end-effector 6234 remains clamped on the stomach tissue, the force-to-close decays and stabilizes to ~150 N over time due to tissue creep. 
     Similarly, with reference to the second clamp stabilization curve  6284 , as the lung tissue is clamped by the end-effector  6234 , the force-to-close applied by the end-effector  6234  increases from 0 N to a peak force-to-close of ~90 N after just less than ~1 Sec. While the end-effector  6234  remains clamped on the lung tissue, the force-to-close decays and stabilizes to ~60 N over time due to tissue creep. 
     The end-effector  6234  clamp stabilization is monitored as described above in connection with  FIGS.  122 - 124    and is displayed every second corresponding the sampling times t 1 , t 2 , t 3 , t 4 , t 5  of the force-to-close to provide user feedback regarding the state of the clamped tissue.  FIG.  125    shows an example of monitoring tissue stabilization for the lung tissue by sampling the force-to-close every second over a 5 seconds period. At each sample time t 1 , t 2 , t 3 , t 4 , t 5 , the instrument  235  or the surgical hub  206  calculates a corresponding vector tangent  6288 ,  6292 ,  6294 ,  6298 ,  6302  to the second clamp stabilization curve  6284 . The vector tangent  6288 ,  6292 ,  6294 ,  6298 ,  6302  is monitored until its slope drops below a threshold to indicate that the tissue creep is complete and the tissue is ready to sealed and cut. As shown in  FIG.  125   , the lung tissue is ready to be sealed and cut after ~5 Sec. clamp stabilization period, where a solid gray circle is shown at sample time  6300 . As shown, the vector tangent  6302  is less than a predetermined threshold. 
     The equation of a vector tangent  6288 ,  6292 ,  6294 ,  6298 ,  6302  to the clamp stabilization curve  6284  may be calculated using differential calculus techniques, for example. In one aspect, at a given point on the clamp stabilization curve  6284 , the gradient of the curve  6284  is equal to the gradient of the tangent to the curve  6284 . The derivative (or gradient function) describes the gradient of the curve  6284  at any point on the curve  6284 . Similarly, it also describes the gradient of a tangent to the curve  6284  at any point on the curve  6284 . The normal to the curve  6284  is a line perpendicular to the tangent to the curve  6284  at any given point. To determine the equation of a tangent to a curve find the derivative using the rules of differentiation. Substitute the x coordinate (independent variable) of the given point into the derivative to calculate the gradient of the tangent. Substitute the gradient of the tangent and the coordinates of the given point into an appropriate form of the straight line equation. Make they coordinate (dependent variable) the subject of the formula. 
       FIG.  126    is a graph  6310  of time dependent proportionate fill of a clamp force stabilization curve, according to one aspect of the present disclosure. The graph  6310  includes clamp stabilization curves  6312 ,  6314 ,  6316  for standard thick stomach tissue, thin stomach tissue, and standard lung tissue. The vertical axis represents FTC (N) scaled from 0-240 N and the horizontal axis represents Time, t, (Sec) scaled from 0-15 Sec. As shown, the standard thick stomach tissue curve  6316  is the default force decay stability curve. All three clamp stabilization curves  6312 ,  6314 ,  6316  FTC profiles reach a maximum force shortly after clamping on the tissue and then the FTC decreases over time until it eventually stabilizes due to the viscoelastic response of the tissue. As shown the standard lung tissue clamp stabilization curve  6312  stabilizes after a period of ~5 Sec., the thin stomach tissue clamp stabilization curve  6314  stabilizes after a period of ~10 Sec., and the thick stomach tissue clamp stabilization curve  6316  stabilizes after a period of ~15 Sec. 
       FIG.  127    is a graph  6320  of the role of tissue creep in the clamp force stabilization curve  6322 , according to one aspect of the present disclosure. The vertical axis represents force-to-close FTC (N) and the horizontal axis represents Time, t, (Sec) in seconds. Vector tangent angles dθ 1 , dθ 2  ... dθ n  are measured at each force-to-close sampling (t 0 , t 1 , t 2 , t 3 , t 4 , etc.) times. The vector tangent angle dθ n  is used to determine when the tissue has reached the creep termination threshold, which indicates that the tissue has reached creep stability. 
       FIGS.  128 A and  128 B  illustrate two graphs  6330 ,  6340  for determining when the clamped tissue has reached creep stability, according to one aspect of the present disclosure. The graph  6330  in  FIG.  128 A  illustrates a curve  6332  that represents a vector tangent angle dθ as a function of time. The vector tangent angle dθ is calculated as discussed in  FIG.  127   . The horizontal line  6334  is the tissue creep termination threshold. The tissue creep is deemed to be stable at the intersection  6336  of the vector tangent angle dθ curve  6332  and the tissue creep termination threshold  6334 . The graph  6340  in  FIG.  128 B  illustrates a ΔFTC curve 6342 that represents ΔFTC as a function of time. The ΔFTC curve  6342  illustrates the threshold  6344  to 100% complete tissue creep stability meter. The tissue creep is deemed to be stable at the intersection  6346  of the ΔFTC curve  6342  and the threshold  6344 . 
     Communication Techniques 
     With reference to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , and in particular,  FIGS.  9 - 10   , in various aspects, the present disclosure provides communications techniques for exchanging information between an instrument  235 , or other modules, and the surgical hub  206 . In one aspect, the communications techniques include image fusion to place instrument status and analysis over a laparoscope image, such as a screen overlay of data, within and around the perimeter of an image presented on a surgical hub display  215 ,  217 . In another aspect, the communication techniques include combining an intermediate short range wireless, e.g., Bluetooth, signal with the image, and in another aspect, the communication techniques include applying security and identification of requested pairing. In yet another aspect, the communication techniques include an independent interactive headset worn by a surgeon that links to the hub with audio and visual information that avoids the need for overlays, but allows customization of displayed information around periphery of view. Each of these communication techniques is discussed hereinbelow. 
     Screen Overlay Of Data Within and Around the Perimeter of the Displayed Image 
     In one aspect, the present disclosure provides image fusion allowing the overlay of the status of a device, the integration landmarks being used to interlock several images, and at least one guidance feature. In another aspect, the present disclosure provides a technique for screen overlay of data within and around the perimeter of displayed image. Radiographic integration may be employed for live internal sensing and pre-procedure overlay. Image fusion of one source may be superimposed over another. Image fusion may be employed to place instrument status and analysis on a medical imaging device (e.g., laparoscope, endoscope, thoracoscope, etc.) image. Image fusion allows the overlay of the status of a device or instrument, integration landmarks to interlock several images, and at least one guidance feature. 
       FIG.  129    illustrates an example of an augmented video image  6350  comprising a pre-operative video image  6352  augmented with data  6354 ,  6356 ,  6358  identifying displayed elements. An augmented reality vision system may be employed in surgical procedures to implement a method for augmenting data onto a pre-operative image  6352 . The method includes generating a pre-operative image  6352  of an anatomical section of a patient and generating an augmented video image of a surgical site within the patient. The augmented video image  6350  includes an image of at least a portion of a surgical tool  6354  operated by a user  6456 . The method further includes processing the pre-operative image  6352  to generate data about the anatomical section of the patient. The data includes a label  6358  for the anatomical section and a peripheral margin of at least a portion of the anatomical section. The peripheral margin is configured to guide a surgeon to a cutting location relative to the anatomical section, embedding the data and an identity of the user  6356  within the pre-operative image  6350  to display an augmented video image  6350  to the user about the anatomical section of the patient. The method further includes sensing a loading condition on the surgical tool  6354 , generating a feedback signal based on the sensed loading condition, and updating, in real time, the data and a location of the identity of the user operating the surgical tool  6354  embedded within the augmented video image  6350  in response to a change in a location of the surgical tool  6354  within the augmented video image  6350 . Further examples are disclosed in U.S. Pat. No. 9,123,155, titled APPARATUS AND METHOD FOR USING AUGMENTED REALITY VISION SYSTEM IN SURGICAL PROCEDURES, which issued on Sep. 1, 2015, which is herein incorporated by reference in its entirety. 
     In another aspect, radiographic integration techniques may be employed to overlay the pre-operative image  6352  with data obtained through live internal sensing or pre-procedure techniques. Radiographic integration may include marker and landmark identification using surgical landmarks, radiographic markers placed in or outside the patient, identification of radio-opaque staples, clips or other tissue-fixated items. Digital radiography techniques may be employed to generate digital images for overlaying with a pre-operative image  6352 . Digital radiography is a form of X-ray imaging that employs a digital image capture device with digital X-ray sensors instead of traditional photographic film. Digital radiography techniques provide immediate image preview and availability for overlaying with the pre-operative image  6352 . In addition, special image processing techniques can be applied to the digital X-ray mages to enhance the overall display quality of the image. 
     Digital radiography techniques employ image detectors that include flat panel detectors (FPDs), which are classified in two main categories indirect FPDs and direct FPDs. Indirect FPDs include amorphous silicon (a-Si) combined with a scintillator in the detector’s outer layer, which is made from cesium iodide (CsI) or gadolinium oxy-sulfide (Gd2O2S), converts X-rays to light. The light is channeled through the a-Si photodiode layer where it is converted to a digital output signal. The digital signal is then read out by thin film transistors (TFTs) or fiber-coupled charge coupled devices (CCDs). Direct FPDs include amorphous selenium (a-Se) FPDs that convert X-ray photons directly into charge. The outer layer of a flat panel in this design is typically a high-voltage bias electrode. X-ray photons create electron-hole pairs in a-Se, and the transit of these electrons and holes depends on the potential of the bias voltage charge. As the holes are replaced with electrons, the resultant charge pattern in the selenium layer is read out by a TFT array, active matrix array, electrometer probes or micro plasma line addressing. Other direct digital detectors are based on CMOS and CCD technology. Phosphor detectors also may be employed to record the X-ray energy during exposure and is scanned by a laser diode to excite the stored energy which is released and read out by a digital image capture array of a CCD. 
       FIG.  130    is a logic flow diagram  6360  of a process depicting a control program or a logic configuration to display images, according to one aspect of the present disclosure. With reference also to  FIGS.  1 - 11    to show interaction with an interactive surgical system  100  environment including a surgical hub  106 ,  206 , the present disclosure provides, in one aspect, a surgical hub  206 , comprising a processor  244  and a memory  249  coupled to the processor  244 . The memory  249  stores instructions executable by the processor  244  to receive  6362  first image data from a first image sensor, receive 6364 second image data from a second image sensor, and display  6366 , on a display  217  coupled to the surgical hub  206 , a first image corresponding to the first field of view and a second image corresponding to the second field of view. The first image data represents a first field of view and the second image data represents a second field of view. 
     In one aspect, the first field of view is a narrow angle field of view and the second field of view is a wide angle field of view. In another aspect, the memory  249  stores instructions executable by the processor  244  to augment the first image with the second image on the display. In another aspect, the memory  249  stores instructions executable by the processor  244  to fuse the first image and the second image into a third image and display a fused image on the display  217 . In another aspect, the fused image data comprises status information associated with a surgical device  235 , an image data integration landmark to interlock a plurality of images, and at least one guidance parameter. In another aspect, the first image sensor is the same as the same image sensor and wherein the first image data is captured as a first time and the second image data is captured at a second time. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to receive third image data from a third image sensor, wherein the third image data represents a third field of view, generate composite image data comprising the second and third image data, display the first image in a first window of the display, wherein the first image corresponds to the first image data, and display a third image in a second window of the display  215 , wherein the third image corresponds to the composite image data. 
     In another aspect, the memory  249  stores instructions executable by the processor  244  to receive third image data from a third image sensor, wherein the third image data represents a third field of view, fuse the second and third image data to generate fused image data, display the first image in a first window of the display  217 , wherein the first image corresponds to the first image data, and display a third image in a second window of the display  217 , wherein the third image corresponds to the fused image data. 
     Intermediate Short Range Wireless (e.g., Bluetooth) Signal Combiner 
     An intermediate short range wireless, e.g., Bluetooth, signal combiner may comprise a wireless heads-up display adapter placed into the communication path of the monitor to a laparoscope console allowing the surgical hub to overlay data onto the screen. Security and identification of requested pairing may augment the communication techniques. 
       FIG.  131    illustrates a communication system  6370  comprising an intermediate signal combiner  6372  positioned in the communication path between an imaging module  238  and a surgical hub display  217 , according to one aspect of the present disclosure. The signal combiner  6372  receives image data from an imaging module  238  in the form of short range wireless or wired signals. The signal combiner  6372  also receives audio and image data form a headset  6374  and combines the image data from the imaging module  238  with the audio and image data from the headset  6374 . The surgical hub  206  receives the combined data from the combiner  6372  and overlays the data provided to the display  217 , where the overlaid data is displayed. The signal combiner  6372  may communicate with the surgical hub  206  via wired or wireless signals. The headset  6374  receives image data from an imaging device  6376  coupled to the headset  6374  and receives audio data from an audio device  6378  coupled to the headset  6374 . The imaging device  6376  may be a digital video camera and the audio device  6378  may be a microphone. In one aspect, the signal combiner  6372  may be an intermediate short range wireless, e.g., Bluetooth, signal combiner. The signal combiner  6374  may comprise a wireless heads-up display adapter to couple to the headset  6374  placed into the communication path of the display  217  to a console allowing the surgical hub  206  to overlay data onto the screen of the display  217 . Security and identification of requested pairing may augment the communication techniques. The imaging module  238  may be coupled to a variety if imaging devices such as an endoscope  239 , laparoscope, etc., for example. 
     Independent Interactive Headset 
       FIG.  132    illustrates an independent interactive headset  6380  worn by a surgeon  6382  to communicate data to the surgical hub, according to one aspect of the present disclosure. Peripheral information of the independent interactive headset  6380  does not include active video. Rather, the peripheral information includes only device settings, or signals that do not have same demands of refresh rates. Interaction may augment the surgeon’s  6382  information based on linkage with preoperative computerized tomography (CT) or other data linked in the surgical hub  206 . The independent interactive headset  6380  can identify structure - ask whether instrument is touching a nerve, vessel, or adhesion, for example. The independent interactive headset  6380  may include pre-operative scan data, an optical view, tissue interrogation properties acquired throughout procedure, and/or processing in the surgical hub  206  used to provide an answer. The surgeon  6382  can dictate notes to the independent interactive headset  6380  to be saved with patient data in the hub storage  248  for later use in report or in follow up. 
     In one aspect, the independent interactive headset  6380  worn by the surgeon  6382  links to the surgical hub  206  with audio and visual information to avoid the need for overlays, and allows customization of displayed information around periphery of view. The independent interactive headset  6380  provides signals from devices (e.g., instruments), answers queries about device settings, or positional information linked with video to identify quadrant or position. The independent interactive headset  6380  has audio control and audio feedback from the headset  6380 . The independent interactive headset  6380  is still able to interact with all other systems in the operating theater (e.g., operating room), and have feedback and interaction available wherever the surgeon  6382  is viewing. 
     Identification and Usage Recording 
     In one aspect, the present disclosure provides a display of the authenticity of reloads, modular components, or loading units.  FIG.  133    illustrates a method  6390  for controlling the usage of a device  6392 . A device  6392  is connected to an energy source  6394 . The device  6392  includes a memory device  6396  that includes storage  6398  and communication  6400  devices. The storage  6398  includes data  6402  that may be locked data  6404  or unlocked data  6406 . Additionally, the storage  6398  includes an error-detecting code  6408  such as a cyclic redundancy check (CRC) value and a sterilization indicator  6410 . The energy source  6394  includes a reader  6412 , display  6414 , a processor  6416 , and a data port  6418  that couples the energy source  6394  to a network  6420 . The network  6420  is coupled to a central server  6422 , which is coupled to a central database  6424 . The network  6420  also is coupled to a reprocessing facility  6426 . The reprocessing facility  6426  includes a reprocessing data reader/writer  6428  and a sterilizing device  6430 . 
     The method comprises connecting the device to an energy source  6394 . Data is read from a memory device  6396  incorporated in the device  6392 . The data including one or more of a unique identifier (UID), a usage value, an activation value, a reprocessing value, or a sterilization indicator. The usage value is incremented when the device  6392  is connected to the energy source  6394 . The activation value is incremented when the device  6392  is activated permitting energy to flow from the energy source  6394  to an energy consuming component of the device  6392 . Usage of the device  6392  may be prevented if: the UID is on a list of prohibited UIDs, the usage value is not lower than a usage limitation value, the reprocessing value is equal to a reprocessing limitation value, the activation value is equal to an activation limitation value, and/or the sterilization indicator does not indicate that the device has been sterilized since its previous usage. Further examples are disclosed in U.S. Pat. Application Publication No. 2015/0317899, titled SYSTEM AND METHOD FOR USING RFID TAGS TO DETERMINE STERILIZATION OF DEVICES, which published on Nov. 5, 2015, which is herein incorporated by reference in its entirety. 
       FIG.  134    provides a surgical system  6500  in accordance with the present disclosure and includes a surgical instrument  6502  that is in communication with a console  6522  or a portable device  6526  through a local area network  6518  or a cloud network  6520  via a wired or wireless connection. In various aspects, the console  6522  and the portable device  6526  may be any suitable computing device. The surgical instrument  6502  includes a handle  6504 , an adapter  6508 , and a loading unit  6514 . The adapter  6508  releasably couples to the handle  6504  and the loading unit  6514  releasably couples to the adapter  6508  such that the adapter  6508  transmits a force from a drive shaft to the loading unit  6514 . The adapter  6508  or the loading unit  6514  may include a force gauge (not explicitly shown) disposed therein to measure a force exerted on the loading unit  6514 . The loading unit  6514  includes an end effector  6530  having a first jaw  6532  and a second jaw  6534 . The loading unit  6514  may be an in-situ loaded or multi-firing loading unit (MFLU) that allows a clinician to fire a plurality of fasteners multiple times without requiring the loading unit  6514  to be removed from a surgical site to reload the loading unit  6514 . 
     The first and second jaws  6532 ,  6534  are configured to clamp tissue therebetween, fire fasteners through the clamped tissue, and sever the clamped tissue. The first jaw  6532  may be configured to fire at least one fastener a plurality of times, or may be configured to include a replaceable multi-fire fastener cartridge including a plurality of fasteners (e.g., staples, clips, etc.) that may be fired more that one time prior to being replaced. The second jaw  6534  may include an anvil that deforms or otherwise secures the fasteners about tissue as the fasteners are ejected from the multi-fire fastener cartridge. 
     The handle  6504  includes a motor that is coupled to the drive shaft to affect rotation of the drive shaft. The handle  6504  includes a control interface to selectively activate the motor. The control interface may include buttons, switches, levers, sliders, touchscreen, and any other suitable input mechanisms or user interfaces, which can be engaged by a clinician to activate the motor. 
     The control interface of the handle  6504  is in communication with a controller  6528  of the handle  6504  to selectively activate the motor to affect rotation of the drive shafts. The controller  6528  is disposed within the handle  6504  and is configured to receive input from the control interface and adapter data from the adapter  6508  or loading unit data from the loading unit  6514 . The controller  6528  analyzes the input from the control interface and the data received from the adapter  6508  and/or loading unit  6514  to selectively activate the motor. The handle  6504  may also include a display that is viewable by a clinician during use of the handle  6504 . The display is configured to display portions of the adapter or loading unit data before, during, or after firing of the instrument  6502 . 
     The adapter  6508  includes an adapter identification device  6510  disposed therein and the loading unit  6514  includes a loading unit identification device  6516  disposed therein. The adapter identification device  6510  is in communication with the controller  6528 , and the loading unit identification device  6516  is in communication with the controller  6528 . It will be appreciated that the loading unit identification device  6516  may be in communication with the adapter identification device  6510 , which relays or passes communication from the loading unit identification device  6516  to the controller  6528 . 
     The adapter  6508  may also include a plurality of sensors  6512  (one shown) disposed thereabout to detect various conditions of the adapter  6508  or of the environment (e.g., if the adapter  6508  is connected to a loading unit, if the adapter  6508  is connected to a handle, if the drive shafts are rotating, the torque of the drive shafts, the strain of the drive shafts, the temperature within the adapter  6508 , a number of firings of the adapter  6508 , a peak force of the adapter  6508  during firing, a total amount of force applied to the adapter  6508 , a peak retraction force of the adapter  6508 , a number of pauses of the adapter  6508  during firing, etc.). The plurality of sensors  6512  provides an input to the adapter identification device  6510  in the form of data signals. The data signals of the plurality of sensors  6512  may be stored within, or be used to update the adapter data stored within, the adapter identification device  6510 . The data signals of the plurality of sensors  6512  may be analog or digital. The plurality of sensors  6512  may include a force gauge to measure a force exerted on the loading unit  6514  during firing. 
     The handle  6504  and the adapter  6508  are configured to interconnect the adapter identification device  6510  and the loading unit identification device  6516  with the controller  6528  via an electrical interface. The electrical interface may be a direct electrical interface (i.e., include electrical contacts that engage one another to transmit energy and signals therebetween). Additionally or alternatively, the electrical interface may be a non-contact electrical interface to wirelessly transmit energy and signals therebetween (e.g., inductively transfer). It is also contemplated that the adapter identification device  6510  and the controller  6528  may be in wireless communication with one another via a wireless connection separate from the electrical interface. 
     The handle  6504  includes a transmitter  6506  that is configured to transmit instrument data from the controller  6528  to other components of the system  6500  (e.g., the LAN  6518 , the cloud  6520 , the console  6522 , or the portable device  6526 ). The transmitter  6506  also may receive data (e.g., cartridge data, loading unit data, or adapter data) from the other components of the system  6500 . For example, the controller  6528  may transmit instrument data including a serial number of an attached adapter (e.g., adapter  6508 ) attached to the handle  6504 , a serial number of a loading unit (e.g., loading unit  6514 ) attached to the adapter, and a serial number of a multi-fire fastener cartridge (e.g., multi-fire fastener cartridge), loaded into the loading unit, to the console  6528 . Thereafter, the console  6522  may transmit data (e.g., cartridge data, loading unit data, or adapter data) associated with the attached cartridge, loading unit, and adapter, respectively, back to the controller  6528 . The controller  6528  can display messages on the local instrument display or transmit the message, via transmitter  6506 , to the console  6522  or the portable device  6526  to display the message on the display  6524  or portable device screen, respectively. 
     Multi-Functional Surgical Control System and Switching Interface For Verbal Control of Imaging Device 
       FIG.  135    illustrates a verbal AESOP camera positioning system. Further examples are disclosed in U.S. Pat. No. 7,097,640, titled MULTI-FUNCTIONAL SURGICAL CONTROL SYSTEM AND SWITCHING INTERFACE, which issued on Aug. 29, 2006, which is herein incorporated by reference in its entirety.  FIG.  135    shows a surgical system  6550  that may be coupled to surgical hub  206 , described in connection with  FIGS.  1 - 11   . The system  6550  allows a surgeon to operate a number of different surgical devices  6552 ,  6554 ,  6556 , and  6558  from a single input device  6560 . Providing a single input device reduces the complexity of operating the various devices and improves the efficiency of a surgical procedure performed by a surgeon. The system  6550  may be adapted and configured to operate a positioning system for an imaging device such as a camera or endoscope using verbal commands. 
     The surgical device  6552  may be a robotic arm which can hold and move a surgical instrument. The arm  6552  may be a device such as that sold by Computer Motion, Inc. of Goleta, Calif. under the trademark AESOP, which is an acronym for Automated Endoscopic System for Optimal Positioning. The arm  6552  is commonly used to hold and move an endoscope within a patient. The system  6550  allows the surgeon to control the operation of the robotic arm  6552  through the input device  6560 . 
     The surgical device  6554  may be an electrocautery device. Electrocautery devices typically have a bi-polar tip which carries a current that heats and denatures tissue. The device is typically coupled to an on-off switch to actuate the device and heat the tissue. The electrocautery device may also receive control signals to vary its power output. The system  6550  allows the surgeon to control the operation of the electrocautery device through the input device  6560 . 
     The surgical device  6556  may be a laser. The laser  6556  may be actuated through an on-off switch. Additionally, the power of the laser  6556  may be controlled by control signals. The system  6550  allows the surgeon to control the operation of the laser  6556  through the input device  6560 . 
     The device  6558  may be an operating table. The operating table  6558  may contain motors and mechanisms which adjust the position of the table. The present invention allows the surgeon to control the position of the table  6558  through the input device  6560 . Although four surgical devices  6552 ,  6554 ,  6556 , and  6558  are described, it is to be understood that other functions within the operating room may be controlled through the input device  6560 . By way of example, the system  6560  may allow the surgeon to control the lighting and temperature of the operating room through the input device  6560 . 
     The input device  6560  may be a foot pedal which has a plurality of buttons  6562 ,  6564 ,  6565 ,  6566 , and  6568  that can be depressed by the surgeon. Each button is typically associated with a specific control command of a surgical device. For example, when the input device  6560  is controlling the robotic arm  6552 , depressing the button  6562  may move the arm in one direction and depressing the button  6566  may move the arm in an opposite direction. Likewise, when the electrocautery device  6554  or the laser  6556  is coupled to the input device  6560 , depressing the button  6568  may energize the devices, and so forth and so on. Although a foot pedal is shown and described, it is to be understood that the input device  6560  may be a hand controller, a speech interface which accepts voice commands from the surgeon, a cantilever pedal or other input devices which may be well known in the art of surgical device control. Using the speech interface, the surgeon is able to position a camera or endoscope connected to the robotic arm  6552  using verbal commands. The imaging device, such as a camera or endoscope, may be coupled to the robotic arm  6552  positioning system that be controlled through the system  6550  using verbal commands. 
     The system  6550  has a switching interface  6570  which couples the input device  6560  to the surgical devices  6552 ,  6554 ,  6556 , and  6558 . The interface  6570  has an input channel  6572  which is connected to the input device  6560  by a bus  6574 . The interface  6570  also has a plurality of output channels  6576 ,  6578 ,  6580 , and  6582  that are coupled to the surgical devices by busses  6584 ,  6586 ,  6588 ,  6590 ,  6624 ,  6626 ,  6628  and which may have adapters or controllers disposed in electrical communication therewith and therebetween. Such adapters and controllers will be discussed in more detail hereinbelow. 
     Because each device  6552 ,  6554 ,  6556 ,  6558  may require specifically configured control signals for proper operation, adapters  6620 ,  6622  or a controller  6618  may be placed intermediate and in electrical communication with a specific output channel and a specific surgical device. In the case of the robotic arm system  6552 , no adapter is necessary and as such, the robotic arm system  6552  may be in direct connection with a specific output channel. The interface  6570  couples the input channel  6572  to one of the output channels  6576 ,  6578 ,  6580 , and  6582 . 
     The interface  6570  has a select channel  6592  which can switch the input channel  6572  to a different output channel  6576 ,  6578 ,  6580 , or  6582  so that the input device  6560  can control any of the surgical devices. The interface  6570  may be a multiplexor circuit constructed as an integrated circuit and placed on an ASIC. Alternatively, the interface  6570  may be a plurality of solenoid actuated relays coupled to the select channel by a logic circuit. The interface  6570  switches to a specific output channel in response to an input signal or switching signal applied on the select channel  6592 . 
     As depicted in  FIG.  135   , there may be several inputs to the select channel  6592 . Such inputs originate from the foot pedal  6560 , the speech interface  6600  and the CPU  6662 . The interface  6570  may have a multiplexing unit such that only one switching signal may be received at the select channel  6592  at any one time, thus ensuring no substantial hardware conflicts. The prioritization of the input devices may be configured so the foot pedal has highest priority followed by the voice interface and the CPU. This is intended for example as the prioritization scheme may be employed to ensure the most efficient system. As such other prioritization schemes may be employed. The select channel  6592  may sequentially connect the input channel to one of the output channels each time a switching signal is provided to the select channel  6592 . Alternatively, the select channel  6592  may be addressable so that the interface  6570  connects the input channel to a specific output channel when an address is provided to the select channel  6592 . Such addressing is known in the art of electrical switches. 
     The select channel  6592  may be connected by line  6594  to a dedicated button  6596  on the foot pedal  6560 . The surgeon can switch surgical devices by depressing the button  6596 . Alternatively, the select channel  6592  may be coupled by line  6598  to a speech interface  6600  which allows the surgeon to switch surgical devices with voice commands. 
     The system  6550  may have a central processing unit (CPU)  6602  which receives input signals from the input device  6560  through the interface  6570  and a bus  6585 . The CPU  6602  receives the input signals, and can ensure that no improper commands are being input at the controller. If this occurs, the CPU  6602  may respond accordingly, either by sending a different switching signal to select channel  6592 , or by alerting the surgeon via a video monitor or speaker. 
     The CPU  6602  can also provide output commands for the select channel  6592  on the bus  6608  and receives input commands from the speech interface  6600  on the same bi-directional bus  6608 . The CPU  6602  may be coupled to a monitor  6610  and/or a speaker  6612  by buses  6614  and  6616 , respectively. The monitor  6610  may provide a visual indication of which surgical device is coupled to the input device  6560 . The monitor may also provide a menu of commands which can be selected by the surgeon either through the speech interface  6600  or button  6596 . Alternatively, the surgeon could switch to a surgical device by selecting a command through a graphic user interface. The monitor  6610  may also provide information regarding improper control signals sent to a specific surgical device  6552 ,  6554 ,  6556 ,  6558  and recognized by the CPU  6602 . Each device  6552 ,  6554 ,  6556 ,  6558  has a specific appropriate operating range, which is well known to the skilled artisan. As such, the CPU  6602  may be programmed to recognize when the requested operation from the input device  6560  is inappropriate and will then alert the surgeon either visually via the monitor  6610  or audibly via the speaker  6612 . The speaker  6612  may also provide an audio indication of which surgical device is coupled to the input device  6560 . 
     The system  6550  may include a controller  6618  which receives the input signals from the input device  6560  and provides corresponding output signals to control the operating table  6558 . Likewise, the system may have adapters  6620 ,  6622  which provide an interface between the input device  6560  and the specific surgical instruments connected to the system. 
     In operation, the interface  6570  initially couples the input device  6560  to one of the surgical devices. The surgeon can control a different surgical device by generating an input command that is provided to the select channel  6592 . The input command switches the interface  6570  so that the input device  6560  is coupled to a different output channel and corresponding surgical device or adapter. What is thus provided is an interface  6570  that allows a surgeon to select, operate and control a plurality of different surgical devices through a common input device  6560 . 
       FIG.  136    illustrates a multi-functional surgical control system  6650  and switching interface for virtual operating room integration. A virtual control system for controlling surgical equipment in an operating room while a surgeon performs a surgical procedure on a patient, comprising: a virtual control device including an image of a control device located on a surface and a sensor for interrogating contact interaction of an object with the image on the surface, the virtual control device delivering an interaction signal indicative of the contact interaction of the object with the image; and a system controller connected to receive the interaction signal from the virtual control device and to deliver a control signal to the surgical equipment in response to the interaction signal to control the surgical equipment in response to the contact interaction of the object with the image. Further examples are disclosed in U.S. Pat. No. 7,317,955, titled VIRTUAL OPERATING ROOM INTEGRATION, which issued on Jan. 8, 2008, which is herein incorporated by reference in its entirety. 
     As shown in  FIG.  136   , communication links  6674  are established between the system controller  6676  and the various components and functions of the virtual control system  6650 . The communication links  6674  are preferably optical paths, but the communication links may also be formed by radio frequency transmission and reception paths, hardwired electrical connections, or combinations of optical, radio frequency and hardwired connection paths as may be appropriate for the type of components and functions obtained by those components. The arrows at the ends of the links  6674  represent the direction of primary information flow. 
     The communication links  6674  with the surgical equipment  6652 , a virtual control panel  6556 , a virtual foot switch  6654  and patient monitoring equipment  6660  are bidirectional, meaning that the information flows in both directions through the links  6674  connecting those components and functions. For example, the system controller  6676  supplies signals which are used to create a control panel image from the virtual control panel  6656  and a foot switch image from the virtual foot switch  6654 . The virtual control panel  6656  and the virtual foot switch  6654  supply information to the system controller  6676  describing the physical interaction of the surgeon’s finger and foot relative to a projected control panel image and the projected foot switch image. The system controller  6676  responds to the information describing the physical interaction with the projected image, and supplies control signals to the surgical equipment  6652  and patient monitoring equipment  6660  to control functionality of those components in response to the physical interaction information. The control, status and functionality information describing the surgical equipment  6652  and patient monitoring equipment  6660  flows to the system controller  6676 , and after that information is interpreted by the system controller  6676 , it is delivered to a system display  6670 , a monitor  6666 , and/or a heads up display  6668  for presentation. 
     The communication links  6674  between the system controller  6676  and the system display  6670 , the heads up display  6668 , the monitor  6666 , a tag printer  6658  and output devices  6664  are all uni-directional, meaning that the information flows from the system controller  6676  to those components and functions. In a similar manner, the communication links  6674  between the system controller  6676  and a scanner  6672  and the input devices  6662  are also unidirectional, but the information flows from the components  6662 ,  6672  to the system controller  6676 . In certain circumstances, certain control and status information may flow between the system controller  6676  and the components  6658 ,  6660 ,  6662 ,  6664 ,  6666 ,  6668 ,  6670 ,  6672  in order to control the functionality of the those components. 
     Each communication link  6674  preferably has a unique identity so that the system controller  6676  can individually communicate with each of the components of the virtual control system  6650 . The unique identity of each communication link is preferable when some or all of the communication links  6674  are through the same medium, as would be the case of optical and radio frequency communications. The unique identity of each communication link  6674  assures that the system controller  6676  has the ability to exercise individual control over each of the components and functions on a very rapid and almost simultaneous manner. The unique identity of each communication link  6674  can be achieved by using different frequencies for each communication link  6674  or by using unique address and identification codes associated with the communications transferred over each communication link  6674 . 
     In one aspect, the present disclosure provides illustrates a surgical communication and control headset that interfaces with the surgical hub  206  described in connection with  FIGS.  1 - 11   . Further examples are disclosed in U.S. Pat. Application Publication No. 2009/0046146, titled SURGICAL COMMUNICATION AND CONTROL SYSTEM, which published on Feb. 19, 2009, which is herein incorporated by reference in its entirety.  FIG.  137    illustrates a diagram  6680  of a beam source and combined beam detector system utilized as a device control mechanism in an operating theater. The system  6680  is configured and wired to allow for device control with the overlay generated on the primary procedural display. The footswitch shows a method to allow the user to click on command icons that would appear on the screen while the beam source is used to aim at the particular desired command icon to be clicked. The control system graphic user interface (GUI) and device control processor communicate and parameters are changed using the system. The system  6680  includes a display  6684  coupled to a beam detecting sensor  6682  and a head mounted source  6686 . The beam detecting sensor  6682  is in communication with a control system GUI overlay processor and beam source processor  6688 . The surgeon operates a footswitch  6692  or other adjunctive switch, which provides a signal to a device control interface unit  6694 . 
     The system  6680  will provide a means for a sterile clinician to control procedural devices in an easy and quick, yet hands free and centralized fashion. The ability to maximize the efficiency of the operation and minimize the time a patient is under anesthesia is important to the best patient outcomes. It is common for surgeons, cardiologists or radiologists to verbally request adjustments be made to certain medical devices and electronic equipment used in the procedure outside the sterile field. It is typical that he or she must rely on another staff member to make the adjustments he or she needs to settings on devices such as cameras, bovies, surgical beds, shavers, insufflators, injectors, to name a few. In many circumstances, having to command a staff member to make a change to a setting can slow down a procedure because the non-sterile staff member is busy with another task. The sterile physician cannot adjust non-sterile equipment without compromising sterility, so he or she must often wait for the non-sterile staff member to make the requested adjustment to a certain device before resuming the procedure. 
     The system  6680  allows a user to use a beam source and beam detector to regenerate a pointer overlay coupled with a GUI and a concurrent switching method (i.e., a foot switch, etc.) to allow the clinician to click through commands on the primary display. In one aspect, a GUI could appear on the procedural video display when activated, such as when the user tilts his or her head twice to awaken it or steps on a foot switch provided with the system. Or it is possible that a right head tilt wakes up the system, and a left head tilt simply activates the beam source. When the overlay (called device control GUI overlay) appears on the screen it shows button icons representing various surgical devices and the user can use the beam source, in this case a laser beam, to aim at the button icons. Once the laser is over the proper button icon, a foot switch, or other simultaneous switch method can be activated, effectively acting like a mouse click on a computer. For example a user can “wake up” the system, causing a the device control GUI overlay to pop up that lists button icons on the screen, each one labeled as a corresponding procedural medical device. The user can point the laser at the correct box or device and click a foot pedal (or some other concurrent control—like voice control, waistband button, etc.) to make a selection, much like clicking a mouse on a computer. The sterile physician can then select “insufflator, for example” The subsequent screen shows arrow icons that can be clicked for various settings for the device that need to be adjusted (pressure, rate, etc.). In one iteration, the user can then can point the laser at the up arrow and click the foot pedal repeatedly until the desired setting is attained. 
     In one aspect, components of the system  6680  could be coupled with existing robotic endoscope holders to “steer” a rigid surgical endoscopic camera by sending movement commands to the robotic endoscope holding arm (provided separately, i.e., AESOP by Computer Motion). The endoscope is normally held by an assistant nurse or resident physician. There are robotic and mechanical scope holders currently on the market and some have even had been introduced with voice control. However, voice control systems have often proven cumbersome, slow and inaccurate. This aspect would employ a series of software and hardware components to allow the overlay to appear as a crosshair on the primary procedural video screen. The user could point the beam source at any part of the quadrant and click a simultaneous switch, such as a foot pedal, to send movement commands to the existing robotic arm, which, when coupled with the secondary trigger (i.e., a foot switch, waist band switch, etc.) would send a command to adjust the arm in minute increments in the direction of the beam source. It could be directed by holding down the secondary trigger until the desired camera angle and position is achieved and then released. This same concept could be employed for surgical bed adjustments by having the overlay resemble the controls of a surgical bed. The surgical bed is commonly adjusted during surgery to allow better access to the anatomy. Using the combination of the beam source, in this case a laser, a beam detecting sensor such as a camera, a control system GUI overlay processing unit and beam source processor, and a device control interface unit, virtually any medical device could be controlled through this system. Control codes would be programmed into the device control interface unit, and most devices can be connected using an RS-232 interface, which is a standard for serial binary data signals connecting between a DTE (Data Terminal Equipment) and a DCE (Data Circuit-terminating Equipment). The present invention while described with reference to application in the medical field can be expanded/modified for use in other fields. Another use of this invention could be in helping those who are without use of their hands due to injury or handicap or for professions where the hands are occupied and hands free interface is desired. 
     Surgical Hub With Direct Interface Control With Secondary Surgeon Display Units Designed to Be Within the Sterile Field and Accessible for Input and Display by the Surgeon 
     In one aspect, the surgical hub  206  provides a secondary user interface that enables display and control of surgical hub  206  functions from with the sterile field. The secondary display could be used to change display locations, what information is displayed where, pass off control of specific functions or devices. 
     During a surgical procedure, the surgeon may not have a user interface device accessible for interactive input by the surgeon and display within the sterile field. Thus, the surgeon cannot interface with the user interface device and the surgical hub from within the sterile field and cannot control other surgical devices through the surgical hub from within the sterile field. 
     One solution provides a display unit designed to be used within the sterile field and accessible for input and display by the surgeon to allow the surgeon to have interactive input control from the sterile field to control other surgical devices coupled to the surgical hub. The display unit is sterile and located within the sterile field to allow the surgeons to interface with the display unit and the surgical hub to directly interface and configure instruments as necessary without leaving the sterile field. The display unit is a master device and may be used for display, control, interchanges of tool control, allowing feeds from other surgical hubs without the surgeon leaving the sterile field. 
     In one aspect, the present disclosure provides a control unit, comprising an interactive touchscreen display, an interface configured to couple the interactive touchscreen display to a surgical hub, a processor, and a memory coupled to the processor. The memory stores instructions executable by the processor to receive input commands from the interactive touchscreen display located inside a sterile field and transmits the input commands to a surgical hub to control devices coupled to the surgical hub located outside the sterile field. 
     In another aspect, the present disclosure provides a control unit, comprising an interactive touchscreen display, an interface configured to couple the interactive touchscreen display to a surgical hub, and a control circuit configured to receive input commands from the interactive touchscreen display located inside a sterile field and transmit the input commands to a surgical hub to control devices coupled to the surgical hub located outside the sterile field. 
     In another aspect, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, causes a machine to receive input commands from an interactive touchscreen display located inside a sterile field and transmit the input commands to a surgical hub through an interface configured to couple the interactive touchscreen display to the surgical hub to control devices coupled to the surgical hub located outside the sterile field. 
     Providing a display unit designed to be used within the sterile field and accessible for input and display by the surgeon provides the surgeon interactive input control from the sterile field to control other surgical devices coupled to the surgical hub. 
     This display unit within the sterile field is sterile and allows the surgeons to interface with it and the surgical hub. This gives the surgeon control of the instruments coupled to the surgical hub and allows the surgeon to directly interface and configure the instruments as necessary without leaving the sterile field. The display unit is a master device and may be used for display, control, interchanges of tool control, allowing feeds from other surgical hubs without the surgeon leaving the sterile field. 
     In various aspects, the present disclosure provides a secondary user interface to enable display and control of surgical hub functions from within a sterile field. This control could be a display device like an I-pad, e.g., a portable interactive touchscreen display device configured to be introduced into the operating theater in a sterile manner. It could be paired like any other device or it could be location sensitive. The display device would be allowed to function in this manner whenever the display device is placed over a specific location of the draped abdomen of the patient during a surgical procedure. In other aspects, the present disclosure provides a smart retractor and a smart sticker. These and other aspects are described hereinbelow. 
     In one aspect, the present disclosure provides a secondary user interface to enable display and control of surgical hub functions from within the sterile field. In another aspect, the secondary display could be used to change display locations, determine what information and where the information is displayed, and pass off control of specific functions or devices. 
     There are four types of secondary surgeon displays in two categories. One type of secondary surgeon display units is designed to be used within the sterile field and accessible for input and display by the surgeon within the sterile field interactive control displays. Sterile field interactive control displays may be shared or common sterile field input control displays. 
     A sterile field display may be mounted on the operating table, on a stand, or merely laying on the abdomen or chest of the patient. The sterile field display is sterile and allows the surgeons to interface with the sterile field display and the surgical hub. This gives the surgeon control of the system and allows them to directly interface and configure the sterile field display as necessary. The sterile field display may be configured as a master device and may be used for display, control, interchanges of tool control, allowing feeds from other surgical hubs, etc. 
     In one aspect, the sterile field display may be employed to re-configure the wireless activation devices within the operating theater (OR) and their paired energy device if a surgeon hands the device to another.  FIGS.  138 A- 138 E  illustrate various types of sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  according to various aspects of the present disclosure. Each of the disclosed sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  comprise at least one touchscreen  6701 ,  6704 / 6706 ,  6709 ,  6713 ,  6716  input/output device layered on the top of an electronic visual display of an information processing system. The sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  may include batteries as a power source. Some include a cable  6710  to connect to a separate power source or to recharge the batteries. A user can give input or control the information processing system through simple or multi-touch gestures by touching the touchscreen  6701 ,  6704 / 6706 ,  6709 ,  6713 ,  6716  with a stylus, one or more fingers, or a surgical tool. The sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  may be used to re-configure wireless activation devices within the operating theater and a paired energy device if a surgeon hands the device to another surgeon. The sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  may be used to accept consult feeds from another operating theater where it would then configure a portion of the operating theater screens or all of them to mirror the other operating theater so the surgeon is able to see what is needed to help. The sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  are configured to communicate with the surgical hub  206 . Accordingly, the description of the surgical hub  206  discussed in connection with  FIGS.  1 - 11    is incorporated in this section by reference. 
       FIG.  138 A  illustrates a single zone sterile field control and data input console  6700 , according to one aspect of the present disclosure. The single zone console  6700  is configured for use in a single zone within a sterile field. Once deployed in a sterile field, the single zone console  6700  can receive touchscreen inputs from a user in the sterile field. The touchscreen  6701  enables the user to interact directly with what is displayed, rather than using a mouse, touchpad, or other such devices (other than a stylus or surgical tool). The single zone console  6700  includes wireless communication circuits to communicate wirelessly to the surgical hub  206 . 
       FIG.  138 B  illustrates a multi zone sterile field control and data input console  6702 , according to one aspect of the present disclosure. The multi zone console  6702  comprises a first touchscreen  6704  to receive an input from a first zone of a sterile field and a second touchscreen  6706  to receive an input from a second zone of a sterile field. The multi zone console  6702  is configured to receive inputs from multiple users in a sterile field. The multi zone console  6702  includes wireless communication circuits to communicate wirelessly to the surgical hub  206 . Accordingly, the multi zone sterile field control and data input console  6702  comprises an interactive touchscreen display with multiple input and output zones. 
       FIG.  138 C  illustrates a tethered sterile field control and data input console  6708 , according to one aspect of the present disclosure. The tethered console  6708  includes a cable  6710  to connect the tethered console  6708  to the surgical hub  206  via a wired connection. The cable  6710  enables the tethered console  6708  to communicate over a wired link in addition to a wireless link. The cable  6710  also enables the tethered console  6708  to connect to a power source for powering the console  6708  and/or recharging the batteries in the console  6708 . 
       FIG.  138 D  illustrates a battery operated sterile field control and data input console  6712 , according to one aspect of the present disclosure. The sterile field console  6712  is battery operated and includes wireless communication circuits to communicate wirelessly with the surgical hub  206 . In particular, in one aspect, the sterile field console  6712  is configured to communicate with any of the modules coupled to the hub  206  such as the generator module  240 . Through the sterile field console  6712 , the surgeon can adjust the power output level of a generator using the touchscreen  6713  interface. One example is described below in connection with  FIG.  138 E . 
       FIG.  138 E  illustrates a battery operated sterile field control and data input console  6714 , according to one aspect of the present disclosure. The sterile field console  6714  includes a user interface displayed on the touchscreen of a generator. The surgeon can thus control the output of the generator by touching the up/down arrow icons  6718 A,  6718 B that increase/decrease the power output of the generator module  240 . Additional icons  6719  enable access to the generator module settings  6174 , volume  6178  using the +/- icons, among other features directly from the sterile field console  6714 . The sterile field console  6714  may be employed to adjust the settings or reconfigure other wireless activations devices or modules coupled to the hub  206  within the operating theater and their paired energy device when the surgeon hands the sterile field console  6714  to another. 
       FIGS.  139 A- 139 B  illustrate a sterile field console  6700  in use in a sterile field during a surgical procedure, according to one aspect of the present disclosure.  FIG.  139 A  shows the sterile field console  6714  positioned in the sterile field near two surgeons engaged in an operation. In  FIG.  139 B , one of the surgeons is shown tapping the touchscreen  6701  of the sterile field console with a surgical tool  6722  to adjust the output of a modular device coupled to the surgical hub  206 , reconfigure the modular device, or an energy device paired with the modular device coupled to the surgical hub  206 . 
     In another aspect, the sterile field display may be employed to accept consult feeds from another operating room (OR), such as another operating theater or surgical hub  206 , where it would then configure a portion of the OR screens or all of them to mirror the other ORs so the surgeon could see what is needed to help.  FIG.  140    illustrates a process  6750  for accepting consult feeds from another operating room, according to one aspect of the present disclosure. The sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  shown in  FIGS.  138 A- 138 E,  139 A- 139 B  may be used as an interact-able scalable secondary display allowing the surgeon to overlay other feeds or images from laser Doppler image scanning arrays or other image sources. The sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  may be used to call up a pre-operative scan or image to review. Laser Doppler techniques are described in U.S. Provisional Pat. Application No. 62/611,341, filed Dec. 28, 2017, and titled INTERACTIVE SURGICAL PLATFORM, which is incorporated herein by reference in its entirety. 
     It is recognized that the tissue penetration depth of light is dependent on the wavelength of the light used. Thus, the wavelength of the laser source light may be chosen to detect particle motion (such a blood cells) at a specific range of tissue depth. A laser Doppler employs means for detecting moving particles such as blood cells based at a variety of tissue depths based on the laser light wavelength. A laser source may be directed to a surface of a surgical site. A blood vessel (such as a vein or artery) may be disposed within the tissue at some depth δ from the tissue surface. Red laser light (having a wavelength in the range of about 635 nm to about 660 nm) may penetrate the tissue to a depth of about 1 mm. Green laser light (having a wavelength in the range of about 520 nm to about 532 nm) may penetrate the tissue to a depth of about 2-3 mm. Blue laser light (having a wavelength in the range of about 405 nm to about 445 nm) may penetrate the tissue to a depth of about 4 mm or greater. A blood vessel may be located at a depth of about 2-3 mm below the tissue surface. Red laser light will not penetrate to this depth and thus will not detect blood cells flowing within this vessel. However, both green and blue laser light can penetrate this depth. Therefore, scattered green and blue laser light from the blood cells will result in an observed Doppler shift in both the green and blue. 
     In some aspects, a tissue may be probed by red, green, and blue laser illumination in a sequential manner and the effect of such illumination may be detected by a CMOS imaging sensor over time. It may be recognized that sequential illumination of the tissue by laser illumination at differing wavelengths may permit a Doppler analysis at varying tissue depths over time. Although red, green, and blue laser sources may be used to illuminate the surgical site, it may be recognized that other wavelengths outside of visible light (such as in the infrared or ultraviolet regions) may be used to illuminate the surgical site for Doppler analysis. The imaging sensor information may be provided to the sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714 . 
     The sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  provide access to past recorded data. In one operating theater designated as OR 1 , the sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  may be configured as “consultants” and to erase all data when the consultation is complete. In another operating theater designated as OR 3  (operating room 3), the sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714  may be configured as a “consultees” and are configured to record all data received from operating theater OR 1  (operating room 1) sterile field control and data input consoles  6700 ,  6702 ,  6708 ,  6712 ,  6714 . These configurations are summarized in TABLE 2 below: 
     
       
         
          TABLE 2
           
               
               
             
               
                 Sterile Field Control And Data Input Console In OR1 
                 Sterile Field Control And Data Input Console In OR3 
               
             
            
               
                 Access to past recorded data 
                   
               
               
                 OR 1  Consultant 
                 OR 3  Consultee 
               
               
                 Erase data when done 
                 Record all data 
               
            
           
         
       
     
     In one implementation of the process  6750 , operating theater OR 1  receives  6752  a consult request from OR 3 . Data is transferred to the OR 1  sterile field control and data input console  6700 , for example. The data is temporarily stored  6754 . The data is backed up in time and the OR 1  view  6756  of the temporary data begins on the OR 1  sterile field control and data input console  6700  touchscreen  6701 . When the view is complete, the data is erased  6758  and control returns  6760  to OR 1 . The data is then erased  6762  from the OR 1  sterile field control and data input console  6700  memory. 
     In yet another aspect, the sterile field display may be employed as an interactable scalable secondary display allowing the surgeon to overlay other feeds or images like laser Doppler scanning arrays. In yet another aspect, the sterile field display may be employed to call up a pre-operative scan or image to review. Once vessel path and depth and device trajectory are estimated, the surgeon employs a sterile field interactable scalable secondary display allowing the surgeon to overlay other feeds or images. 
       FIG.  141    is a diagram  6770  that illustrates a technique for estimating vessel path, depth, and device trajectory. Prior to dissecting a vessel  6772 ,  6774  located below the surface of the tissue  6775  using a standard approach, the surgeon estimates the path and depth of the vessel  6772 ,  6774  and a trajectory  6776  of a surgical device  6778  will take to reach the vessel  6772 ,  6774 . It is often difficult to estimate the path and depth  6776  of a vessel  6772 ,  6774  located below the surface of the tissue  6775  because the surgeon cannot accurately visualize the location of the vessel  6772 ,  6774  path and depth  6776 . 
       FIGS.  142 A- 142 D  illustrate multiple real time views of images of a virtual anatomical detail for dissection including perspective views ( FIGS.  142 A,  142 C ) and side views ( FIGS.  142 B,  142 D ). The images are displayed on a sterile field display of tablet computer or sterile field control and data input console employed as an interactable scalable secondary display allowing the surgeon to overlay other feeds or images, according to one aspect of the present disclosure. The images of the virtual anatomy enable the surgeon to more accurately predict the path and depth of a vessel  6772 ,  6774  located below the surface of the tissue  6775  as shown in  FIG.  141    and the best trajectory  6776  of the surgical device  6778 . 
       FIG.  142 A  is a perspective view of a virtual anatomy  6780  displayed on a tablet computer or sterile field control and data input console.  FIG.  142 B  is a side view of the virtual anatomy  6780  shown in  FIG.  142 A , according to one aspect of the present disclosure. With reference to  FIGS.  142 A- 142 B , in one aspect, the surgeon uses a smart surgical device  6778  and a tablet computer to visualize the virtual anatomy  6780  in real time and in multiple views. The three dimensional perspective view includes a portion of tissue  6775  in which the vessels  6772 ,  6774  are located below surface. The portion of tissue is overlaid with a grid  6786  to enable the surgeon to visualize a scale and gauge the path and depth of the vessels  6772 ,  6774  at target locations  6782 ,  6784  each marked by an X. The grid  6786  also assists the surgeon determine the best trajectory  6776  of the surgical device  6778 . As illustrated, the vessels  6772 ,  6774  have an unusual vessel path. 
       FIG.  142 C  illustrates a perspective view of the virtual anatomy  6780  for dissection, according to one aspect of the present disclosure.  FIG.  142 D  is a side view of the virtual anatomy  6780  for dissection, according to one aspect of the present disclosure. With reference to  FIGS.  142 C- 142 D , using the tablet computer, the surgeon can zoom and pan 360° to obtain an optimal view of the virtual anatomy  6780  for dissection. The surgeon then determines the best path or trajectory  6776  to insert the surgical device  6778  (e.g., a dissector in this example). The surgeon may view the anatomy in a three-dimensional perspective view or any one of six views. See for example the side view of the virtual anatomy in  FIG.  142 D  and the insertion of the surgical device  6778  (e.g., the dissector). 
     In another aspect, a sterile field control and data input console may allow live chatting between different departments, such as, for example, with the oncology or pathology department, to discuss margins or other particulars associated with imaging. The sterile field control and data input console may allow the pathology department to tell the surgeon about relationships of the margins within a specimen and show them to the surgeon in real time using the sterile field console. 
     In another aspect, a sterile field control and data input console may be used to change the focus and field of view of its own image or control that of any of the other monitors coupled to the surgical hub. 
     In another aspect, a sterile field control and data input console may be used to display the status of any of the equipment or modules coupled to the surgical hub  206 . Knowledge of which device coupled to the surgical hub  206  is being used may be obtained via information such as the device is not on the instrument pad or on-device sensors. Based on this information, the sterile field control and data input console may change display, configurations, switch power to drive one device, and not another, one cord from capital to instrument pad and multiple cords from there. Device diagnostics may obtain knowledge that the device is inactive or not being used. Device diagnostics may be based on information such as the device is not on the instrument pad or based on-device sensors. 
     In another aspect, a sterile field control and data input console may be used as a learning tool. The console may display checklists, procedure steps, and/or sequence of steps. A timer/clock may be displayed to measure time to complete steps and/or procedures. The console may display room sound pressure level as indicator for activity, stress, etc. 
       FIGS.  143 A- 143 B  illustrate a touchscreen display  6890  that may be used within the sterile field, according to one aspect of the present disclosure. Using the touchscreen display  6890 , a surgeon can manipulate images  6892  displayed on the touchscreen display  6890  using a variety of gestures such as, for example, drag and drop, scroll, zoom, rotate, tap, double tap, flick, drag, swipe, pinch open, pinch close, touch and hold, two-finger scroll, among others. 
       FIG.  143 A  illustrates an image  6892  of a surgical site displayed on a touchscreen display  6890  in portrait mode.  FIG.  143 B  shows the touchscreen display  6890  rotated  6894  to landscape mode and the surgeon uses his index finger  6896  to scroll the image  6892  in the direction of the arrows.  FIG.  143 C  shows the surgeon using his index finger  6896  and thumb  6898  to pinch open the image  6892  in the direction of the arrows  6899  to zoom in.  FIG.  143 D  shows the surgeon using his index finger  6896  and thumb  6898  to pinch close the image  6892  in the direction of the arrows  6897  to zoom out.  FIG.  143 E  shows the touchscreen display  6890  rotated in two directions indicated by arrows  6894 ,  6896  to enable the surgeon to view the image  6892  in different orientations. 
     Outside the sterile field, control and static displays are used that are different from the control and static displays used inside the sterile field. The control and static displays located outside the sterile field provide interactive and static displays for operating theater (OR) and device control. The control and static displays located outside the sterile field may include secondary static displays and secondary touchscreens for input and output. 
     Secondary static non-sterile displays  107 ,  109 ,  119  ( FIG.  2   ) for used outside the sterile field include monitors placed on the wall of the operating theater, on a rolling stand, or on capital equipment. A static display is presented with a feed from the control device to which they are attached and merely displays what is presented to it. 
     Secondary touch input screens located outside the sterile field may be part of the visualization system  108  ( FIG.  2   ), part of the surgical hub  108  ( FIG.  2   ), or may be fixed placement touch monitors on the walls or rolling stands. One difference between secondary touch input screens and static displays is that a user can interact with a secondary touch input screen by changing what is displayed on that specific monitor or others. For capital equipment applications, it could be the interface to control the setting of the connected capital equipment. The secondary touch input screens and the static displays outside the sterile field can be used to preload the surgeon’s preferences (instrumentation settings and modes, lighting, procedure and preferred steps and sequence, music, etc.). 
     Secondary surgeon displays may include personal input displays with a personal input device that functions similarly to the common sterile field input display device but it is controlled by a specific surgeon. Personal secondary displays may be implemented in many form factors such as, for example, a watch, a small display pad, interface glasses, etc. A personal secondary display may include control capabilities of a common display device and since it is located on or controlled by a specific surgeon, the personal secondary display would be keyed to him/her specifically and would indicate that to others and itself. Generally speaking, a personal secondary display would normally not be useful to exchanging paired devices because they are not accessible to more than one surgeon. Nevertheless, a personal secondary display could be used to grant permission for release of a device. 
     A personal secondary display may be used to provide dedicated data to one of several surgical personnel that wants to monitor something that the others typically would not want to monitor. In addition, a personal secondary display may be used as the command module. Further, a personal secondary display may be held by the chief surgeon in the operating theater and would give the surgeon the control to override any of the other inputs from anyone else. A personal secondary display may be coupled to a short range wireless, e.g., Bluetooth, microphone and earpiece allowing the surgeon to have discrete conversations or calls or the personal secondary display may be used to broadcast to all the others in the operating theater or other department. 
       FIG.  144    illustrates a surgical site  6900  employing a smart surgical retractor  6902  comprising a direct interface control to a surgical hub  206  ( FIGS.  1 - 11   ), according to one aspect of the present disclosure. The smart surgical retractor  6902  helps the surgeon and operating room professionals hold an incision or wound open during surgical procedures. The smart surgical retractor  6902  aids in holding back underlying organs or tissues, allowing doctors/nurses better visibility and access to the exposed area. With reference also to  FIGS.  1 - 11   , the smart surgical retractor  6902  may comprise an input display  6904  operated by the smart surgical retractor  6902 . The smart surgical retractor  6902  may comprise a wireless communication device to communicate with a device connected to a generator module  240  coupled to the surgical hub  206 . Using the input display  6904  of the smart surgical retractor  6902 , the surgeon can adjust power level or mode of the generator module  240  to cut and/or coagulate tissue. If using automatic on/off for energy delivery on closure of an end effector on the tissue, the status of automatic on/off may be indicated by a light, screen, or other device located on the smart retractor  6902  housing. Power being used may be changed and displayed. 
     In one aspect, the smart surgical retractor  6902  can sense or know what device/instrument  235  the surgeon is using, either through the surgical hub  206  or RFID or other device placed on the device/instrument  235  or the smart surgical retractor  6902 , and provide an appropriate display. Alarm and alerts may be activated when conditions require. Other features include displaying the temperature of the ultrasonic blade, nerve monitoring, light source  6906  or fluorescence. The light source  6906  may be employed to illuminate the surgical field of view  6908  and to charge photocells  6918  on single use sticker display that stick onto the smart retractor  6902  (see  FIG.  145   , for example). In another aspect, the smart surgical retractor  6902  may include an augmented reality projected on the patient’s anatomy (e.g., like a vein viewer). 
       FIG.  145    illustrates a surgical site  6910  with a smart flexible sticker display  6912  attached to the body/skin  6914  of a patient, according to one aspect of the present disclosure. As shown, the smart flexible sticker display  6912  is applied to the body/skin  6914  of a patient between the area exposed by the surgical retractors  6916 . In one aspect, the smart flexible sticker display  6912  may be powered by light, an on board battery, or a ground pad. The flexible sticker display  6912  may communicate via short range wireless (e.g., Bluetooth) to a device, may provide readouts, lock power, or change power. The smart flexible sticker display  6912  also comprises photocells  6918  to power the smart flexible sticker display  6912  using ambient light energy. The flexible sticker display  6912  includes a display of a control panel  6920  user interface to enable the surgeon to control devices  235  or other modules coupled to the surgical hub  206  ( FIGS.  1 - 11   ). 
       FIG.  146    is a logic flow diagram  6920  of a process depicting a control program or a logic configuration to communicate from inside a sterile field to a device located outside the sterile field, according to one aspect of the present disclosure. In one aspect, a control unit comprises an interactive touchscreen display, an interface configured to couple the interactive touchscreen display to a surgical hub, a processor, and a memory coupled to the processor. The memory stores instructions executable by the processor to receive  6922  input commands from the interactive touchscreen display located inside a sterile field and transmits  6924  the input commands to a surgical hub to control devices coupled to the surgical hub located outside the sterile field. 
       FIG.  147    illustrates a system for performing surgery. The system comprises a control box which includes internal circuitry; a surgical instrument including a distal element and techniques for sensing a position or condition of said distal element; techniques associated with said surgical instrument for transmitting said sensed position or condition to said internal circuitry of said control box; and for transmitting said sensed position or condition from said internal circuitry of said control box to a video monitor for display thereon, wherein said sensed position or condition is displayed on said video monitor as an icon or symbol, further comprising a voltage source for generating a voltage contained entirely within said surgical instrument. Further examples are disclosed in U.S. Pat. No. 5,503,320, titled SURGICAL APPARATUS WITH INDICATOR, which issued on Apr. 2, 1996, which is herein incorporated by reference in its entirety. 
       FIG.  147    shows schematically a system whereby data is transmitted to a video monitor for display, such data relating to the position and/or condition of one or more surgical instruments. As shown in  FIG.  147   , a laparoscopic surgical procedure is being performed wherein a plurality of trocar sleeves  6930  are inserted through a body wall  6931  to provide access to a body cavity  6932 . A laparoscope  6933  is inserted through one of the trocar sleeves  6930  to provide illumination (light cable  6934  is shown leading toward a light source, not pictured) to the surgical site and to obtain an image thereof. A camera adapter  6935  is attached at the proximal end of laparoscope  6933  and image cable  6936  extends therefrom to a control box  6937  discussed in more detail below. Image cable inputs to image receiving port  416  on control box  6937 . 
     Additional surgical instruments  6939 ,  6940  are inserted through additional trocar sleeves  6900  which extend through body wall  6931 . In  FIG.  147   , instrument  6939  schematically illustrates an endoscopic stapling device, e.g., an Endo GIA ∗  instrument manufactured by the assignee of this application, and instrument  6940  schematically illustrates a hand instrument, e.g., an Endo Grasp* device also manufactured by the present assignee. Additional and/or alternative instruments may also be utilized according to the present invention; the illustrated instruments are merely exemplary of surgical instruments which may be utilized according to the present invention. 
     Instruments  6939 ,  6940  include adapters  6941 ,  6942  associated with their respective handle portions. The adapters electronically communicate with conductive mechanisms (not pictured). These mechanisms, which include electrically conductive contact members electrically connected by wires, cables and the like, are associated with the distal elements of the respective instruments, e.g., the anvil  6943  and cartridge  6944  of the Endo GIA ∗  instrument, the jaws  6945 ,  6946  of the Endo Grasp ∗  device, and the like. The mechanisms are adapted to interrupt an electronic circuit when the distal elements are in a first position or condition and to complete the electronic circuit when the distal elements are in a second position or condition. A voltage source for the electronic circuit may be provided in the surgical instrument, e.g., in the form of a battery, or supplied from control box  6937  through cables  6947 ,  6948 . 
     Control box  6937  includes a plurality of jacks  6949  which are adapted to receive cables  6947 ,  6948  and the like. Control box  6937  further includes an outgoing adapter  6950  which is adapted to cooperate with a cable  6951  for transmitting the laparoscopic image obtained by the laparoscope  6933  together with data concerning surgical instruments  6939 ,  6940  to video monitor  6952 . Circuitry within control box  6937  is provided for converting the presence of an interrupted circuit, e.g., for the electronics within cable  6947  and the mechanism associated with the distal elements of instrument  6939 , to an icon or symbol for display on video monitor  6952 . Similarly, the circuitry within control box  6937  is adapted to provide a second icon or symbol to video monitor  6952  when a completed circuit exists for cable  6947  and the associated mechanism. 
     Illustrative icons/symbols  6953 ,  6954  are shown on video monitor  6952 . Icon  6953  shows a surgical staple and could be used to communicate to the surgeon that the cartridge  6944  and anvil  6943  of instrument  6939  are properly positioned to form staples in tissue  6955 . Icon  6953  could take another form when the cartridge  6944  and anvil  6943  are not properly positioned for forming staples, thereby interrupting the circuit. Icon  6954  shows a hand instrument with jaws spread apart, thereby communicating to the surgeon that the jaws  6945 ,  6946  of instrument  6940  are open. Icon  6954  could take another form when jaws  6945 ,  6946  are closed, thereby completing the circuit. 
       FIG.  148    illustrates a second layer of information overlaying a first layer of information. The second layer of information includes a symbolic representation of the knife overlapping the detected position of the knife in the DLU depicted in the first layer of information. Further examples are disclosed in U.S. Pat. No. 9,283,054, titled SURGICAL APPARATUS WITH INDICATOR, which issued on Mar. 15, 2016, which is herein incorporated by reference in its entirety. 
     Referring to  FIG.  148   , the second layer of information  6963  can overlay at least a portion of the first layer of information  6962  on the display  6960 . Furthermore, the touch screen  6961  can allow a user to manipulate the second layer of information  6963  relative to the video feedback in the underlying first layer of information  6962  on the display  6960 . For example, a user can operate the touch screen  6961  to select, manipulate, reformat, resize, and/or otherwise modify the information displayed in the second layer of information  6963 . In certain aspects, the user can use the touch screen  6961  to manipulate the second layer of information  6963  relative to the surgical instrument  6964  depicted in the first layer of information  6962  on the display  6960 . A user can select a menu, category and/or classification of the control panel  6967  thereof, for example, and the second layer of information  6963  and/or the control panel  6967  can be adjusted to reflect the user’s selection. In various aspects, a user may select a category from the instrument feedback category  6969  that corresponds to a specific feature or features of the surgical instrument  6964  depicted in the first layer of information  6962 . Feedback corresponding to the user-selected category can move, locate itself, and/or “snap” to a position on the display  6960  relative to the specific feature or features of the surgical instrument  6964 . For example, the selected feedback can move to a position near and/or overlapping the specific feature or features of the surgical instrument  6964  depicted in the first layer of information  6962 . 
     The instrument feedback menu  6969  can include a plurality of feedback categories, and can relate to the feedback data measured and/or detected by the surgical instrument  6964  during a surgical procedure. As described herein, the surgical instrument  6964  can detect and/or measure the position  6970  of a moveable jaw between an open orientation and a closed orientation, the thickness  6973  of clamped tissue, the clamping force  6976  on the clamped tissue, the articulation  6974  of the DLU  6965 , and/or the position  6971 , velocity  6972 , and/or force  6975  of the firing element, for example. Furthermore, the feedback controller in signal communication with the surgical instrument  6964  can provide the sensed feedback to the display  6960 , which can display the feedback in the second layer of information  6963 . As described herein, the selection, placement, and/or form of the feedback data displayed in the second layer of information  6963  can be modified based on the user’s input to the touch screen  6961 , for example. 
     When the knife of the DLU  6965  is blocked from view by the end effector jaws  6966  and/or tissue T, for example, the operator can track and/or approximate the position of the knife in the DLU  6964  based on the changing value of the feedback data and/or the shifting position of the feedback data relative to the DLU  6965  depicted in the underlying first layer of information  6962 . 
     In various aspects, the display menu  6977  of the control panel  6967  can relate to a plurality of categories, such as unit systems  6978  and/or data modes  6979 , for example. In certain aspects, a user can select the unit systems category  6978  to switch between unit systems, such as between metric and U.S. customary units, for example. Additionally, a user can select the data mode category  6979  to switch between types of numerical representations of the feedback data and/or types of graphical representations of the feedback data, for example. The numerical representations of the feedback data can be displayed as numerical values and/or percentages, for example. Furthermore, the graphical representations of the feedback data can be displayed as a function of time and/or distance, for example. As described herein, a user can select the instrument controller menu  6980  from the control panel  6967  to input directives for the surgical instrument  6964 , which can be implemented via the instrument controller and/or the microcontroller, for example. A user can minimize or collapse the control panel  6967  by selecting the minimize/maximize icon  6968 , and can maximize or un-collapse the control panel  6967  by re-selecting the minimize/maximize icon  6968 . 
       FIG.  149    depicts a perspective view of a surgeon using a surgical instrument that includes a handle assembly housing and a wireless circuit board during a surgical procedure, with the surgeon wearing a set of safety glasses. The wireless circuit board transmits a signal to a set of safety glasses worn by a surgeon using the surgical instrument during a procedure. The signal is received by a wireless port on the safety glasses. One or more lighting devices on a front lens of the safety glasses change color, fade, or glow in response to the received signal to indicate information to the surgeon about the status of the surgical instrument. The lighting devices are disposable on peripheral edges of the front lens to not distract the direct line of vision of the surgeon. Further examples are disclosed in U.S. Pat. No. 9,011,427, titled SURGICAL INSTRUMENT WITH SAFETY GLASSES, which issued on Apr. 21, 2015, which is herein incorporated by reference in its entirety. 
       FIG.  149    shows a version of safety glasses  6991  that may be worn by a surgeon  6992  during a surgical procedure while using a medical device. In use, a wireless communications board housed in a surgical instrument  6993  may communicate with a wireless port  6994  on safety glasses  6991 . Exemplary surgical instrument  6993  is a battery-operated device, though instrument  6993  could be powered by a cable or otherwise. Instrument  6993  includes an end effector. Particularly, wireless communications board  6995  transmits one or more wireless signals indicated by arrows (B, C) to wireless port  6994  of safety glasses  6991 . Safety glasses  6991  receive the signal, analyze the received signal, and display indicated status information received by the signal on lenses  6996  to a user, such as surgeon  6992 , wearing safety glasses  6991 . Additionally or alternatively, wireless communications board  6995  transmits a wireless signal to surgical monitor  6997  such that surgical monitor  6997  may display received indicated status information to surgeon  6992 , as described above. 
     A version of the safety glasses  6991  may include lighting device on peripheral edges of the safety glasses  6991 . A lighting device provides peripheral-vision sensory feedback of instrument  6993 , with which the safety glasses  6991  communicate to a user wearing the safety glasses  6991 . The lighting device may be, for example, a light-emitted diode (“LED”), a series of LEDs, or any other suitable lighting device known to those of ordinary skill in the art and apparent in view of the teachings herein. 
     LEDs may be located at edges or sides of a front lens of the safety glasses  6991  so not to distract from a user’s center of vision while still being positioned within the user’s field of view such that the user does not need to look away from the surgical site to see the lighting device. Displayed lights may pulse and/or change color to communicate to the wearer of the safety glasses  6991  various aspects of information retrieved from instrument  6993 , such as system status information or tissue sensing information (i.e., whether the end effector has sufficiently severed and sealed tissue). Feedback from housed wireless communications board  6995  may cause a lighting device to activate, blink, or change color to indicate information about the use of instrument  6993  to a user. For example, a device may incorporate a feedback mechanism based on one or more sensed tissue parameters. In this case, a change in the device output(s) based on this feedback in synch with a tone change may submit a signal through wireless communications board  6995  to the safety glasses  6991  to trigger activation of the lighting device. Such described means of activation of the lighting device should not be considered limiting as other means of indicating status information of instrument  6993  to the user via the safety glasses  6991  are contemplated. Further, the safety glasses  6991  may be single-use or reusable eyewear. Button-cell power supplies such as button-cell batteries may be used to power wireless receivers and LEDs of versions of safety glasses  6991 , which may also include a housed wireless board and tri-color LEDs. Such button-cell power supplies may provide a low-cost means of providing sensory feedback of information about instrument  6993  when in use to surgeon  6992  wearing safety glasses  6991 . 
       FIG.  150    is a schematic diagram of a feedback control system for controlling a surgical instrument. The surgical instrument includes a housing and an elongated shaft that extends distally from the housing and defines a first longitudinal axis. The surgical instrument also includes a firing rod disposed in the elongated shaft and a drive mechanism disposed at least partially within the housing. The drive mechanism mechanically cooperates with the firing rod to move the firing rod. A motion sensor senses a change in the electric field (e.g., capacitance, impedance, or admittance) between the firing rod and the elongated shaft. The measurement unit determines a parameter of the motion of the firing rod, such as the position, speed, and direction of the firing rod, based on the sensed change in the electric field. A controller uses the measured parameter of the motion of the firing rod to control the drive mechanism. Further examples are disclosed in U.S. Pat. No. 8,960,520, titled METHOD AND APPARATUS FOR DETERMINING PARAMETERS OF LINEAR MOTION IN A SURGICAL INSTRUMENT, which issued on Feb. 24, 2015, which is herein incorporated by reference in its entirety. 
     With reference to  FIG.  150   , aspects of the present disclosure may include a feedback control system  6150 . The system  6150  includes a feedback controller  6152 . The surgical instrument  6154  is connected to the feedback controller  6152  via a data port, which may be either wired (e.g., FireWire®, USB, Serial RS232, Serial RS485, USART, Ethernet, etc.) or wireless (e.g., Bluetooth®, ANT3®, KNX®, Z-WaveX10®, Wireless USB®, Wi-Fi®, IrDA®, nanoNET®, TinyOS®, ZigBee®, 802.11 IEEE, and other radio, infrared, UHF, VHF communications and the like). The feedback controller  6152  is configured to store the data transmitted to it by the surgical instrument  6154  as well as process and analyze the data. The feedback controller  6152  is also connected to other devices, such as a video display  6154 , a video processor  6156  and a computing device  6158  (e.g., a personal computer, a PDA, a smartphone, a storage device, etc.). The video processor  6156  is used for processing output data generated by the feedback controller  6152  for output on the video display  6154 . The computing device  6158  is used for additional processing of the feedback data. In one aspect, the results of the sensor feedback analysis performed by a microcontroller may be stored internally for later retrieval by the computing device  6158 . 
       FIG.  151    illustrates a feedback controller  6152  including an on-screen display (OSD) module and a heads-up-display (HUD) module. The modules process the output of a microcontroller for display on various displays. More specifically, the OSD module overlays text and/or graphical information from the feedback controller  6152  over other video images received from the surgical site via cameras disposed therein. The modified video signal having overlaid text is transmitted to the video display allowing the user to visualize useful feedback information from the surgical instrument  6154  and/or feedback controller  6152  while still observing the surgical site. The feedback controller  6152  includes a data port  6160  coupled to a microcontroller which allows the feedback controller  6152  to be connected to the computing device  6158  ( FIG.  150   ). The data port  6160  may provide for wired and/or wireless communication with the computing device  6158  providing for an interface between the computing device  6158  and the feedback controller  6152  for retrieval of stored feedback data, configuration of operating parameters of the feedback controller  6152  and upgrade of firmware and/or other software of the feedback controller  6152 . 
     The feedback controller  6152  includes a housing  6162  and a plurality of input and output ports, such as a video input  6164 , a video output  6166 , and a HUD display output  6168 . The feedback controller  6152  also includes a screen for displaying status information concerning the feedback controller  6152 .Further examples are disclosed in U.S. Pat. No. 8,960,520, titled METHOD AND APPARATUS FOR DETERMINING PARAMETERS OF LINEAR MOTION IN A SURGICAL INSTRUMENT, which issued on Feb. 24, 2015, which is herein incorporated by reference in its entirety. 
     Visualization System 
     During a surgical procedure, a surgeon may be required to manipulate tissues to effect a desired medical outcome. The actions of the surgeon are limited by what is visually observable in the surgical site. Thus, the surgeon may not be aware, for example, of the disposition of vascular structures that underlie the tissues being manipulated during the procedure. Since the surgeon is unable to visualize the vasculature beneath a surgical site, the surgeon may accidentally sever one or more critical blood vessels during the procedure. The solution is a surgical visualization system that can acquire imaging data of the surgical site for presentation to a surgeon, in which the presentation can include information related to the presence and depth of vascular structures located beneath the surface of a surgical site. 
     In one aspect, the surgical hub  106  incorporates a visualization system  108  to acquire imaging data during a surgical procedure. The visualization system  108  may include one or more illumination sources and one or more light sensors. The one or more illumination sources and one or more light sensors may be incorporated together into a single device or may comprise one or more separate devices. The one or more illumination sources may be directed to illuminate portions of the surgical field. The one or more light sensors may receive light reflected or refracted from the surgical field including light reflected or refracted from tissue and/or surgical instruments. The following description includes all of the hardware and software processing techniques disclosed above and in those applications incorporated herein by reference as presented above. 
     In some aspects, the visualization system  108  may be integrated into a surgical system  100  as disclosed above and depicted in  FIGS.  1  and  2   . In addition to the visualization system  108 , the surgical system  100  may include one or more hand-held intelligent instruments  112 , a multi-functional robotic system  110 , one or more visualization systems  108 , and a centralized surgical hub system  106 , among other components. The centralized surgical hub system  106  may control several functions a disclosed above and also depicted in  FIG.  3   . In one non-limiting example, such functions may include supplying and controlling power to any number of powered surgical devices. In another non-limiting example, such functions may include controlling fluid supplied to and evacuated from the surgical site. The centralized surgical hub system  106  may also be configured to manage and analyze data received from any of the surgical system components as well as communicate data and other information among and between the components of the surgical system. The centralized surgical hub system  106  may also be in data communication with a cloud computing system  104  as disclosed above and depicted, for example, in  FIG.  1   . 
     In some non-limiting examples, imaging data generated by the visualization system  108  may be analyzed by on-board computational components of the visualization system  108 , and analysis results may be communicated to the centralized surgical hub  106 . In alternative non-limiting examples, the imaging data generated by the visualization system  108  may be communicated directly to the centralized surgical hub  106  where the data may be analyzed by computational components in the hub system  106 . The centralized surgical hub  106  may communicate the image analysis results to any one or more of the other components of the surgical system. In some other non-limiting examples, the centralized surgical hub may communicate the image data and/or the image analysis results to the cloud computing system 104. 
       FIGS.  152 A-D  and  FIGS.  153 A-F  depict various aspects of one example of a visualization system  2108  that may be incorporated into a surgical system. The visualization system  2108  may include an imaging control unit  2002  and a hand unit  2020 . The imaging control unit  2002  may include one or more illumination sources, a power supply for the one or more illumination sources, one or more types of data communication interfaces (including USB, Ethernet, or wireless interfaces  2004 ), and one or more a video outputs  2006 . The imaging control unit  2002  may further include an interface, such as a USB interface  2010 , configured to transmit integrated video and image capture data to a USB enabled device. The imaging control unit  2002  may also include one or more computational components including, without limitation, a processor unit, a transitory memory unit, a non-transitory memory unit, an image processing unit, a bus structure to form data links among the computational components, and any interface (e.g. input and/or output) devices necessary to receive information from and transmit information to components not included in the imaging control unit. The non-transitory memory may further contain instructions that when executed by the processor unit, may perform any number of manipulations of data that may be received from the hand unit  2020  and/or computational devices not included in the imaging control unit. 
     The illumination sources may include a white light source  2012  and one or more laser light sources. The imaging control unit  2002  may include one or more optical and/or electrical interfaces for optical and/or electrical communication with the hand unit  2020 . The one or more laser light sources may include, as non-limiting examples, any one or more of a red laser light source, a green laser light source, a blue laser light source, an infrared laser light source, and an ultraviolet laser light source. In some non-limiting examples, the red laser light source may source illumination having a peak wavelength that may range between 635 nm and 660 nm, inclusive. Non-limiting examples of a red laser peak wavelength may include about 635 nm, about 640 nm, about 645 nm, about 650 nm, about 655 nm, about 660 nm, or any value or range of values therebetween. In some non-limiting examples, the green laser light source may source illumination having a peak wavelength that may range between 520 nm and 532 nm, inclusive. Non-limiting examples of a green laser peak wavelength may include about 520 nm, about 522 nm, about 524 nm, about 526 nm, about 528 nm, about 530 nm, about 532 nm, or any value or range of values therebetween. In some non-limiting examples, the blue laser light source may source illumination having a peak wavelength that may range between 405 nm and 445 nm, inclusive. Non-limiting examples of a blue laser peak wavelength may include about 405 nm, about 410 nm, about 415 nm, about 420 nm, about 425 nm, about 430 nm, about 435 nm, about 440 nm, about 445 nm, or any value or range of values therebetween. In some non-limiting examples, the infrared laser light source may source illumination having a peak wavelength that may range between 750 nm and 3000 nm, inclusive. Non-limiting examples of an infrared laser peak wavelength may include about 750 nm, about 1000 nm, about 1250 nm, about 1500 nm, about 1750 nm, about 2000 nm, about 2250 nm, about 2500 nm, about 2750 nm, 3000 nm, or any value or range of values therebetween. In some non-limiting examples, the ultraviolet laser light source may source illumination having a peak wavelength that may range between 200 nm and 360 nm, inclusive. Non-limiting examples of an ultraviolet laser peak wavelength may include about 200 nm, about 220 nm, about 240 nm, about 260 nm, about 280 nm, about 300 nm, about 320 nm, about 340 nm, about 360 nm, or any value or range of values therebetween. 
     In one non-limiting aspect, the hand unit  2020  may include a body  2021 , a camera scope cable  2015  attached to the body  2021 , and an elongated camera probe  2024 . The body  2021  of the hand unit  2020  may include hand unit control buttons  2022  or other controls to permit a health professional using the hand unit  2020  to control the operations of the hand unit  2020  or other components of the imaging control unit  2002 , including, for example, the light sources. The camera scope cable  2015  may include one or more electrical conductors and one or more optical fibers. The camera scope cable  2015  may terminate with a camera head connector  2008  at a proximal end in which the camera head connector  2008  is configured to mate with the one or more optical and/or electrical interfaces of the imaging control unit  2002 . The electrical conductors may supply power to the hand unit  2020 , including the body  2021  and the elongated camera probe  2024 , and/or to any electrical components internal to the hand unit  2020  including the body  2021  and/or elongated camera probe  2024 . The electrical conductors may also serve to provide bi-directional data communication between any one or more components the hand unit  2020  and the imaging control unit  2002 . The one or more optical fibers may conduct illumination from the one or more illumination sources in the imaging control unit  2002  through the hand unit body  2021  and to a distal end of the elongated camera probe  2024 . In some non-limiting aspects, the one or more optical fibers may also conduct light reflected or refracted from the surgical site to one or more optical sensors disposed in the elongated camera probe  2024 , the hand unit body  2021 , and/or the imaging control unit  2002 . 
       FIG.  152 B  (a top plan view) depicts in more detail some aspects of a hand unit  2020  of the visualization system  2108 . The hand unit body  2021  may be constructed of a plastic material. The hand unit control buttons  2022  or other controls may have a rubber overmolding to protect the controls while permitting them to be manipulated by the surgeon. The camera scope cable  2015  may have optical fibers integrated with electrical conductors, and the camera scope cable  2015  may have a protective and flexible overcoating such as PVC. In some non-limiting examples, the camera scope cable  2015  may be about 10 ft. long to permit ease of use during a surgical procedure. The length of the camera scope cable  2015  may range from about 5 ft. to about 15 ft. Non-limiting examples of a length of the camera scope cable  2015  may be about 5 ft., about 6 ft., about 7 ft., about 8 ft., about 9 ft., about 10 ft., about 11 ft., about 12 ft., about 13 ft., about 14 ft., about 15 ft., or any length or range of lengths therebetween. The elongated camera probe  2024  may be fabricated from a rigid material such as stainless steel. In some aspects, the elongated camera probe  2024  may be joined with the hand unit body  2021  via a rotatable collar  2026 . The rotatable collar  2026  may permit the elongated camera probe  2024  to be rotated with respect to the hand unit body  2021 . In some aspects, the elongated camera probe  2024  may terminate at a distal end with a plastic window  2028  sealed with epoxy. 
     The side plan view of the hand unit, depicted in  FIG.  152 C  illustrates that a light or image sensor  2030  maybe disposed at a distal end  2032   a  of the elongated camera probe or within the hand unit body  2032   b . In some alternative aspects, the light or image sensor  2030  may be dispose with additional optical elements in the imaging control unit  2002 .  FIG.  152 C  further depicts an example of a light sensor  2030  comprising a CMOS image sensor  2034  disposed within a mount  2036  having a radius of about 4 mm.  FIG.  152 D  illustrates aspects of the CMOS image sensor  2034 , depicting the active area  2038  of the image sensor. Although the CMOS image sensor in  FIG.  152 C  is depicted to be disposed within a mount  2036  having a radius of about 4 mm, it may be recognized that such a sensor and mount combination may be of any useful size to be disposed within the elongated camera probe  2024 , the hand unit body  2021 , or in the image control unit  2002 . Some non-limiting examples of such alternative mounts may include a 5.5 mm mount  2136   a , a 4 mm mount  2136   b , a 2.7 mm mount  2136   c , and a 2 mm mount  2136   d . It may be recognized that the image sensor may also comprise a CCD image sensor. The CMOS or CCD sensor may comprise an array of individual light sensing elements (pixels). 
       FIGS.  153 A- 153 F  depict various aspects of some examples of illumination sources and their control that may be incorporated into the visualization system  2108 . 
       FIG.  153 A  illustrates an aspect of a laser illumination system having a plurality of laser bundles emitting a plurality of wavelengths of electromagnetic energy. As can be seen in the figure, the illumination system  2700  may comprise a red laser bundle  2720 , a green laser bundle  2730 , and a blue laser bundle  2740  that are all optically coupled together though fiber optics  2755 . As can be seen in the figure, each of the laser bundles may have a corresponding light sensing element or electromagnetic sensor  2725 ,  2735 ,  2745  respectively, for sensing the output of the specific laser bundle or wavelength. 
     Additional disclosures regarding the laser illumination system depicted in  FIG.  153 A  for use in a surgical visualization system  2108  may be found in U.S. Pat. Application Publication No. 2014/0268860, titled CONTROLLING THE INTEGRAL LIGHT ENERGY OF A LASER PULSE filed on Mar. 15, 2014, which issued on Oct. 3, 2017 as U.S. Pat. No. 9,777,913, the contents thereof being incorporated by reference herein in its entirety and for all purposes. 
       FIG.  153 B  illustrates the operational cycles of a sensor used in rolling readout mode. It will be appreciated that the x direction corresponds to time and the diagonal lines  2202  indicate the activity of an internal pointer that reads out each frame of data, one line at time. The same pointer is responsible for resetting each row of pixels for the next exposure period. The net integration time for each row  2219   a - c  is equivalent, but they are staggered in time with respect to one another due to the rolling reset and read process. Therefore, for any scenario in which adjacent frames are required to represent different constitutions of light, the only option for having each row be consistent is to pulse the light between the readout cycles  2230   a - c . More specifically, the maximum available period corresponds to the sum of the blanking time plus any time during which optical black or optically blind (OB) rows ( 2218 ,  2220 ) are serviced at the start or end of the frame. 
       FIG.  153 B  illustrates the operational cycles of a sensor used in rolling readout mode or during the sensor readout  2200 . The frame readout may start at and may be represented by vertical line  2210 . The read out period is represented by the diagonal or slanted line  2202 . The sensor may be read out on a row by row basis, the top of the downwards slanted edge being the sensor top row  2212  and the bottom of the downwards slanted edge being the sensor bottom row  2214 . The time between the last row readout and the next readout cycle may be called the blanking time  2216   a - d . It may be understood that the blanking time  2216   a - d  may be the same between success readout cycles or it may differ between success readout cycles. It should be noted that some of the sensor pixel rows might be covered with a light shield (e.g., a metal coating or any other substantially black layer of another material type). These covered pixel rows may be referred to as optical black rows  2218  and  2220 . Optical black rows  2218  and  2220  may be used as input for correction algorithms. 
     As shown in  FIG.  153 B , these optical black rows  2218  and  2220  may be located on the top of the pixel array or at the bottom of the pixel array or at the top and the bottom of the pixel array. In some aspects, it may be desirable to control the amount of electromagnetic radiation, e.g., light, that is exposed to a pixel, thereby integrated or accumulated by the pixel. It will be appreciated that photons are elementary particles of electromagnetic radiation. Photons are integrated, absorbed, or accumulated by each pixel and converted into an electrical charge or current. In some aspects, an electronic shutter or rolling shutter may be used to start the integration time ( 2219   a - c ) by resetting the pixel. The light will then integrate until the next readout phase. In some aspects, the position of the electronic shutter can be moved between two readout cycles  2202  in order to control the pixel saturation for a given amount of light. In some alternative aspects lacking an electronic shutter, the integration time  2219   a - c  of the incoming light may start during a first readout cycle  2202  and may end at the next readout cycle  2202 , which also defines the start of the next integration. In some alternative aspects, the amount of light accumulated by each pixel may be controlled by a time during which light is pulsed  2230   a - d  during the blanking times  2216   a - d . This ensures that all rows see the same light issued from the same light pulse  2230   a - c . In other words, each row will start its integration in a first dark environment  2231 , which may be at the optical black back row  2220  of read out frame (m) for a maximum light pulse width, and will then receive a light strobe and will end its integration in a second dark environment  2232 , which may be at the optical black front row  2218  of the next succeeding read out frame (m + 1) for a maximum light pulse width. Thus, the image generated from the light pulse  2230   a - c  will be solely available during frame (m+1) readout without any interference with frames (m) and (m+2). 
     It should be noted that the condition to have a light pulse  2230   a - c  to be read out only in one frame and not interfere with neighboring frames is to have the given light pulse  2230   a - c  firing during the blanking time  2216 . Because the optical black rows  2218 ,  2220  are insensitive to light, the optical black back rows  2220  time of frame (m) and the optical black front rows  2218  time of frame (m+1) can be added to the blanking time  2216  to determine the maximum range of the firing time of the light pulse  2230 . 
     In some aspects,  FIG.  153 B  depicts an example of a timing diagram for sequential frame captures by a conventional CMOS sensor. Such a CMOS sensor may incorporate a Bayer pattern of color filters, as depicted in  FIG.  153 C . It is recognized that the Bayer pattern provides for greater luminance detail than chrominance. It may further be recognized that the sensor has a reduced spatial resolution since a total of 4 adjacent pixels are required to produce the color information for the aggregate spatial portion of the image. In an alternative approach, the color image may be constructed by rapidly strobing the visualized area at high speed with a variety of optical sources (either laser or light-emitting diodes) having different central optical wavelengths. 
     The optical strobing system may be under the control of the camera system, and may include a specially designed CMOS sensor with high speed readout. The principal benefit is that the sensor can accomplish the same spatial resolution with significantly fewer pixels compared with conventional Bayer or 3-sensor cameras. Therefore, the physical space occupied by the pixel array may be reduced. The actual pulse periods ( 2230   a - c ) may differ within the repeating pattern, as illustrated in  FIG.  153 B . This is useful for, e.g., apportioning greater time to the components that require the greater light energy or those having the weaker sources. As long as the average captured frame rate is an integer multiple of the requisite final system frame rate, the data may simply be buffered in the signal processing chain as appropriate. 
     The facility to reduce the CMOS sensor chip-area to the extent allowed by combining all of these methods is particularly attractive for small diameter (~3-10 mm) endoscopy. In particular, it allows for endoscope designs in which the sensor is located in the space-constrained distal end, thereby greatly reducing the complexity and cost of the optical section, while providing high definition video. A consequence of this approach is that to reconstruct each final, full color image, requires that data be fused from three separate snapshots in time. Any motion within the scene, relative to the optical frame of reference of the endoscope, will generally degrade the perceived resolution, since the edges of objects appear at slightly different locations within each captured component. In this disclosure, a means of diminishing this issue is described which exploits the fact that spatial resolution is much more important for luminance information, than for chrominance. 
     The basis of the approach is that, instead of firing monochromatic light during each frame, combinations of the three wavelengths are used to provide all of the luminance information within a single image. The chrominance information is derived from separate frames with, e.g., a repeating pattern such as Y-Cb-Y-Cr ( FIG.  153 D ). While it is possible to provide pure luminance data by a shrewd choice of pulse ratios, the same is not true of chrominance. 
     In one aspect, as illustrated in  FIG.  153 D , an endoscopic system  2300   a  may comprise a pixel array  2302   a  having uniform pixels and the system  2300   a  may be operated to receive Y (luminance pulse)  2304   a , Cb (ChromaBlue)  2306   a  and Cr (ChromaRed)  2308   a  pulses. 
     To complete a full color image requires that the two components of chrominance also be provided. However, the same algorithm that was applied for luminance cannot be directly applied for chrominance images since it is signed, as reflected in the fact that some of the RGB coefficients are negative. The solution to this is to add a degree of luminance of sufficient magnitude that all of the final pulse energies become positive. As long as the color fusion process in the ISP is aware of the composition of the chrominance frames, they can be decoded by subtracting the appropriate amount of luminance from a neighboring frame. The pulse energy proportions are given by: 
     
       
         
           
             Y 
             = 
             0.183 
             ⋅ 
             R 
             + 
             0.614 
             ⋅ 
             G 
             + 
             0.062 
             ⋅ 
             B 
           
         
       
     
     
       
         
           
             Cb 
             = 
             λ 
             ⋅ 
             Y-0 
             .101 
             ⋅ 
             R 
               
             - 
               
             0 
             .339 
             ⋅ 
             G 
               
             + 
               
             0 
             .439 
             ⋅ 
             B 
           
         
       
     
     
       
         
           
             Cr 
             = 
             δ 
             ⋅ 
             Y 
             + 
             0.439 
             ⋅ 
             R 
               
             - 
               
             0 
             .399 
             ⋅ 
             G 
               
             - 
               
             0 
             .040 
             ⋅ 
             B 
           
         
       
     
      where 
     
       
         
           
             
               
                 λ 
                 ≥ 
                 0.399 
               
               / 
               
                 0.614 
                 = 
                 0.552 
               
             
           
         
       
     
     
       
         
           
             δ 
             ≥ 
             
               
                 0.399 
               
               / 
               
                 0.614 
               
             
             = 
             0.650 
           
         
       
     
     It turns out that if the λ factor is equal to 0.552; both the red and the green components are exactly cancelled, in which case the Cb information can be provided with pure blue light. Similarly, setting δ =0.650 cancels out the blue and green components for Cr which becomes pure red. This particular example is illustrated in  FIG.  153 E , which also depicts λ and δ as integer multiples of ½ 8 . This is a convenient approximation for the digital frame reconstruction. 
     In the case of the Y-Cb-Y-Cr pulsing scheme, the image data is already in the YCbCr space following the color fusion. Therefore, in this case it makes sense to perform luminance and chrominance based operations up front, before converting back to linear RGB to perform the color correction etc. 
     The color fusion process is more straightforward than de-mosaic, which is necessitated by the Bayer pattern (see  FIG.  153 C ), since there is no spatial interpolation. It does require buffering of frames though in order to have all of the necessary information available for each pixel. In one general aspect, data for the Y-Cb-Y-Cr pattern may be pipelined to yield one full color image per two raw captured images. This is accomplished by using each chrominance sample twice. In  FIG.  153 F  the specific example of a 120 Hz frame capture rate providing 60 Hz final video is depicted. 
     Additional disclosures regarding the control of the laser components of an illumination system as depicted in  FIGS.  153 B -  153 F  for use in a surgical visualization system 108 may be found in U.S. Pat. Application Publication No. 2014/0160318, titled YCBCR PULSED ILLUMINATION SCHEME IN A LIGHT DEFICIENT ENVIRONMENT, filed on Jul. 26, 2013, which issued on Dec. 6, 2016 as U.S. Pat. No. 9,516,239, and U.S. Pat. Application Publication No. 2014/0160319, titled CONTINUOUS VIDEO IN A LIGHT DEFICIENT ENVIRONMENT, filed on Jul. 26, 2013, which issued on Aug. 22, 2017 as U.S. Pat. No. 9,743,016, the contents thereof being incorporated by reference herein in their entirety and for all purposes. 
     Subsurface Vascular Imaging 
     During a surgical procedure, a surgeon may be required to manipulate tissues to effect a desired medical outcome. The actions of the surgeon are limited by what is visually observable in the surgical site. Thus, the surgeon may not be aware, for example, of the disposition of vascular structures that underlie the tissues being manipulated during the procedure. 
     Since the surgeon is unable to visualize the vasculature beneath a surgical site, the surgeon may accidentally sever one or more critical blood vessels during the procedure. 
     Therefore, it is desirable to have a surgical visualization system that can acquire imaging data of the surgical site for presentation to a surgeon in which the presentation can include information related to the presence of vascular structures located beneath the surface of a surgical site. 
     Some aspects of the present disclosure further provide for a control circuit configured to control the illumination of a surgical site using one or more illumination sources such as laser light sources and to receive imaging data from one or more image sensors. In some aspects, the present disclosure provides for a non-transitory computer readable medium storing computer readable instructions that, when executed, cause a device to detect a blood vessel in a tissue and determine its depth below the surface of the tissue. 
     In some aspects, a surgical image acquisition system may include a plurality of illumination sources wherein each illumination source is configured to emit light having a specified central wavelength, a light sensor configured to receive a portion of the light reflected from a tissue sample when illuminated by the one or more of the plurality of illumination sources, and a computing system. The computing system may be configured to: receive data from the light sensor when the tissue sample is illuminated by each of the plurality of illumination sources; determine a depth location of a structure within the tissue sample based on the data received by the light sensor when the tissue sample is illuminated by each of the plurality of illumination sources, and calculate visualization data regarding the structure and the depth location of the structure. In some aspects, the visualization data may have a data format that may be used by a display system, and the structure may comprise one or more vascular tissues. 
     Vascular Imaging Using NIR Spectroscopy 
     In one aspect, a surgical image acquisition system may include an independent color cascade of illumination sources comprising visible light and light outside of the visible range to image one or more tissues within a surgical site at different times and at different depths. The surgical image acquisition system may further detect or calculate characteristics of the light reflected and/or refracted from the surgical site. The characteristics of the light may be used to provide a composite image of the tissue within the surgical site as well as provide an analysis of underlying tissue not directly visible at the surface of the surgical site. The surgical image acquisition system may determine tissue depth location without the need for separate measurement devices. 
     In one aspect, the characteristic of the light reflected and/or refracted from the surgical site may be an amount of absorbance of light at one or more wavelengths. Various chemical components of individual tissues may result in specific patterns of light absorption that are wavelength dependent. 
     In one aspect, the illumination sources may comprise a red laser source and a near infrared laser source, wherein the one or more tissues to be imaged may include vascular tissue such as veins or arteries. In some aspects, red laser sources (in the visible range) may be used to image some aspects of underlying vascular tissue based on spectroscopy in the visible red range. In some non-limiting examples, a red laser light source may source illumination having a peak wavelength that may range between 635 nm and 660 nm, inclusive. Non-limiting examples of a red laser peak wavelength may include about 635 nm, about 640 nm, about 645 nm, about 650 nm, about 655 nm, about 660 nm, or any value or range of values therebetween. In some other aspects, near infrared laser sources may be used to image underlying vascular tissue based on near infrared spectroscopy. In some non-limiting examples, a near infrared laser source may emit illumination have a wavelength that may range between 750-3000 nm, inclusive. Non-limiting examples of an infrared laser peak wavelength may include about 750 nm, about 1000 nm, about 1250 nm, about 1500 nm, about 1750 nm, about 2000 nm, about 2250 nm, about 2500 nm, about 2750 nm, 3000 nm, or any value or range of values therebetween. It may be recognized that underlying vascular tissue may be probed using a combination of red and infrared spectroscopy. In some examples, vascular tissue may be probed using a red laser source having a peak wavelength at about 660 nm and a near IR laser source having a peak wavelength at about 750 nm or at about 850 nm. 
     Near infrared spectroscopy (NIRS) is a non-invasive technique that allows determination of tissue oxygenation based on spectro-photometric quantitation of oxy- and deoxyhemoglobin within a tissue. In some aspects, NIRS can be used to image vascular tissue directly based on the difference in illumination absorbance between the vascular tissue and non-vascular tissue. Alternatively, vascular tissue can be indirectly visualized based on a difference of illumination absorbance of blood flow in the tissue before and after the application of physiological interventions, such as arterial and venous occlusions methods. 
     Instrumentation for near-IR (NIR) spectroscopy may be similar to instruments for the UV-visible and mid-IR ranges. Such spectroscopic instruments may include an illumination source, a detector, and a dispersive element to select a specific near-IR wavelength for illuminating the tissue sample. In some aspects, the source may comprise an incandescent light source or a quartz halogen light source. In some aspects, the detector may comprise semiconductor (for example, an InGaAs) photodiode or photo array. In some aspects, the dispersive element may comprise a prism or, more commonly, a diffraction grating. Fourier transform NIR instruments using an interferometer are also common, especially for wavelengths greater than about 1000 nm. Depending on the sample, the spectrum can be measured in either reflection or transmission mode. 
       FIG.  154    depicts schematically one example of instrumentation  2400  similar to instruments for the UV-visible and mid-IR ranges for NIR spectroscopy. A light source  2402  may emit a broad spectral range of illumination  2404  that may impinge upon a dispersive element  2406  (such as a prism or a diffraction grating). The dispersive element  2406  may operate to select a narrow wavelength portion  2408  of the light emitted by the broad spectrum light source  2402 , and the selected portion  2408  of the light may illuminate the tissue  2410 . The light reflected from the tissue  2412  may be directed to a detector  2416  (for example, by means of a dichroic mirror  2414 ) and the intensity of the reflected light  2412  may be recorded. The wavelength of the light illuminating the tissue  2410  may be selected by the dispersive element  2406 . In some aspects, the tissue  2410  may be illuminated only by a single narrow wavelength portion  2408  selected by the dispersive element  2406  form the light source  2402 . In other aspects, the tissue  2410  may be scanned with a variety of narrow wavelength portions  2408  selected by the dispersive element  2406 . In this manner, a spectroscopic analysis of the tissue  2410  may be obtained over a range of NIR wavelengths. 
       FIG.  155    depicts schematically one example of instrumentation  2430  for determining NIRS based on Fourier transform infrared imaging. In  FIG.  155   , a laser source emitting  2432  light in the near IR range  2434  illuminates a tissue sample  2440 . The light reflected  2436  by the tissue  2440  is reflected  2442  by a mirror, such as a dichroic mirror  2444 , to a beam splitter  2446 . The beam splitter  2446  directs one portion of the light  2448  reflected  2436  by the tissue  2440  to a stationary mirror  2450  and one portion of the light  2452  reflected  2436  by the tissue  2440  a moving mirror  2454 . The moving mirror  2454  may oscillate in position based on an affixed piezoelectric transducer activated by a sinusoidal voltage having a voltage frequency. The position of the moving mirror  2454  in space corresponds to the frequency of the sinusoidal activation voltage of the piezoelectric transducer. The light reflected from the moving mirror and the stationary mirror may be recombined  2458  at the beam splitter  2446  and directed to a detector  2456 . Computational components may receive the signal output of the detector  2456  and perform a Fourier transform (in time) of the received signal. Because the wavelength of the light received from the moving mirror  2454  varies in time with respect to the wavelength of the light received from the stationary mirror  2450 , the time-based Fourier transform of the recombined light corresponds to a wavelength-based Fourier transform of the recombined light  2458 . In this manner, a wavelength-based spectrum of the light reflected from the tissue  2440  may be determined and spectral characteristics of the light reflected  2436  from the tissue  2440  may be obtained. Changes in the absorbance of the illumination in spectral components from the light reflected from the tissue  2440  may thus indicate the presence or absence of tissue having specific light absorbing properties (such as hemoglobin). 
     An alternative to near infrared light to determine hemoglobin oxygenation would be the use of monochromatic red light to determine the red light absorbance characteristics of hemoglobin. The absorbance characteristics of red light having a central wavelength of about 660 nm by the hemoglobin may indicate if the hemoglobin is oxygenated (arterial blood) or deoxygenated (venous blood). 
     In some alternative surgical procedures, contrasting agents can be used to improve the data that is collected on oxygenation and tissue oxygen consumption. In one non-limiting example, NIRS techniques may be used in conjunction with a bolus injection of a near-IR contrast agent such as indocyanine green (ICG) which has a peak absorbance at about 800 nm. ICG has been used in some medical procedures to measure cerebral blood flow. 
     Vascular Imaging Using Laser Doppler Flowmetry 
     In one aspect, the characteristic of the light reflected and/or refracted from the surgical site may be a Doppler shift of the light wavelength from its illumination source. 
     Laser Doppler flowmetry may be used to visualize and characterized a flow of particles moving relative to an effectively stationary background. Thus, laser light scattered by moving particles, such as blood cells, may have a different wavelength than that of the original illuminating laser source. In contrast, laser light scattered by the effectively stationary background (for example, the vascular tissue) may have the same wavelength of that of the original illuminating laser source. The change in wavelength of the scattered light from the blood cells may reflect both the direction of the flow of the blood cells relative to the laser source as well as the blood cell velocity.  FIGS.  156 A-C  illustrate the change in wavelength of light scattered from blood cells that may be moving away from ( FIG.  156 A ) or towards ( FIG.  156 C ) the laser light source. 
     In each of  FIGS.  156 A-C , the original illuminating light  2502  is depicted having a relative central wavelength of 0. It may be observed from  FIG.  156 A  that light scattered from blood cells moving away from the laser source  2504  has a wavelength shifted by some amount  2506  to a greater wavelength relative to that of the laser source (and is thus red shifted). It may also be observed from  FIG.  156 C  that light scattered from blood cells moving towards from the laser source  2508  has a wavelength shifted by some amount  2510  to a shorter wavelength relative to that of the laser source (and is thus blue shifted). The amount of wavelength shift (for example  2506  or  2510 ) may be dependent on the velocity of the motion of the blood cells. In some aspects, an amount of a red shift ( 2506 ) of some blood cells may be about the same as the amount of blue shift ( 2510 ) of some other blood cells. Alternatively, an amount of a red shift ( 2506 ) of some blood cells may differ from the amount of blue shift ( 2510 ) of some other blood cells Thus, the velocity of the blood cells flowing away from the laser source as depicted in  FIG.  156 A  may be less than the velocity of the blood cells flowing towards the laser source as depicted in  FIG.  156 C  based on the relative magnitude of the wavelength shifts ( 2506  and  2510 ). In contrast, and as depicted in  FIG.  156 B , light scattered from tissue not moving relative to the laser light source (for example blood vessels  2512  or non-vascular tissue  2514 ) may not demonstrate any change in wavelength. 
       FIG.  157    depicts an aspect of instrumentation  2530  that may be used to detect a Doppler shift in laser light scattered from portions of a tissue  2540 . Light  2534  originating from a laser  2532  may pass through a beam splitter  2544 . Some portion of the laser light  2536  may be transmitted by the beam splitter  2544  and may illuminate tissue  2540 . Another portion of the laser light may be reflected  2546  by the beam splitter  2544  to impinge on a detector  2550 . The light back-scattered  2542  by the tissue  2540  may be directed by the beam splitter  2544  and also impinge on the detector  2550 . The combination of the light  2534  originating from the laser  2532  with the light back-scattered  2542  by the tissue  2540  may result in an interference pattern detected by the detector  2550 . The interference pattern received by the detector  2550  may include interference fringes resulting from the combination of the light  2534  originating from the laser  2532  and the Doppler shifted (and thus wavelength shifted) light back-scattered  2452  from the tissue  2540 . 
     It may be recognized that back-scattered light  2542  from the tissue  2540  may also include back scattered light from boundary layers within the tissue  2540  and/or wavelength-specific light absorption by material within the tissue  2540 . As a result, the interference pattern observed at the detector  2550  may incorporate interference fringe features from these additional optical effects and may therefore confound the calculation of the Doppler shift unless properly analyzed. 
       FIG.  158    depicts some of these additional optical effects. It is well known that light traveling through a first optical medium having a first refractive index,  n   1 , may be reflected at an interface with a second optical medium having a second refractive index,  n   2 . The light transmitted through the second optical medium will have a transmission angle relative to the interface that differs from the angle of the incident light based on a difference between the refractive indices  n   1  and  n   2  (Snell’s Law).  FIG.  158    illustrates the effect of Snell’s Law on light impinging on the surface of a multi-component tissue  2150 , as may be presented in a surgical field. The multi-component tissue  2150  may be composed of an outer tissue layer  2152  having a refractive index  n   1  and a buried tissue, such as a blood vessel having a vessel wall  2156 . The blood vessel wall  2156  may be characterized by a refractive index  n   2 . Blood may flow within the lumen of the blood vessel  2160 . In some aspects, it may be important during a surgical procedure to determine the position of the blood vessel  2160  below the surface  2154  of the outer tissue layer  2152  and to characterize the blood flow using Doppler shift techniques. 
     An incident laser light  2170   a  may be used to probe for the blood vessel  2160  and may be directed on the top surface  2154  of the outer tissue layer  2152 . A portion  2172  of the incident laser light  2170   a  may be reflected at the top surface  2154 . Another portion  2170   b  of the incident laser light  2170   a  may penetrate the outer tissue layer  2152 . The reflected portion  2172  at the top surface  2154  of the outer tissue layer  2152  has the same path length of the incident light  2170   a , and therefore has the same wavelength and phase of the incident light  2170   a . However, the portion  2170   b  of light transmitted into the outer tissue layer  2152  will have a transmission angle that differs from the incidence angle of the light impinging on the tissue surface because the outer tissue layer  2152  has an index of refraction n1 that differs from the index of refraction of air. 
     If the portion of light transmitted through the outer tissue layer  2152  impinges on a second tissue surface  2158 , for example of the blood vessel wall  2156 , some portion  2174   a , b  of light will be reflected back towards the source of the incident light  2170   a . The light thus reflected  2174   a  at the interface between the outer tissue layer  2152  and the blood vessel wall  2156  will have the same wavelength as the incident light  2170   a , but will be phase shifted due to the change in the light path length. Projecting the light reflected  2174   a , b  from the interface between the outer tissue layer  2152  and the blood vessel wall  2156  along with the incident light on the sensor, will produce an interference pattern based on the phase difference between the two light sources. 
     Further, a portion of the incident light  2170   c  may be transmitted through the blood vessel wall  2156  and penetrate into the blood vessel lumen  2160 . This portion of the incident light  2170   c  may interact with the moving blood cells in the blood vessel lumen  2160  and may be reflected back  2176   a - c  towards the source of the impinging light having a wavelength Doppler shifted according to the velocity of the blood cells, as disclosed above. The Doppler shifted light reflected  2176   a - c  from the moving blood cells may be projected along with the incident light on the sensor, resulting in an interference pattern having a fringe pattern based on the wavelength difference between the two light sources. 
     In  FIG.  158   , a light path  2178  is presented of light impinging on the red blood cells in the blood vessel lumen  2160  if there are no changes in refractive index between the emitted light and the light reflected by the moving blood cells. In this example, only a Doppler shift in the reflected light wavelength can be detected. However, the light reflected by the blood cells ( 2176   a - c ) may incorporate phase changes due to the variation in the tissue refractive indices in addition to the wavelength changes due to the Doppler Effect. 
     Thus, it may be understood that if the light sensor receives the incident light, the light reflected from one or more tissue interfaces ( 2172 , and  2174   a , b ) and the Doppler shifted light from the blood cells ( 2176   a - c ), the interference pattern thus produced on the light sensor may include the effects due to the Doppler shift (change in wavelength) as well as the effects due to the change in refractive index within the tissue (change in phase). As a result, a Doppler analysis of the light reflected by the tissue sample may produce erroneous results if the effects due to changes in the refractive index within the sample are not compensated for. 
       FIG.  159    illustrates an example of the effects on a Doppler analysis of light that impinge  2250  on a tissue sample to determine the depth and location of an underlying blood vessel. If there is no intervening tissue between the blood vessel and the tissue surface, the interference pattern detected at the sensor may be due primarily to the change in wavelength reflected from the moving blood cells. As a result, a spectrum  2252  derived from the interference pattern may generally reflect only the Doppler shift of the blood cells. However, if there is intervening tissue between the blood vessel and the tissue surface, the interference pattern detected at the sensor may be due to a combination of the change in wavelength reflected from the moving blood cells and the phase shift due to the refractive index of the intervening tissue. A spectrum  2254  derived from such an interference pattern, may result in the calculation of the Doppler shift that is confounded due to the additional phase change in the reflected light. In some aspects, if information regarding the characteristics (thickness and refractive index) of the intervening tissue is known, the resulting spectrum  2256  may be corrected to provide a more accurate calculation of the change in wavelength. 
     It is recognized that the tissue penetration depth of light is dependent on the wavelength of the light used. Thus, the wavelength of the laser source light may be chosen to detect particle motion (such a blood cells) at a specific range of tissue depth.  FIGS.  160 A-C  depict schematically a means for detect moving particles such as blood cells at a variety of tissue depths based on the laser light wavelength. As illustrated in  FIG.  160 A , a laser source  2340  may direct an incident beam of laser light  2342  onto a surface  2344  of a surgical site. A blood vessel  2346  (such as a vein or artery) may be disposed within the tissue  2348  at some depth δfrom the tissue surface. The penetration depth  2350  of a laser into a tissue  2348  may be dependent at least in part on the laser wavelength. Thus, laser light having a wavelength in the red range of about 635 nm to about 660 nm, may penetrate the tissue  2351   a  to a depth of about 1 mm. Laser light having a wavelength in the green range of about 520 nm to about 532 nm may penetrate the tissue  2351   b  to a depth of about 2-3 mm. Laser light having a wavelength in the blue range of about 405 nm to about 445 nm may penetrate the tissue  2351   c  to a depth of about 4 mm or greater. In the example depicted in  FIGS.  160 A-C , a blood vessel  2346  may be located at a depth δof about 2-3 mm below the tissue surface. Red laser light will not penetrate to this depth and thus will not detect blood cells flowing within this vessel. However, both green and blue laser light can penetrate this depth. Therefore, scattered green and blue laser light from the blood cells within the blood vessel  2346  may demonstrate a Doppler shift in wavelength. 
       FIG.  160 B  illustrates how a Doppler shift  2355  in the wavelength of reflected laser light may appear. The emitted light (or laser source light  2342 ) impinging on a tissue surface  2344  may have a central wavelength  2352 . For example, light from a green laser may have a central wavelength  2352  within a range of about 520 nm to about 532 nm. The reflected green light may have a central wavelength  2354  shifted to a longer wavelength (red shifted) if the light was reflected from a particle such as a red blood cell that is moving away from the detector. The difference between the central wavelength  2352  of the emitted laser light and the central wavelength  2354  of the emitted laser light comprises the Doppler shift  2355 . 
     As disclosed above with respect to  FIGS.  158  and  159   , laser light reflected from structures within a tissue  2348  may also show a phase shift in the reflected light due to changes in the index of refraction arising from changes in tissue structure or composition. The emitted light (or laser source light  2342 ) impinging on a tissue surface  2344  may have a first phase characteristic  2356 . The reflected laser light may have a second phase characteristic  2358 . It may be recognized that blue laser light that can penetrate tissue to a depth of about 4 mm or greater  2351   c  may encounter a greater variety of tissue structures than red laser light (about 1 mm  2351   a ) or green laser light (about 2-3 mm  2351   b ). Consequently, as illustrated in  FIG.  160 C , the phase shift  2358  of reflected blue laser light may be significant at least due to the depth of penetration. 
       FIG.  160 D  illustrates aspects of illuminating tissue by red  2360   a , green  2360   b  and blue  2360   c  laser light in a sequential manner. In some aspects, a tissue may be probed by red  2360   a , green  2360   b  and blue  2360   c  laser illumination in a sequential manner. In some alternative examples, one or more combinations of red  2360   a , green  2360   b , and blue  2360   c  laser light, as depicted in  FIGS.  153 D -  153 F  and disclosed above, may be used to illuminate the tissue according to a defined illumination sequence. 30D illustrates the effect of such illumination on a CMOS imaging sensor  2362   a - d  over time. Thus, at a first time ti, the CMOS sensor  2362   a  may be illuminated by the red  2360   a  laser. At a second time t 2  the CMOS sensor  2362   b  may be illuminated by the green  2360   b  laser. At a third time t 3 , the CMOS sensor  2362   c  may be illuminated by the blue  2360   c  laser. The illumination cycle may then be repeated starting at a fourth time t 4  in which the CMOS sensor  2362   d  may be illuminated by the red  2360   a  lase again. It may be recognized that sequential illumination of the tissue by laser illumination at differing wavelengths may permit a Doppler analysis at varying tissue depths over time. Although red  2360   a , green  2360   b  and blue  2360   c  laser sources may be used to illuminate the surgical site, it may be recognized that other wavelengths outside of visible light (such as in the infrared or ultraviolet regions) may be used to illuminate the surgical site for Doppler analysis. 
       FIG.  161    illustrates an example of a use of Doppler imaging to detect the present of blood vessels not otherwise viewable at a surgical site  2600 . In  FIG.  161   , a surgeon may wish to excise a tumor  2602  found in the right superior posterior lobe  2604  of a lung. Because the lungs are highly vascular, care must be taken to identify only those blood vessels associate with the tumor and to seal only those vessels without compromising the blood flow to the non-affected portions of the lung. In  FIG.  161   , the surgeon has identified the margin  2606  of the tumor  2604 . The surgeon may then cut an initial dissected area  2608  in the margin region  2606 , and exposed blood vessels  2610  may be observed for cutting and sealing. The Doppler imaging detector  2620  may be used to locate and identify blood vessels not observable  2612  in the dissected area. An imaging system may receive data from the Doppler imaging detector  2620  for analysis and display of the data obtained from the surgical site  2600 . In some aspects, the imaging system may include a display to illustrate the surgical site  2600  including a visible image of the surgical site  2600  along with an image overlay of the hidden blood vessels  2612  on the image of the surgical site  2600 . 
     In the scenario disclosed above regarding  FIG.  161   , a surgeon wishes to sever blood vessels that supply oxygen and nutrients to a tumor while sparing blood vessels associated with non-cancerous tissue. Additionally, the blood vessels may be disposed at different depths in or around the surgical site  2600 . The surgeon must therefore identify the position (depth) of the blood vessels as well as determine if they are appropriate for resection.  FIG.  162    illustrates one method for identifying deep blood vessels based on a Doppler shift of light from blood cells flowing therethrough. As disclosed above, red laser light has a penetration depth of about 1 mm and green laser light has a penetration depth of about 2-3 mm. However, a blood vessel having a below-surface depth of 4 mm or more will be outside the penetration depths at these wavelengths. Blue laser light, however, can detect such blood vessels based on their blood flow. 
       FIG.  162    depicts the Doppler shift of laser light reflected from a blood vessel at a specific depth below a surgical site. The site may be illuminated by red laser light, green laser light, and blue laser light. The central wavelength  2630  of the illuminating light may be normalized to a relative central  3631 . If the blood vessel lies at a depth of 4 or more mm below the surface of the surgical site, neither the red laser light nor the green laser light will be reflected by the blood vessel. Consequently, the central wavelength  2632  of the reflected red light and the central wavelength  2634  of the reflected green light will not differ much from the central wavelength  2630  of the illuminating red light or green light, respectively. However, if the site is illuminated by blue laser light, the central wavelength  2638  of the reflected blue light  2636  will differ from the central wavelength  2630  of the illuminating blue light. In some instances, the amplitude of the reflected blue light  2636  may also be significantly reduced from the amplitude of the illuminating blue light. A surgeon may thus determine the presence of a deep lying blood vessel along with its approximate depth, and thereby avoiding the deep blood vessel during surface tissue dissection. 
       FIGS.  163  and  164    illustrates schematically the use of laser sources having differing central wavelengths (colors) for determining the approximate depth of a blood vessel beneath the surface of a surgical site.  FIG.  163    depicts a first surgical site  2650  having a surface  2654  and a blood vessel  2656  disposed below the surface  2654 . In one method, the blood vessel  2656  may be identified based on a Doppler shift of light impinging on the flow  2658  of blood cells within the blood vessel  2656 . The surgical site  2650  may be illuminated by light from a number of lasers  2670 ,  2676 ,  2682 , each laser being characterized by emitting light at one of several different central wavelengths. As noted above, illumination by a red laser  2670  can only penetrate tissue by about 1 mm. Thus, if the blood vessel  2656  was located at a depth of less than 1 mm  2672  below the surface  2654 , the red laser illumination would be reflected  2674  and a Doppler shift of the reflected red illumination  2674  may be determined. Further, as noted above, illumination by a green laser  2676  can only penetrate tissue by about 2-3 mm. If the blood vessel  2656  was located at a depth of about 2-3 mm  2678  below the surface  2654 , the green laser illumination would be reflected  2680  while the red laser illumination  2670  would not, and a Doppler shift of the reflected green illumination  2680  may be determined. However, as depicted in  FIG.  163   , the blood vessel  2656  is located at a depth of about 4 mm  2684  below the surface  2654 . Therefore, neither the red laser illumination  2670  nor the green laser illumination  2676  would be reflected. Instead, only the blue laser illumination would be reflected  2686  and a Doppler shift of the reflected blue illumination  2686  may be determined. 
     In contrast to the blood vessel  2656  depicted in  FIG.  163   , the blood vessel  2656 ′ depicted in  FIG.  164    is located closer to the surface of the tissue at the surgical site. Blood vessel  2656 ′ may also be distinguished from blood vessel  2656  in that blood vessel  2656 ′ is illustrated to have a much thicker wall  2657 . Thus, blood vessel  2656 ′ may be an example of an artery while blood vessel  2656  may be an example of a vein because arterial walls are known to be thicker than venous walls. In some examples, arterial walls may have a thickness of about 1.3 mm. As disclosed above, red laser illumination  2670 ′ can penetrate tissue to a depth of about 1 mm  2672 ′. Thus, even if a blood vessel  2656 ′ is exposed at a surgical site (see  2610  at  FIG.  161   ), red laser light that is reflected  2674 ′ from the surface of the blood vessel  2656 ′, may not be able to visualize blood flow  2658 ′ within the blood vessel  2656 ′ under a Doppler analysis due to the thickness of the blood vessel wall  2657 . However, as disclosed above, green laser light impinging  2676 ′ on the surface of a tissue may penetrate to a depth of about 2-3 mm  2678 ′. Further, blue laser light impinging  2682 ′ on the surface of a tissue may penetrate to a depth of about 4 mm  2684 ′. Consequently, green laser light may be reflected  2680 ′ from the blood cells flowing  2658 ′ within the blood vessel  2656 ′ and blue laser light may be reflected  2686 ′ from the blood cells flowing  2658 ′ within the blood vessel  2656 ′ . As a result, a Doppler analysis of the reflected green light  2680 ′ and reflected blue light  2686 ′ may provide information regarding blood flow in near-surface blood vessel, especially the approximate depth of the blood vessel. 
     As disclosed above, the depth of blood vessels below the surgical site may be probed based on wavelength-dependent Doppler imaging. The amount of blood flow through such a blood vessel may also be determined by speckle contrast (interference) analysis. Doppler shift may indicate a moving particle with respect to a stationary light source. As disclosed above, the Doppler wavelength shift may be an indication of the velocity of the particle motion. Individual particles such as blood cells may not be separately observable. However, the velocity of each blood cell will produce a proportional Doppler shift. An interference pattern may be generated by the combination of the light back-scattered from multiple blood cells due to the differences in the Doppler shift of the back-scattered light from each of the blood cells. The interference pattern may be an indication of the number density of blood cells within a visualization frame. The interference pattern may be termed speckle contrast. Speckle contrast analysis may be calculated using a full frame 300x300 CMOS imaging array, and the speckle contrast may be directly related to the amount of moving particles (for example blood cells) interacting with the laser light over a given exposure period. 
     A CMOS image sensor may be coupled to a digital signal processor (DSP). Each pixel of the sensor may be multiplexed and digitized. The Doppler shift in the light may be analyzed by looking at the source laser light in comparison to the Doppler shifted light. A greater Doppler shift and speckle may be related to a greater number of blood cells and their velocity in the blood vessel. 
       FIG.  165    depicts an aspect of a composite visual display  2800  that may be presented a surgeon during a surgical procedure. The composite visual display  2800  may be constructed by overlaying a white light image  2830  of the surgical site with a Doppler analysis image  2850 . 
     In some aspects, the white light image  2830  may portray the surgical site  2832 , one or more surgical incisions  2834 , and the tissue  2836  readily visible within the surgical incision  2834 . The white light image  2830  may be generated by illuminating  2840  the surgical site  2832  with a white light source  2838  and receiving the reflected white light  2842  by an optical detector. Although a white light source  2838  may be used to illuminate the surface of the surgical site, in one aspect, the surface of the surgical site may be visualized using appropriate combinations of red  2854 , green  2856 , and blue  2858  laser light as disclosed above with respect to  FIGS.  153 C - 153 F . 
     In some aspects, the Doppler analysis image  2850  may include blood vessel depth information along with blood flow information  2852  (from speckle analysis). As disclosed above, blood vessel depth and blood flow velocity may be obtained by illuminating the surgical site with laser light of multiple wavelengths, and determining the blood vessel depth and blood flow based on the known penetration depth of the light of a particular wavelength. In general, the surgical site  2832  may be illuminated by light emitted by one or more lasers such as a red leaser  2854 , a green laser  2856 , and a blue laser  2858 . A CMOS detector  2872  may receive the light reflected back ( 2862 ,  2866 ,  2870 ) from the surgical site  2832  and its surrounding tissue. The Doppler analysis image  2850  may be constructed  2874  based on an analysis of the multiple pixel data from the CMOS detector  2872 . 
     In one aspect, a red laser  2854  may emit red laser illumination  2860  on the surgical site  2832  and the reflected light  2862  may reveal surface or minimally subsurface structures. In one aspect, a green laser  2856  may emit green laser illumination  2864  on the surgical site  2832  and the reflected light  2866  may reveal deeper subsurface characteristics. In another aspect, a blue laser  2858  may emit blue laser illumination  2868  on the surgical site  2832  and the reflected light  2870  may reveal, for example, blood flow within deeper vascular structures. In addition, the speckle contrast analysis my present the surgeon with information regarding the amount and velocity of blood flow through the deeper vascular structures. 
     Although not depicted in  FIG.  165   , it may be understood that the imaging system may also illuminate the surgical site with light outside of the visible range. Such light may include infrared light and ultraviolet light. In some aspects, sources of the infrared light or ultraviolet light may include broad-band wavelength sources (such as a tungsten source, a tungsten-halogen source, or a deuterium source). In some other aspects, the sources of the infrared or ultraviolet light may include narrow-band wavelength sources (IR diode lasers, UV gas lasers or dye lasers). 
       FIG.  166    is a flow chart  2900  of a method for determining a depth of a surface feature in a piece of tissue. An image acquisition system may illuminate  2910  a tissue with a first light beam having a first central frequency and receive  2912  a first reflected light from the tissue illuminated by the first light beam. The image acquisition system may then calculate  2914  a first Doppler shift based on the first light beam and the first reflected light. The image acquisition system may then illuminate  2916  the tissue with a second light beam having a second central frequency and receive  2918  a second reflected light from the tissue illuminated by the second light beam. The image acquisition system may then calculate  2920  a second Doppler shift based on the second light beam and the second reflected light. The image acquisition system may then calculate  2922  a depth of a tissue feature based at least in part on the first central wavelength, the first Doppler shift, the second central wavelength, and the second Doppler shift. In some aspects, the tissue features may include the presence of moving particles, such as blood cells moving within a blood vessel, and a direction and velocity of flow of the moving particles. It may be understood that the method may be extended to include illumination of the tissue by any one or more additional light beams. Further, the system may calculate an image comprising a combination of an image of the tissue surface and an image of the structure disposed within the tissue. 
     In some aspects, multiple visual displays may be used. For example, a 3D display may provide a composite image displaying the combined white light (or an appropriate combination of red, green, and blue laser light) and laser Doppler image. Additional displays may provide only the white light display or a displaying showing a composite white light display and an NIRS display to visualize only the blood oxygenation response of the tissue. However, the NIRS display may not be required every cycle allowing for response of tissue. 
     Subsurface Tissue Characterization Using Multispectral OCT 
     During a surgical procedure, the surgeon may employ “smart” surgical devices for the manipulation of tissue. Such devices may be considered “smart” in that they include automated features to direct, control, and/or vary the actions of the devices based parameters relevant to their uses. The parameters may include the type and/or composition of the tissue being manipulated. If the type and/or composition of the tissue being manipulated is unknown, the actions of the smart devices may be inappropriate for the tissue being manipulated. As a result, tissues may be damaged or the manipulation of the tissue may be ineffective due to inappropriate settings of the smart device. 
     The surgeon may manually attempt to vary the parameters of the smart device in a trial-and-error manner, resulting in an inefficient and lengthy surgical procedure. 
     Therefore, it is desirable to have a surgical visualization system that can probe tissue structures underlying a surgical site to determine their structural and compositional characteristics, and to provide such data to smart surgical instruments being used in a surgical procedure. 
     Some aspects of the present disclosure further provide for a control circuit configured to control the illumination of a surgical site using one or more illumination sources such as laser light sources and to receive imaging data from one or more image sensors. In some aspects, the present disclosure provides for a non-transitory computer readable medium storing computer readable instructions that, when executed, cause a device to characterize structures below the surface at a surgical site and determine the depth of the structures below the surface of the tissue. 
     In some aspects, a surgical image acquisition system may comprise a plurality of illumination sources wherein each illumination source is configured to emit light having a specified central wavelength, a light sensor configured to receive a portion of the light reflected from a tissue sample when illuminated by the one or more of the plurality of illumination sources, and a computing system. The computing system may be configured to receive data from the light sensor when the tissue sample is illuminated by each of the plurality of illumination sources, calculate structural data related to a characteristic of a structure within the tissue sample based on the data received by the light sensor when the tissue sample is illuminated by each of the illumination sources, and transmit the structural data related to the characteristic of the structure to be received by a smart surgical device. In some aspects, the characteristic of the structure is a surface characteristic or a structure composition. 
     In one aspect, a surgical system may include multiple laser light sources and may receive laser light reflected from a tissue. The light reflected from the tissue may be used by the system to calculate surface characteristics of components disposed within the tissue. The characteristics of the components disposed within the tissue may include a composition of the components and/or a metric related to surface irregularities of the components. 
     In one aspect, the surgical system may transmit data related to the composition of the components and/or metrics related to surface irregularities of the components to a second instrument to be used on the tissue to modify the control parameters of the second instrument. 
     In some aspects, the second device may be an advanced energy device and the modifications of the control parameters may include a clamp pressure, an operational power level, an operational frequency, and a transducer signal amplitude. 
     As disclosed above, blood vessels may be detected under the surface of a surgical site base on the Doppler shift in light reflected by the blood cells moving within the blood vessels. 
     Laser Doppler flowmetry may be used to visualize and characterized a flow of particles moving relative to an effectively stationary background. Thus, laser light scattered by moving particles, such as blood cells, may have a different wavelength than that of the original illuminating laser source. In contrast, laser light scattered by the effectively stationary background (for example, the vascular tissue) may have the same wavelength of that of the original illuminating laser source. The change in wavelength of the scattered light from the blood cells may reflect both the direction of the flow of the blood cells relative to the laser source as well as the blood cell velocity. As previously disclosed,  FIGS.  156 A-C  illustrate the change in wavelength of light scattered from blood cells that may be moving away from ( FIG.  156 A ) or towards ( FIG.  156 C ) the laser light source. 
     In each of  FIGS.  156 A-C , the original illuminating light  2502  is depicted having a relative central wavelength of 0. It may be observed from  FIG.  156 A  that light scattered from blood cells moving away from the laser source  2504  has a wavelength shifted by some amount  2506  to a greater wavelength relative to that of the laser source (and is thus red shifted). It may also be observed from  FIG.  154 C  that light scattered from blood cells moving towards from the laser source  2508  has a wavelength shifted by some amount  2510  to a shorter wavelength relative to that of the laser source (and is thus blue shifted). The amount of wavelength shift (for example  2506  or  2510 ) may be dependent on the velocity of the motion of the blood cells. In some aspects, an amount of a red shift ( 2506 ) of some blood cells may be about the same as the amount of blue shift ( 2510 ) of some other blood cells. Alternatively, an amount of a red shift ( 2506 ) of some blood cells may differ from the amount of blue shift ( 2510 ) of some other blood cells Thus, the velocity of the blood cells flowing away from the laser source as depicted in  FIG.  154 A  may be less than the velocity of the blood cells flowing towards the laser source as depicted in  FIG.  156 C  based on the relative magnitude of the wavelength shifts ( 2506  and  2510 ). In contrast, and as depicted in  FIG.  156 B , light scattered from tissue not moving relative to the laser light source (for example blood vessels  2512  or non-vascular tissue  2514 ) may not demonstrate any change in wavelength. 
     As previously disclosed,  FIG.  157    depicts an aspect of instrumentation  2530  that may be used to detect a Doppler shift in laser light scattered from portions of a tissue  2540 . Light  2534  originating from a laser  2532  may pass through a beam splitter  2544 . Some portion of the laser light  2536  may be transmitted by the beam splitter  2544  and may illuminate tissue  2540 . Another portion of the laser light may be reflected  2546  by the beam splitter  2544  to impinge on a detector  2550 . The light back-scattered  2542  by the tissue  2540  may be directed by the beam splitter  2544  and also impinge on the detector  2550 . The combination of the light  2534  originating from the laser  2532  with the light back-scattered  2542  by the tissue  2540  may result in an interference pattern detected by the detector  2550 . The interference pattern received by the detector  2550  may include interference fringes resulting from the combination of the light  2534  originating from the laser  2532  and the Doppler shifted (and thus wavelength shifted) light back-scattered  2452  from the tissue  2540 . 
     It may be recognized that back-scattered light  2542  from the tissue  2540  may also include back scattered light from boundary layers within the tissue  2540  and/or wavelength-specific light absorption by material within the tissue  2540 . As a result, the interference pattern observed at the detector  2550  may incorporate interference fringe features from these additional optical effects and may therefore confound the calculation of the Doppler shift unless properly analyzed. 
     It may be recognized that light reflected from the tissue may also include back scattered light from boundary layers within the tissue and/or wavelength-specific light absorption by material within the tissue. As a result, the interference pattern observed at the detector may incorporate fringe features that may confound the calculation of the Doppler shift unless properly analyzed. 
     As previously disclosed,  FIG.  158    depicts some of these additional optical effects. It is well known that light traveling through a first optical medium having a first refractive index, n1, may be reflected at an interface with a second optical medium having a second refractive index, n2. The light transmitted through the second optical medium will have a transmission angle relative to the interface that differs from the angle of the incident light based on a difference between the refractive indices n1 and n2 (Snell’s Law).  FIG.  156    illustrates the effect of Snell’s Law on light impinging on the surface of a multi-component tissue  2150 , as may be presented in a surgical field. The multi-component tissue  2150  may be composed of an outer tissue layer  2152  having a refractive index n1 and a buried tissue, such as a blood vessel having a vessel wall  2156 . The blood vessel wall  2156  may be characterized by a refractive index n2. Blood may flow within the lumen of the blood vessel  2160 . In some aspects, it may be important during a surgical procedure to determine the position of the blood vessel  2160  below the surface  2154  of the outer tissue layer  2152  and to characterize the blood flow using Doppler shift techniques. 
     An incident laser light  2170   a  may be used to probe for the blood vessel  2160  and may be directed on the top surface  2154  of the outer tissue layer  2152 . A portion  2172  of the incident laser light  2170   a  may be reflected at the top surface  2154 . Another portion  2170   b  of the incident laser light  2170   a  may penetrate the outer tissue layer  2152 . The reflected portion  2172  at the top surface  2154  of the outer tissue layer  2152  has the same path length of the incident light  2170   a , and therefore has the same wavelength and phase of the incident light  2170   a . However, the portion  2170   b  of light transmitted into the outer tissue layer  2152  will have a transmission angle that differs from the incidence angle of the light impinging on the tissue surface because the outer tissue layer  2152  has an index of refraction n1 that differs from the index of refraction of air. 
     If the portion of light transmitted through the outer tissue layer  2152  impinges on a second tissue surface  2158 , for example of the blood vessel wall  2156 , some portion  2174   a , b  of light will be reflected back towards the source of the incident light  2170   a . The light thus reflected  2174   a  at the interface between the outer tissue layer  2152  and the blood vessel wall  2156  will have the same wavelength as the incident light  2170   a , but will be phase shifted due to the change in the light path length. Projecting the light reflected  2174   a , b  from the interface between the outer tissue layer  2152  and the blood vessel wall  2156  along with the incident light on the sensor, will produce an interference pattern based on the phase difference between the two light sources. 
     Further, a portion of the incident light  2170   c  may be transmitted through the blood vessel wall  2156  and penetrate into the blood vessel lumen  2160 . This portion of the incident light  2170   c  may interact with the moving blood cells in the blood vessel lumen  2160  and may be reflected back  2176   a - c  towards the source of the impinging light having a wavelength Doppler shifted according to the velocity of the blood cells, as disclosed above. The Doppler shifted light reflected  2176   a - c  from the moving blood cells may be projected along with the incident light on the sensor, resulting in an interference pattern having a fringe pattern based on the wavelength difference between the two light sources. 
     In  FIG.  158   , a light path  2178  is presented of light impinging on the red blood cells in the blood vessel lumen  2160  if there are no changes in refractive index between the emitted light and the light reflected by the moving blood cells. In this example, only a Doppler shift in the reflected light wavelength can be detected. However, the light reflected by the blood cells ( 2176   a - c ) may incorporate phase changes due to the variation in the tissue refractive indices in addition to the wavelength changes due to the Doppler Effect. 
     Thus, it may be understood that if the light sensor receives the incident light, the light reflected from one or more tissue interfaces ( 2172 , and  2174   a , b ) and the Doppler shifted light from the blood cells ( 2176   a - c ), the interference pattern thus produced on the light sensor may include the effects due to the Doppler shift (change in wavelength) as well as the effects due to the change in refractive index within the tissue (change in phase). As a result, a Doppler analysis of the light reflected by the tissue sample may produce erroneous results if the effects due to changes in the refractive index within the sample are not compensated for. 
     As previously disclosed,  FIG.  159    illustrates an example of the effects on a Doppler analysis of light that impinge  2250  on a tissue sample to determine the depth and location of an underlying blood vessel. If there is no intervening tissue between the blood vessel and the tissue surface, the interference pattern detected at the sensor may be due primarily to the change in wavelength reflected from the moving blood cells. As a result, a spectrum  2252  derived from the interference pattern may generally reflect only the Doppler shift of the blood cells. However, if there is intervening tissue between the blood vessel and the tissue surface, the interference pattern detected at the sensor may be due to a combination of the change in wavelength reflected from the moving blood cells and the phase shift due to the refractive index of the intervening tissue. A spectrum  2254  derived from such an interference pattern, may result in the calculation of the Doppler shift that is confounded due to the additional phase change in the reflected light. In some aspects, if information regarding the characteristics (thickness and refractive index) of the intervening tissue is known, the resulting spectrum  2256  may be corrected to provide a more accurate calculation of the change in wavelength. 
     It may be recognized that the phase shift in the reflected light from a tissue may provide additional information regarding underlying tissue structures, regardless of Doppler effects. 
       FIG.  167    illustrates that the location and characteristics of non-vascular structures may be determined based on the phase difference between the incident light  2372  and the light reflected from the deep tissue structures ( 2374 ,  2376 ,  2378 ). As noted above, the penetration depth of light impinging on a tissue is dependent on the wavelength of the impinging illumination. Red laser light (having a wavelength in the range of about 635 nm to about 660 nm) may penetrate the tissue to a depth of about 1 mm. Green laser light (having a wavelength in the range of about 520 nm to about 532 nm) may penetrate the tissue to a depth of about 2-3 mm. Blue laser light (having a wavelength in the range of about 405 nm to about 445 nm) may penetrate the tissue to a depth of about 4 mm or greater. In one aspect, an interface  2381   a  between two tissues differing in refractive index that is located less than or about 1 mm below a tissue surface  2380  may reflect  2374  red, green, or blue laser light. The phase of the reflected light  2374  may be compared to the incident light  2372  and thus the difference in the refractive index of the tissues at the interface  2381   a  may be determined. In another aspect, an interface  2381   b  between two tissues differing in refractive index that is located between 2 and 3 mm  2381   b  below a tissue surface  2380  may reflect  2376  green or blue laser light, but not red light. The phase of the reflected light  2376  may be compared to the incident light  2372  and thus the difference in the refractive index of the tissues at the interface  2381   b  may be determined. In yet another aspect, an interface  2381   c  between two tissues differing in refractive index that is located between 3 and 4 mm  2381   c  below a tissue surface  2380  may reflect  2378  only blue laser light, but not red or green light. The phase of the reflected light  2378  may be compared to the incident light  2372  and thus the difference in the refractive index of the tissues at the interface  2381   c  may be determined. 
     A phase interference measure of a tissue illuminated by light having different wavelengths may therefore provide information regarding the relative indices of refraction of the reflecting tissue as well as the depth of the tissue. The indices of refraction of the tissue may be assessed using the multiple laser sources and their intensity, and thereby relative indices of refraction may be calculated for the tissue. It is recognized that different tissues may have different refractive indices. For example, the refractive index may be related to the relative composition of collagen and elastin in a tissue or the amount of hydration of the tissue. Therefore, a technique to measure relative tissue index of refraction may result in the identification of a composition of the tissue. 
     In some aspects, smart surgical instruments include algorithms to determine parameters associated with the function of the instruments. One non-limiting example of such parameters may be the pressure of an anvil against a tissue for a smart stapling device. The amount of pressure of an anvil against a tissue may depend on the type and composition of the tissue. For example, less pressure may be required to staple a highly compressive tissue, while a greater amount of pressure may be required to stable a more non-compressive tissue. Another non-limiting example of a parameter associated with a smart surgical device may include a rate of firing of an i-beam knife to cut the tissue. For example, a stiff tissue may require more force and a slower cutting rate than a less stiff tissue. Another non-limiting example of such parameters may be the amount of current provided to an electrode in a smart cauterizing or RF sealing device. Tissue composition, such as percent tissue hydration, may determine an amount of current necessary to heat seal the tissue. Yet another non-limiting example of such parameters may be the amount of power provided to an ultrasonic transducer of a smart ultrasound cutting device or the driving frequency of the cutting device. A stiff tissue may require more power for cutting, and contact of the ultrasonic cutting tool with a stiff tissue may shift the resonance frequency of the cutter. 
     It may be recognized that a tissue visualization system that can identify tissue type and depth may provide such data to one or more smart surgical devices. The identification and location data may then be used by the smart surgical devices to adjust one or more of their operating parameters thereby allowing them to optimize their manipulation of the tissue. It may be understood that an optical method to characterize a type of tissue may permit automation of the operating parameters of the smart surgical devices. Such automation of the operation of smart surgical instruments may be preferable to relying on human estimation to determine the operational parameters of the instruments. 
     In one aspect, Optical Coherence Tomography (OCT) is a technique that can visual subsurface tissue structures based on the phase difference between an illuminating light source, and light reflected from structures located within the tissue.  FIG.  168    depicts schematically one example of instrumentation  2470  for Optical Coherence Tomography. In  FIG.  168   , a laser source  2472  may emit light  2482  according to any optical wavelength of interest (red, green, blue, infrared, or ultraviolet). The light  2482  may be directed to a beam splitter  2486 . The beam splitter  2486  directs one portion of the light  2488  to a tissue sample  2480 . The beam splitter  2486  may also direct a portion of the light  2492  to a stationary reference mirror  2494 . The light reflected from the tissue sample  2480  and from the stationary mirror  2494  may be recombined  2498  at the beam splitter  2486  and directed to a detector  2496 . The phase difference between the light from the reference mirror  2494  and from the tissue sample  2480  may be detected at the detector  2496  as an interference pattern. Appropriate computing devices may then calculate phase information from the interference pattern. Additional computation may then provide information regarding structures below the surface of the tissue sample. Additional depth information may also be obtained by comparing the interference patterns generated from the sample when illuminated at different wavelengths of laser light. 
     As disclosed above, depth information regarding subsurface tissue structures may be ascertained from a combination of laser light wavelength and the phase of light reflected from a deep tissue structure. Additionally, local tissue surface inhomogeneity may be ascertained by comparing the phase as well as amplitude difference of light reflected from different portions of the same sub-surface tissues. Measurements of a difference in the tissue surface properties at a defined location compared to those at a neighboring location may be indicative of adhesions, disorganization of the tissue layers, infection, or a neoplasm in the tissue being probed. 
       FIG.  169    illustrates this effect. The surface characteristics of a tissue determine the angle of reflection of light impinging on the surface. A smooth surface  2551   a  reflects the light essentially with the same spread  2544  as the light impinging on the surface  2542  (specular reflection). Consequently, the amount of light received by a light detector having a known fixed aperture may effectively receive the entire amount of light reflected  2544  from the smooth surface  2551   a . However, increased surface roughness at a tissue surface may result in an increase spread in the reflected light with respect to the incident light (diffuse reflection). 
     Some amount of the reflected light  2546  from a tissue surface having some amount of surface irregularities  2551   b  will fall outside the fixed aperture of the light detector due to the increased spread of the reflected light  2546 . As a result, the light detector will detect less light (shown in  FIG.  169    as a decrease in the amplitude of the reflected light signal  2546 ). It may be understood that the amount of reflected light spread will increase as the surface roughness of a tissue increases. Thus, as depicted in  FIG.  169   , the amplitude of light reflected  2548  from a surface  2551   c  having significant surface roughness may have a smaller amplitude than the light reflected  2544  from a smooth surface  2551   a , or light reflected  2546  form a surface having only a moderate amount of surface roughness  2551   b . Therefore, in some aspects, a single laser source may be used to investigate the quality of a tissue surface or subsurface by comparing the optical properties of reflected light from the tissue with the optical properties of reflected light from adjacent surfaces. 
     In other aspects, light from multiple laser sources (for example, lasers emitting light having different central wavelengths) may be used sequentially to probe tissue surface characteristics at a variety of depths below the surface  2550 . As disclosed above (with reference to  FIG.  167   ), the absorbance profile of a laser light in a tissue is dependent on the central wavelength of the laser light. Laser light having a shorter (more blue) central wavelength can penetrate tissue deeper than laser light having a longer (more red) central wavelength. Therefore, measurements related to light diffuse reflection made at different light wavelengths can indicate both an amount of surface roughness as well as the depth of the surface being measured. 
       FIG.  170    illustrates one method of displaying image processing data related to a combination of tissue visualization modalities. Data used in the display may be derived from image phase data related to tissue layer composition, image intensity (amplitude) data related to tissue surface features, and image wavelength data related to tissue mobility (such as blood cell transport) as well as tissue depth. As one example, light emitted by a laser in the blue optical region  2562  may impinge on blood flowing at a depth of about 4 mm below the surface of the tissue. The reflected light  2564  may be red shifted due to the Doppler effect of the blood flow. As a result, information may be obtained regarding the existence of a blood vessel and its depth below the surface. 
     In another example, a layer of tissue may lie at a depth of about 2-3 mm below the surface of the surgical site. This tissue may include surface irregularities indicative of scarring or other pathologies. Emitted red light  2572  may not penetrate to the 2-3 mm depth, so consequently, the reflected red light  2580  may have about the same amplitude of the emitted red light  2572  because it is unable to probe structures more than 1 mm below the top surface of the surgical site. However, green light reflected from the tissue  2578  may reveal the existence of the surface irregularities at that depth in that the amplitude of the reflected green light  2578  may be less than the amplitude of the emitted green light  2570 . Similarly, blue light reflected from the tissue  2574  may reveal the existence of the surface irregularities at that depth in that the amplitude of the reflected blue light  2574  may be less than the amplitude of the emitted blue light  2562 .In one example of an image processing step, the image  2582  may be smoothed using a moving window filter  2584  to reduce inter-pixel noise as well as reduce small local tissue anomalies  2586  that may hide more important features  2588 . 
       FIGS.  171 A-C  illustrate several aspects of displays that may be provided to a surgeon for a visual identification of surface and sub-surface structures of a tissue in a surgical site.  FIG.  171 A  may represent a surface map of the surgical site with color coding to indicate structures located at varying depths below the surface of the surgical site.  FIG.  171 B  depicts an example of one of several horizontal slices through the tissue at varying depths, which may be color coded to indicate depth and further include data associated with differences in tissue surface anomalies (for example, as displayed in a 3D bar graph).  FIG.  171 C  depicts yet another visual display in which surface irregularities as well as Doppler shift flowmetry data may indicate sub-surface vascular structures as well as tissue surface characteristics. 
       FIG.  172    is a flow chart  2950  of a method for providing information related to a characteristic of a tissue to a smart surgical instrument. An image acquisition system may illuminate  2960  a tissue with a first light beam having a first central frequency and receive  2962  a first reflected light from the tissue illuminated by the first light beam. The image acquisition system may then calculate  2964  a first tissue surface characteristic at a first depth based on the first emitted light beam and the first reflected light from the tissue. The image acquisition system may then illuminate  2966  the tissue with a second light beam having a second central frequency and receive  2968  a second reflected light from the tissue illuminated by the second light beam. The image acquisition system may then calculate  2970  a second tissue surface characteristic at a second depth based on the second emitted light beam and the second reflected light from the tissue. Tissue features that may include a tissue type, a tissue composition, and a tissue surface roughness metric may be determined from the first central light frequency, the second central light frequency, the first reflected light from the tissue, and the second reflected light from the tissue. The tissue characteristic may be used to calculate  2972  one or more parameters related to the function of a smart surgical instrument such as jaw pressure, power to effect tissue cauterization, or current amplitude and/or frequency to drive a piezoelectric actuator to cut a tissue. In some additional examples, the parameter may be transmitted  2974  either directly or indirectly to the smart surgical instrument which may modify its operating characteristics in response to the tissue being manipulated. 
     Multifocal Minimally Invasive Camera 
     In a minimally invasive procedure, e.g., laparoscopic, a surgeon may visualize the surgical site using imaging instruments including a light source and a camera. The imaging instruments may allow the surgeon to visualize the end effector of a surgical device during the procedure. However, the surgeon may need to visualize tissue away from the end effector to prevent unintended damage during the surgery. Such distant tissue may lie outside the field of view of the camera system when focused on the end effector. The imaging instrument may be moved in order to change the field of view of the camera, but it may be difficult to return the camera system back to its original position after being moved. 
     The surgeon may attempt to move the imaging system within the surgical site to visualize different portions of the site during the procedure. Repositioning of the imaging system is time consuming and the surgeon is not guaranteed to visualize the same field of view of the surgical site when the imaging system is returned to its original location. 
     It is therefore desirable to have a medical imaging visualization system that can provide multiple fields of view of the surgical site without the need to reposition the visualization system. Medical imaging devices include, without limitation, laparoscopes, endoscopes, thoracoscopes, and the like, as described herein. In some aspects, a single display system may display each of the multiple fields of view of the surgical site at about the same time. The display of each of the multiple fields of view may be independently updated depending on a display control system composed of one or more hardware modules, one or more software modules, one or more firmware modules, or any combination or combinations thereof. 
     Some aspects of the present disclosure further provide for a control circuit configured to control the illumination of a surgical site using one or more illumination sources such as laser light sources and to receive imaging data from one or more image sensors. In some aspects, the control circuit may be configured to control the operation of one or more light sensor modules to adjust a field of view. In some aspects, the present disclosure provides for a non-transitory computer readable medium storing computer readable instructions that, when executed, cause a device to adjust one or more components of the one or more light sensor modules and to process an image from each of the one or more light sensor modules. 
     An aspect of a minimally invasive image acquisition system may comprise a plurality of illumination sources wherein each illumination source is configured to emit light having a specified central wavelength, a first light sensing element having a first field of view and configured to receive illumination reflected from a first portion of the surgical site when the first portion of the surgical site is illuminated by at least one of the plurality of illumination sources, a second light sensing element having a second field of view and configured to receive illumination reflected from a second portion of the surgical site when the second portion of the surgical site is illuminated by at least one of the plurality of illumination sources, wherein the second field of view overlaps at least a portion of the first field of view; and a computing system. 
     The computing system may be configured to receive data from the first light sensing element, receive data from the second light sensing element, compute imaging data based on the data received from the first light sensing element and the data received from the second light sensing element, and transmit the imaging data for receipt by a display system. 
     A variety of surgical visualization systems have been disclosed above. Such systems provide for visualizing tissue and sub-tissue structures that may be encountered during one or more surgical procedures. Non-limiting examples of such systems may include: systems to determine the location and depth of subsurface vascular tissue such as veins and arteries; systems to determine an amount of blood flowing through the subsurface vascular tissue; systems to determine the depth of non-vascular tissue structures; systems to characterize the composition of such non-vascular tissue structures; and systems to characterize one or more surface characteristics of such tissue structures. 
     It may be recognized that a single surgical visualization system may incorporate components of any one or more of these visualization modalities.  FIGS.  152 A-D  depict some examples of such a surgical visualization system  2108 . 
     As disclosed above, in one non-limiting aspect, a surgical visualization system  2108  may include an imaging control unit  2002  and a hand unit  2020 . The hand unit  2020  may include a body  2021 , a camera scope cable  2015  attached to the body  2021 , and an elongated camera probe  2024 . The elongated camera probe  2024  may also terminate at its distal end with at least one window. In some non-limiting examples, a light sensor  2030  may be incorporated in the hand unit  2020 , for example either in the body of the hand unit  2032   b , or at a distal end  2032   a  of the elongated camera probe, as depicted in  FIG.  152 C . The light sensor  2030  may be fabricated using a CMOS sensor array or a CCD sensor array. As illustrated in  FIG.  153 C , a typical CMOS or CCD sensor array may generate an RGB (red-green-blue) image from light impinging on a mosaic of sensor elements, each sensor element having one of a red, green, or blue optical filter. 
     Alternatively, the illumination of the surgical site may be cycled among visible illumination sources as depicted in  FIG.  160 D . In some example, the illumination sources may include any one or more of a red laser  2360   a , a green laser  2360   b , or a blue laser  2360   c . In some non-limiting examples, a red laser  2360   a  light source may source illumination having a peak wavelength that may range between 635 nm and 660 nm, inclusive. Non-limiting examples of a red laser peak wavelength may include about 635 nm, about 640 nm, about 645 nm, about 650 nm, about 655 nm, about 660 nm, or any value or range of values therebetween. In some non-limiting examples, a green laser  2360   b  light source may source illumination having a peak wavelength that may range between 520 nm and 532 nm, inclusive. Non-limiting examples of a red laser peak wavelength may include about 520 nm, about 522 nm, about 524 nm, about 526 nm, about 528 nm, about 530 nm, about 532 nm, or any value or range of values therebetween. In some non-limiting examples, the blue laser  2360   c  light source may source illumination having a peak wavelength that may range between 405 nm and 445 nm, inclusive. Non-limiting examples of a blue laser peak wavelength may include about 405 nm, about 410 nm, about 415 nm, about 420 nm, about 425 nm, about 430 nm, about 435 nm, about 440 nm, about 445 nm, or any value or range of values therebetween. 
     Additionally, illumination of the surgical site may be cycled to include non-visible illumination sources that may supply infrared or ultraviolet illumination. In some non-limiting examples, an infrared laser light source may source illumination having a peak wavelength that may range between 750 nm and 3000 nm, inclusive. Non-limiting examples of an infrared laser peak wavelength may include about 750 nm, about 1000 nm, about 1250 nm, about 1500 nm, about 1750 nm, about 2000 nm, about 2250 nm, about 2500 nm, about 2750 nm, 3000 nm, or any value or range of values therebetween. In some non-limiting examples, an ultraviolet laser light source may source illumination having a peak wavelength that may range between 200 nm and 360 nm, inclusive. Non-limiting examples of an ultraviolet laser peak wavelength may include about 200 nm, about 220 nm, about 240 nm, about 260 nm, about 280 nm, about 300 nm, about 320 nm, about 340 nm, about 360 nm, or any value or range of values therebetween. 
     The outputs of the sensor array under the different illumination wavelengths may be combined to form the RGB image, for example, if the illumination cycle time is sufficiently fast and the laser light is in the visible range.  FIGS.  173 A and  173 B  illustrate a multi-pixel light sensor receiving by light reflected by a tissue illuminated, for example, by sequential exposure to red, green, blue, infrared, ( FIG.  173 A ) or red, green, blue, and ultraviolet laser light sources ( FIG.  173 B ). 
       FIG.  174 A  depicts the distal end of a flexible elongated camera probe  2120  having a flexible camera probe shaft  2122  and a single light sensor module  2124  disposed at the distal end  2123  of the flexible camera probe shaft  2122 . In some non-limiting examples, the flexible camera probe shaft  2122  may have an outer diameter of about 5 mm. The outer diameter of the flexible camera probe shaft  2122  may depend on geometric factors that may include, without limitation, the amount of allowable bend in the shaft at the distal end  2123 . As depicted in  FIG.  174 A , the distal end  2123  of the flexible camera probe shaft  2122  may bend about 90° with respect to a longitudinal axis of an un-bent portion of the flexible camera probe shaft  2122  located at a proximal end of the elongated camera probe  2120 . It may be recognized that the distal end  2123  of the flexible camera probe shaft  2122  may bend any appropriate amount as may be required for its function. Thus, as non-limiting examples, the distal end  2123  of the flexible camera probe shaft  2122  may bend any amount between about 0° and about 90°. Non-limiting examples of the bend angle of the distal end  2123  of the flexible camera probe shaft  2122  may include about 0°, about 10°, about 20°, about 30°, about 40°, about 50°, about 60°, about 70°, about 80°, about 90°, or any value or range of values therebetween. In some examples, the bend angle of the distal end  2123  of the flexible camera probe shaft  2122  may be set by a surgeon or other health care professional prior to or during a surgical procedure. In some other example, the bend angle of the distal end  2123  of the flexible camera probe shaft  2122  may be a fixed angle set at a manufacturing site. 
     The single light sensor module  2124  may receive light reflected from the tissue when illuminated by light emitted by one or more illumination sources  2126  disposed at the distal end of the elongated camera probe. In some examples, the light sensor module  2124  may be a 4 mm sensor module such as 4 mm mount  2136   b , as depicted in  FIG.  152 D . It may be recognized that the light sensor module  2124  may have any appropriate size for its intended function. Thus, the light sensor module  2124  may include a 5.5 mm mount  2136   a , a 2.7 mm mount  2136   c , or a 2 mm mount  2136   d  as depicted in  FIG.  152 D . 
     It may be recognized that the one or more illumination sources  2126  may include any number of illumination sources  2126  including, without limitation, one illumination source, two illumination sources, three illumination sources, four illumination sources, or more than four illumination sources. It may be further understood that each illumination source may source illumination having any central wavelength including a central red illumination wavelength, a central green illumination wavelength, a central blue illumination wavelength, a central infrared illumination wavelength, a central ultraviolet illumination wavelength, or any other wavelength. In some examples, the one or more illumination sources  2126  may include a white light source, which may illuminate tissue with light having wavelengths that may span the range of optical white light from about 390 nm to about 700 nm. 
       FIG.  174 B  depicts the distal end  2133  of an alternative elongated camera probe  2130  having multiple light sensor modules, for example the two light sensor modules  2134   a , b , each disposed at the distal end  2133  of the elongated camera probe  2130 . In some non-limiting examples, the alternative elongated camera probe  2130  may have an outer diameter of about 7 mm. In some examples, the light sensor modules  2134   a , b  may each comprise a 4 mm sensor module, similar to light sensor module  2124  in  FIG.  174 A . Alternatively, each of the light sensor modules  2134   a , b  may comprise a 5.5 mm light sensor module, a 2.7 mm light sensor module, or a 2 mm light sensor module as depicted in  FIG.  152 D . In some examples, both light sensor modules  2134   a , b  may have the same size. In some examples, the light sensor modules  2134   a , b  may have different sizes. As one non-limiting example, an alternative elongated camera probe  2130  may have a first 4 mm light sensor and two additional 2 mm light sensors. In some aspects, a visualization system may combine the optical outputs from the multiple light sensor modules  2134   a , b  to form a 3D or quasi-3D image of the surgical site. In some other aspects, the outputs of the multiple light sensor modules  2134   a , b  may be combined in such a manner as to enhance the optical resolution of the surgical site, which may not be otherwise practical with only a single light sensor module. 
     Each of the multiple light sensor modules  2134   a , b  may receive light reflected from the tissue when illuminated by light emitted by one or more illumination sources  2136   a , b  disposed at the distal end  2133  of the alternative elongated camera probe  2130 . In some non-limiting examples, the light emitted by all of the illumination sources  2136   a , b  may be derived from the same light source (such as a laser). In other non-limiting examples, the illumination sources  2136   a  surrounding a first light sensor module  2134   a  may emit light at a first wavelength and the illumination sources  2136   b  surrounding a second light sensor module  2134   b  may emit light at a second wavelength. It may be further understood that each illumination source  2136   a , b  may source illumination having any central wavelength including a central red illumination wavelength, a central green illumination wavelength, a central blue illumination wavelength, a central infrared illumination wavelength, a central ultraviolet illumination wavelength, or any other wavelength. In some examples, the one or more illumination sources  2136   a , b  may include a white light source, which may illuminate tissue with light having wavelengths that may span the range of optical white light from about 390 nm to about 700 nm. 
     In some additional aspects, the distal end  2133  of the alternative elongated camera probe  2130  may include one or more working channels  2138 . Such working channels  2138  may be in fluid communication with an aspiration port of a device to aspirate material from the surgical site, thereby permitting the removal of material that may potentially obscure the field of view of the light sensor modules  2134   a , b . Alternatively, such working channels  2138  may be in fluid communication with an fluid source port of a device to provide a fluid to the surgical site, to flush debris or material away from the surgical site. Such fluids may be used to clear material from the field of view of the light sensor modules  2134   a , b . 
       FIG.  174 C  depicts a perspective view of an aspect of a monolithic sensor  2160  having a plurality of pixel arrays for producing a three dimensional image in accordance with the teachings and principles of the disclosure. Such an implementation may be desirable for three dimensional image capture, wherein the two pixel arrays  2162  and  2164  may be offset during use. In another implementation, a first pixel array  2162  and a second pixel array  2164  may be dedicated to receiving a predetermined range of wave lengths of electromagnetic radiation, wherein the first pixel array  2162  is dedicated to a different range of wave length electromagnetic radiation than the second pixel array  2164 . 
     Additional disclosures regarding a dual sensor array may be found in U.S. Pat. Application Publication No. 2014/0267655, titled SUPER RESOLUTION AND COLOR MOTION ARTIFACT CORRECTION IN A PULSED COLOR IMAGING SYSTEM, filed on Mar. 14, 2014, which issued on May 2, 2017 as U.S. Pat. No. 9,641,815, the contents thereof being incorporated by reference herein in its entirety and for all purposes. 
     In some aspects, a light sensor module may comprise a multi-pixel light sensor such as a CMOS array in addition to one or more additional optical elements such as a lens, a reticle, and a filter. 
     In some alternative aspects, the one or more light sensors may be located within the body  2021  of the hand unit  2020 . Light reflected from the tissue may be acquired at a light receiving surface of one or more optical fibers at the distal end of the elongated camera probe  2024 . The one or more optical fibers may conduct the light from the distal end of the elongated camera probe  2024  to the one or more light sensors, or to additional optical elements housed in the body of the hand unit  2020  or in the imaging control unit  2002 . The additional optical elements may include, without limitation, one or more dichroic mirrors, one or more reference mirrors, one or more moving mirrors, and one or more beam splitters and/or combiners, and one or more optical shutters. In such alternative aspects, the light sensor module may include any one or more of a lens, a reticle and a filter, disposed at the distal end of the elongated camera probe  2024 . 
     Images obtained from each of the multiple light sensors for example  2134   a , b  may be combined or processed in several different manners, either in combination or separately, and then displayed in a manner to allow a surgeon to visualize different aspects of the surgical site. 
     In one non-limiting example, each light sensor may have an independent field of view. In some additional examples, the field of view of a first light sensor may partially or completely overlap the field of view of a second light sensor. 
     As disclosed above, an imaging system may include a hand unit  2020  having an elongated camera probe  2024  with one or more light sensor modules  2124 ,  2134   a , b  disposed at its distal end  2123 ,  2133 . As an example, the elongated camera probe  2024  may have two light sensor modules  2134   a , b , although it may be recognized that there may be three, four, five, or more light sensor modules at the distal end of the elongated camera probe  2024 . Although  FIGS.  175  and  176 A-D  depict examples of the distal end of an elongated camera probe having two light sensor modules, it may be recognized that the description of the operation of the light sensor modules is not limited to solely two light sensor modules. As depicted in  FIGS.  175 , and  46 A-D , the light sensor modules may include an image sensor, such as a CCD or CMOS sensor that may be composed of an array of light sensing elements (pixels). The light sensor modules may also include additional optical elements, such as lenses. Each lens may be adapted to provide a field of view for the light sensor of the respective light sensor module. 
       FIG.  175    depicts a generalized view of a distal end  2143  of an elongated camera probe having multiple light sensor modules  2144   a , b . Each light sensor module  2144   a , b  may be composed of a CCD or CMOS sensor and one or more optical elements such as filters, lenses, shutters, and similar. In some aspects, the components of the light sensor modules  2144   a , b  may be fixed within the elongated camera probe. In some other aspects, one or more of the components of the light sensor modules  2144   a , b  may be adjustable. For example, the CCD or CMOS sensor of a light sensor module  2144   a , b  may be mounted on a movable mount to permit automated adjustment of the center  2145   a , b  of a field of view  2147   a , b  of the CCD or CMOS sensor. In some other aspects, the CCD or CMOS sensor may be fixed, but a lens in each light sensor modules  2144   a , b  may be adjustable to change the focus. In some aspects, the light sensor modules  2144   a , b  may include adjustable irises to permit changes in the visual aperture of the sensor modules  2144   a , b . 
     As depicted in  FIG.  175   , each of the sensor modules  2144   a , b  may have a field of view  2147   a , b  having an acceptance angle. As depicted in  FIG.  175   , the acceptance angle for each sensor modules  2144   a , b  may have an acceptance angle of greater than 90°. In some examples, the acceptance angle may be about 100°. In some examples, the acceptance angle may be about 120°. In some examples, if the sensor modules  2144   a , b  have an acceptance angle of greater than 90° (for example, 100°), the fields of view  2147   a  and  2147   b  may form an overlap region  2150   a , b . In some aspects, an optical field of view having an acceptance angle of 100° or greater may be called a “fish-eyed” field of view. A visualization system control system associated with such an elongated camera probe may include computer readable instructions that may permit the display of the overlap region  2150   a , b  in such a manner so that the extreme curvature of the overlapping fish-eyed fields of view is corrected, and a sharpened and flattened image may be displayed. In  FIG.  175   , the overlap region  2150   a  may represent a region wherein the overlapping fields of view  2147   a , b  of the sensor modules  2144   a , b  have their respective centers  2145   a , b  directed in a forward direction. However, if any one or more components of the sensor modules  2144   a , b  is adjustable, it may be recognized that the overlap region  2150   b  may be directed to any attainable angle within the fields of view  2147   a , b  of the sensor modules  2144   a , b . 
       FIGS.  176 A-D  depict a variety of examples of an elongated light probe having two light sensor modules  2144   a , b  with a variety of fields of view. The elongated light probe may be directed to visualize a surface  2152  of a surgical site. 
     In  FIG.  176 A , the first light sensor module  2144   a  has a first sensor field of view  2147   a  of a tissue surface  2154   a , and the second light sensor module  2144   b  has a second sensor field of view  2147   b  of a tissue surface  2154   b . As depicted in  FIG.  176 A , the first field of view  2147   a  and the second field of view  2147   b  have approximately the same angle of view. Additionally, the first sensor field of view  2147   a  is adjacent to but does not overlap the second sensor field of view  2147   b . The image received by the first light sensor module  2144   a  may be displayed separately from the image received by the second light sensor module  2144   b , or the images may be combined to form a single image. In some non-limiting examples, the angle of view of a lens associated with the first light sensor module  2144   a  and the angle of view of a lens associated with the second light sensor module  2144   b  may be somewhat narrow, and image distortion may not be great at the periphery of their respective images. Therefore, the images may be easily combined edge to edge. 
     As depicted in  FIG.  176 B , the first field of view  2147   a  and the second field of view  2147   b  have approximately the same angular field of view, and the first sensor field of view  2147   a  overlaps completely the second sensor field of view  2147   b . This may result in a first sensor field of view  2147   a  of a tissue surface  2154   a  being identical to the view of a tissue surface  2154   b  as obtained by the second light sensor module  2144   b  from the second sensor field  2147   b  of view. This configuration may be useful for applications in which the image from the first light sensor module  2144   a  may be processed differently than the image from the second light sensor module  2144   b . The information in the first image may complement the information in the second image and refer to the same portion of tissue. 
     As depicted in  FIG.  176 C , the first field of view  2147   a  and the second field of view  2147   b  have approximately the same angular field of view, and the first sensor field of view  2147   a  partially overlaps the second sensor field of view  2147   b . In some non-limiting examples, a lens associated with the first light sensor module  2144   a  and a lens associated with the second light sensor module  2144   b  may be wide angle lenses. These lenses may permit the visualization of a wider field of view than that depicted in  FIG.  176 A . Wide angle lenses are known to have significant optical distortion at their periphery. Appropriate image processing of the images obtained by the first light sensor module  2144   a  and the second light sensor module  2144   b  may permit the formation of a combined image in which the central portion of the combined image is corrected for any distortion induced by either the first lens or the second lens. It may be understood that a portion of the first sensor field of view  2147   a  of a tissue surface  2154   a  may thus have some distortion due to the wide angle nature of a lens associated with the first light sensor module  2144   a  and a portion of the second sensor field of view  2147   b  of a tissue surface  2154   b  may thus have some distortion due to the wide angle nature of a lens associated with the second light sensor module  2144   b . However, a portion of the tissue viewed in the overlap region  2150 ′ of the two light sensor modules  2144   a , b  may be corrected for any distortion induced by either of the light sensor modules  2144   a , b . The configuration depicted in  FIG.  176 C  may be useful for applications in which it is desired to have a wide field of view of the tissue around a portion of a surgical instrument during a surgical procedure. In some examples, lenses associated with each light sensor module  2144   a , b  may be independently controllable, thereby controlling the location of the overlap region  2150 ′ of view within the combined image. 
     As depicted in  FIG.  176 D , the first light sensor module  2144   a  may have a first angular field of view  2147   a  that is wider than the second angular field of view  2147   b  of the second light sensor module  2144   b . In some non-limiting examples, the second sensor field of view  2147   b  may be totally disposed within the first sensor field of view  2147   a . In alternative examples, the second sensor field of view may lie outside of or tangent to the wide angle field of view  2147   a  of the first sensor  2144   a . A display system that may use the configuration depicted in  FIG.  176 D  may display a wide angle portion of tissue  2154   a  imaged by the first sensor module  2144   a  along with a magnified second portion of tissue  2154   b  imaged by the second sensor module  2144   b  and located in an overlap region  2150 ″ of the first field of view  2147   a  and the second field of view  2147   b . This configuration may be useful to present a surgeon with a close-up image of tissue proximate to a surgical instrument (for example, imbedded in the second portion of tissue  2154   b ) and a wide-field image of the tissue surrounding the immediate vicinity of the medical instrument (for example, the proximal first portion of tissue  2154   a ). In some non-limiting examples, the image presented by the narrower second field of view  2147   b  of the second light sensor module  2144   b  may be a surface image of the surgical site. In some additional examples, the image presented in the first wide field view  2147   a  of the first light sensor module  2144   a  may include a display based on a hyperspectral analysis of the tissue visualized in the wide field view. 
       FIGS.  177 A-C  illustrate an example of the use of an imaging system incorporating the features disclosed in  FIG.  176 D .  FIG.  177 A  illustrates schematically a proximal view  2170  at the distal end of the elongated camera probe depicting the light sensor arrays  2172   a , b  of the two light sensor modules  2174   a , b . A first light sensor module  2174   a  may include a wide angle lens, and the second light sensor module  2174   b  may include a narrow angle lens. In some aspects, the second light sensor module  2174   b  may have a narrow aperture lens. In other aspects, the second light sensor module  2174   b  may have a magnifying lens. The tissue may be illuminated by the illumination sources disposed at the distal end of the elongated camera probe. The light sensor arrays  2172 ′ (either light sensor array  2172   a  or  2172   b , or both  2172   a  and  2172   b ) may receive the light reflected from the tissue upon illumination. The tissue may be illuminated by light from a red laser source, a green laser source, a blue laser source, an infrared laser source, and/or an ultraviolet laser source. In some aspects, the light sensor arrays  2172 ′ may sequentially receive the red laser light  2175   a , green laser light  2175   b , blue laser light  2175   c , infrared laser light  2175   d , and the ultra-violet laser light  2175   e . The tissue may be illuminated by any combination of such laser sources simultaneously, as depicted in  FIGS.  153 E and  153 F . Alternatively, the illuminating light may be cycled among any combination of such laser sources, as depicted for example in  FIG.  153 D , and  FIGS.  173 A and  173 B . 
       FIG.  177 B  schematically depicts a portion of lung tissue  2180  which may contain a tumor  2182 . The tumor  2182  may be in communication with blood vessels including one or more veins  2184  and/or arteries  2186 . In some surgical procedures, the blood vessels (veins  2184  and arteries  2186 ) associated with the tumor  2182  may require resection and/or cauterization prior to the removal of the tumor. 
       FIG.  177 C  illustrates the use of a dual imaging system as disclosed above with respect to  FIG.  177 A . The first light sensor module  2174   a  may acquire a wide angle image of the tissue surrounding a blood vessel  2187  to be severed with a surgical knife  2190 . The wide angle image may permit the surgeon to verify the blood vessel to be severed  2187 . In addition, the second light sensor module  2174   b  may acquire a narrow angle image of the specific blood vessel  2187  to be manipulated. The narrow angle image may show the surgeon the progress of the manipulation of the blood vessel  2187 . In this manner, the surgeon is presented with the image of the vascular tissue to be manipulated as well as its environs to assure that the correct blood vessel is being manipulated. 
       FIGS.  178 A and  178 B  depict another example of the use of a dual imaging system.  FIG.  178 A  depicts a primary surgical display providing an image of a section of a surgical site. The primary surgical display may depict a wide view image  2800  of a section of intestine  2802  along with its vasculature  2804 . The wide view image  2800  may include a portion of the surgical field  2809  that may be separately displayed as a magnified view  2810  in a secondary surgical display ( FIG.  178 B ). As disclosed above with respect to surgery to remove a tumor from a lung ( FIGS.  177 A-C ), it may be necessary to dissect blood vessels supplying a tumor  2806  before removing the cancerous tissue. The vasculature  2804  supplying the intestines  2802  is complex and highly ramified. It may necessary to determine which blood vessels supply the tumor  2806  and to identify blood vessels supplying blood to healthy intestinal tissue. The wide view image  2800  permits a surgeon to determine which blood vessel may supply the tumor  2806 . The surgeon may then test a blood vessel using a clamping device  2812  to determine if the blood vessel supplies the tumor  2806  or not. 
       FIG.  178 B  depicts a secondary surgical display that may only display a narrow magnified view image  2810  of one portion of the surgical field  2809 . The narrow magnified view image  2810  may present a close-up view of the vascular tree  2814  so that the surgeon can focus on dissecting only the blood vessel of interest  2815 . For resecting the blood vessel of interest  2815 , a surgeon may use a smart RF cautery device  2816 . It may be understood that any image obtained by the visualization system may include not only images of the tissue in the surgical site but also images of the surgical instruments inserted therein. In some aspects, such a surgical display (either the primary display in  FIG.  178 A  or the secondary display in  FIG.  178 B ) may also include indicia  2817  related to functions or settings of any surgical device used during the surgical procedure. For example, the indicia  2817  may include a power setting of the smart RF cautery device  2816 . In some aspects, such smart medical devices may transmit data related to their operating parameters to the visualization system to incorporate in display data to be transmitted to one or more display devices. 
       FIGS.  179 A-C  illustrate examples of a sequence of surgical steps for the removal of an intestinal/colon tumor and which may benefit from the use of multi-image analysis at the surgical site.  FIG.  179 A  depicts a portion of the surgical site, including the intestines  2932  and the ramified vasculature  2934  supplying blood and nutrients to the intestines  2932 . The intestines  2932  may have a tumor  2936  surrounded by a tumor margin  2937 . A first light sensor module of a visualization system may have a wide field of view  2930 , and it may provide imaging data of the wide field of view  2930  to a display system. A second light sensor module of the visualization system may have a narrow or standard field of view  2940 , and it may provide imaging data of the narrow field of view  2940  to the display system. In some aspects, the wide field image and the narrow field image may be displayed by the same display device. In another aspect, the wide field image and the narrow field image may be displayed by separate display devices. 
     During the surgical procedure, it my be important to remove not just the tumor  2936  but the margin  2937  surrounding it to assure complete removal of the tumor. A wide angle field of view  2930  may be used to image both the vasculature  2934  as well as the section of the intestines  2932  surrounding the tumor  2936  and the margin  2637 . As noted above, the vasculature feeding the tumor  2936  and the margin  2637  should be removed, but the vasculature feeding the surrounding intestinal tissue must be preserved to provide oxygen and nutrients to the surrounding tissue. Transection of the vasculature feeding the surrounding colon tissue will remove oxygen and nutrients from the tissue, leading to necrosis. In some examples, laser Doppler imaging of the tissue visualized in the wide angle field  2630  may be analyzed to provide a speckle contrast analysis  2933 , indicating the blood flow within the intestinal tissue. 
       FIG.  179 B  illustrates a step during the surgical procedure. The surgeon may be uncertain which part of the vascular tree supplies blood to the tumor  2936 . The surgeon may test a blood vessel  2944  to determine if it feeds the tumor  2936  or the healthy tissue. The surgeon may clamp a blood vessel  2944  with a clamping device  2812  and determine the section of the intestinal tissue  2943  that is no longer perfused by means of the speckle contrast analysis. The narrow field of view  2940  displayed on an imaging device may assist the surgeon in the close-up and detailed work required to visualize the single blood vessel  2944  to be tested. When the suspected blood vessel  2944  is clamped, a portion of the intestinal tissue  2943  is determined to lack perfusion based on the Doppler imaging speckle contras analysis. As depicted in  FIG.  159 B , the suspected blood vessel  2944  does not supply blood to the tumor  2935  or the tumor margin  2937 , and therefore is recognized as a blood vessel to be spared during the surgical procedure. 
       FIG.  179 C  depicts a following stage of the surgical procedure. In stage, a supply blood vessel  2984  has been identified to supply blood to the margin  2937  of the tumor. When this supply blood vessel  2984  has been severed, blood is no longer supplied to a section of the intestine  2987  that may include at least a portion of the margin  2937  of the tumor  2936 . In some aspects, the lack of perfusion to the section  2987  of the intestines may be determined by means of a speckle contrast analysis based on a Doppler analysis of blood flow into the intestines. The non-perfused section  2987  of the intestines may then be isolated by a seal  2985  applied to the intestine. In this manner, only those blood vessels perfusing the tissue indicated for surgical removal may be identified and sealed, thereby sparing healthy tissue from unintended surgical consequences. 
     In some additional aspects, a surgical visualization system may permit imaging analysis of the surgical site. 
     In some aspects, the surgical site may be inspected for the effectiveness of surgical manipulation of a tissue. Non-limiting examples of such inspection may include the inspection of surgical staples or welds used to seal tissue at a surgical site. Cone beam coherent tomography using one or more illumination sources may be used for such methods. 
     In some additional aspects, an image of a surgical site may have landmarks denoted in the image. In some examples, the landmarks may be determined through image analysis techniques. In some alternative examples, the landmarks may be denoted through a manual intervention of the image by the surgeon. 
     In some additional aspects, non-smart ready visualizations methods may be imported for used in Hub image fusion techniques. 
     In additional aspects, instruments that are not integrated in the Hub system may be identified and tracked during their use within the surgical site. In this aspect, computational and/or storage components of the Hub or in any of its components (including, for example, in the cloud system) may include a database of images related to EES and competitive surgical instruments that are identifiable from one or more images acquired through any image acquisition system or through visual analytics of such alternative instruments. The imaging analysis of such devices may further permit identification of when an instrument is replaced with a different instrument to do the same or a similar job. The identification of the replacement of an instrument during a surgical procedure may provide information related to when an instrument is not doing the job or a failure of the device. 
     Cloud System Hardware and Functional Modules 
     Aspects of the present disclosure include a cloud-based medical analytics system that communicatively couples to multiple Hub systems, as described above, and multiple robotic surgical devices, described more below. The cloud-based medical analytics system is configured to receive data pertaining to a patient and/or medical procedure and provide various integrated processes that span multiple Hub systems and multiple robotic surgical devices. The cloud-based medical analytics system generally aggregates data and forms insights based on the aggregated data that may not otherwise be concluded without gathering the various disparate data sources that span the multiple Hub systems and robotic devices. Described below are various examples of different types of functions and structures present in the cloud-based medical analytics system that provide more detail toward these ends. 
       FIG.  180    is a block diagram of the computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure. In one aspect, the computer-implemented interactive surgical system is configured to monitor and analyze data related to the operation of various surgical systems that include surgical hubs, surgical instruments, robotic devices and operating theaters or healthcare facilities. The computer-implemented interactive surgical system comprises a cloud-based analytics system. Although the cloud-based analytics system is described as a surgical system, it is not necessarily limited as such and could be a cloud-based medical system generally. As illustrated in  FIG.  180   , the cloud-based analytics system comprises a plurality of surgical instruments  7012  (may be the same or similar to instruments  112 ), a plurality of surgical hubs  7006  (may be the same or similar to hubs  106 ), and a surgical data network  7001  (may be the same or similar to network  201 ) to couple the surgical hubs  7006  to the cloud  7004  (may be the same or similar to cloud  204 ). Each of the plurality of surgical hubs  7006  is communicatively coupled to one or more surgical instruments  7012 . The hubs  7006  are also communicatively coupled to the cloud  7004  of the computer-implemented interactive surgical system via the network  7001 . The cloud  7004  is a remote centralized source of hardware and software for storing, manipulating, and communicating data generated based on the operation of various surgical systems. As shown in  FIG.  180   , access to the cloud  7004  is achieved via the network  7001 , which may be the Internet or some other suitable computer network. Surgical hubs  7006  that are coupled to the cloud  7004  can be considered the client side of the cloud computing system (i.e., cloud-based analytics system). Surgical instruments  7012  are paired with the surgical hubs  7006  for control and implementation of various surgical procedures or operations as described herein. 
     In addition, surgical instruments  7012  may comprise transceivers for data transmission to and from their corresponding surgical hubs  7006  (which may also comprise transceivers). Combinations of surgical instruments  7012  and corresponding hubs  7006  may indicate particular locations, such as operating theaters in healthcare facilities (e.g., hospitals), for providing medical operations. For example, the memory of a surgical hub  7006  may store location data. As shown in  FIG.  180   , the cloud  7004  comprises central servers  7013  (may be same or similar to remote server  7013 ), hub application servers  7002 , data analytics modules  7034 , and an input/output (“I/O”) interface  7006 . The central servers  7013  of the cloud  7004  collectively administer the cloud computing system, which includes monitoring requests by client surgical hubs  7006  and managing the processing capacity of the cloud  7004  for executing the requests. Each of the central servers  7013  comprises one or more processors  7008  coupled to suitable memory devices  7010  which can include volatile memory such as random-access memory (RAM) and non-volatile memory such as magnetic storage devices. The memory devices  7010  may comprise machine executable instructions that when executed cause the processors  7008  to execute the data analytics modules  7034  for the cloud-based data analysis, operations, recommendations and other operations described below. Moreover, the processors  7008  can execute the data analytics modules  7034  independently or in conjunction with hub applications independently executed by the hubs  7006 . The central servers  7013  also comprise aggregated medical data databases  2212 , which can reside in the memory  2210 . 
     Based on connections to various surgical hubs  7006  via the network  7001 , the cloud  7004  can aggregate data from specific data generated by various surgical instruments  7012  and their corresponding hubs  7006 . Such aggregated data may be stored within the aggregated medical databases  7012  of the cloud  7004 . In particular, the cloud  7004  may advantageously perform data analysis and operations on the aggregated data to yield insights and/or perform functions that individual hubs  7006  could not achieve on their own. To this end, as shown in  FIG.  180   , the cloud  7004  and the surgical hubs  7006  are communicatively coupled to transmit and receive information. The I/O interface  7006  is connected to the plurality of surgical hubs  7006  via the network  7001 . In this way, the I/O interface  7006  can be configured to transfer information between the surgical hubs  7006  and the aggregated medical data databases  7011 . Accordingly, the I/O interface  7006  may facilitate read/write operations of the cloud-based analytics system. Such read/write operations may be executed in response to requests from hubs  7006 . These requests could be transmitted to the hubs  7006  through the hub applications. The I/O interface  7006  may include one or more high speed data ports, which may include universal serial bus (USB) ports, IEEE 1394 ports, as well as Wi-Fi and Bluetooth I/O interfaces for connecting the cloud  7004  to hubs  7006 . The hub application servers  7002  of the cloud  7004  are configured to host and supply shared capabilities to software applications (e.g., hub applications) executed by surgical hubs  7006 . For example, the hub application servers  7002  may manage requests made by the hub applications through the hubs  7006 , control access to the aggregated medical data databases  7011 , and perform load balancing. The data analytics modules  7034  are described in further detail with reference to  FIG.  181   . 
     The particular cloud computing system configuration described in the present disclosure is specifically designed to address various issues arising in the context of medical operations and procedures performed using medical devices, such as the surgical instruments  7012 ,  112 . In particular, the surgical instruments  7012  may be digital surgical devices configured to interact with the cloud  7004  for implementing techniques to improve the performance of surgical operations. Various surgical instruments  7012  and/or surgical hubs  7006  may comprise touch controlled user interfaces such that clinicians may control aspects of interaction between the surgical instruments  7012  and the cloud  7004 . Other suitable user interfaces for control such as auditory controlled user interfaces can also be used. 
       FIG.  181    is a block diagram which illustrates the functional architecture of the computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure. The cloud-based analytics system includes a plurality of data analytics modules  7034  that may be executed by the processors  7008  of the cloud  7004  for providing data analytic solutions to problems specifically arising in the medical field. As shown in  FIG.  181   , the functions of the cloud-based data analytics modules  7034  may be assisted via hub applications  7014  hosted by the hub application servers  7002  that may be accessed on surgical hubs  7006 . The cloud processors  7008  and hub applications  7014  may operate in conjunction to execute the data analytics modules  7034 . Application program interfaces (APIs)  7016  define the set of protocols and routines corresponding to the hub applications  7014 . Additionally, the APIs  7016  manage the storing and retrieval of data into and from the aggregated medical databases  7012  for the operations of the applications  7014 . The caches  7018  also store data (e.g., temporarily) and are coupled to the APIs  7016  for more efficient retrieval of data used by the applications  7014 . The data analytics modules  7034  in  FIG.  181    include modules for resource optimization  7020 , data collection and aggregation  7022 , authorization and security  7024 , control program updating  7026 , patient outcome analysis  7028 , recommendations  7030 , and data sorting and prioritization  7032 . Other suitable data analytics modules could also be implemented by the cloud  7004 , according to some aspects. In one aspect, the data analytics modules are used for specific recommendations based on analyzing trends, outcomes, and other data. 
     For example, the data collection and aggregation module  7022  could be used to generate self-describing data (e.g., metadata) including identification of notable features or configuration (e.g., trends), management of redundant data sets, and storage of the data in paired data sets which can be grouped by surgery but not necessarily keyed to actual surgical dates and surgeons. In particular, pair data sets generated from operations of surgical instruments  7012  can comprise applying a binary classification, e.g., a bleeding or a non-bleeding event. More generally, the binary classification may be characterized as either a desirable event (e.g., a successful surgical procedure) or an undesirable event (e.g., a misfired or misused surgical instrument  7012 ). The aggregated self-describing data may correspond to individual data received from various groups or subgroups of surgical hubs  7006 . Accordingly, the data collection and aggregation module  7022  can generate aggregated metadata or other organized data based on raw data received from the surgical hubs  7006 . To this end, the processors  7008  can be operationally coupled to the hub applications  7014  and aggregated medical data databases  7011  for executing the data analytics modules  7034 . The data collection and aggregation module  7022  may store the aggregated organized data into the aggregated medical data databases  2212 . 
     The resource optimization module  7020  can be configured to analyze this aggregated data to determine an optimal usage of resources for a particular or group of healthcare facilities. For example, the resource optimization module  7020  may determine an optimal order point of surgical stapling instruments  7012  for a group of healthcare facilities based on corresponding predicted demand of such instruments  7012 . The resource optimization module  7020  might also assess the resource usage or other operational configurations of various healthcare facilities to determine whether resource usage could be improved. Similarly, the recommendations module  7030  can be configured to analyze aggregated organized data from the data collection and aggregation module  7022  to provide recommendations. For example, the recommendations module  7030  could recommend to healthcare facilities (e.g., medical service providers such as hospitals) that a particular surgical instrument  7012  should be upgraded to an improved version based on a higher than expected error rate, for example. Additionally, the recommendations module  7030  and/or resource optimization module  7020  could recommend better supply chain parameters such as product reorder points and provide suggestions of different surgical instrument  7012 , uses thereof, or procedure steps to improve surgical outcomes. The healthcare facilities can receive such recommendations via corresponding surgical hubs  7006 . More specific recommendations regarding parameters or configurations of various surgical instruments  7012  can also be provided. Hubs  7006  and/or surgical instruments  7012  each could also have display screens that display data or recommendations provided by the cloud  7004 . 
     The patient outcome analysis module  7028  can analyze surgical outcomes associated with currently used operational parameters of surgical instruments  7012 . The patient outcome analysis module  7028  may also analyze and assess other potential operational parameters. In this connection, the recommendations module  7030  could recommend using these other potential operational parameters based on yielding better surgical outcomes, such as better sealing or less bleeding. For example, the recommendations module  7030  could transmit recommendations to a surgical  7006  regarding when to use a particular cartridge for a corresponding stapling surgical instrument  7012 . Thus, the cloud-based analytics system, while controlling for common variables, may be configured to analyze the large collection of raw data and to provide centralized recommendations over multiple healthcare facilities (advantageously determined based on aggregated data). For example, the cloud-based analytics system could analyze, evaluate, and/or aggregate data based on type of medical practice, type of patient, number of patients, geographic similarity between medical providers, which medical providers/facilities use similar types of instruments, etc., in a way that no single healthcare facility alone would be able to analyze independently. The control program updating module  7026  could be configured to implement various surgical instrument  7012  recommendations when corresponding control programs are updated. For example, the patient outcome analysis module  7028  could identify correlations linking specific control parameters with successful (or unsuccessful) results. Such correlations may be addressed when updated control programs are transmitted to surgical instruments  7012  via the control program updating module  7026 . Updates to instruments  7012  that are transmitted via a corresponding hub  7006  may incorporate aggregated performance data that was gathered and analyzed by the data collection and aggregation module  7022  of the cloud  7004 . Additionally, the patient outcome analysis module  7028  and recommendations module  7030  could identify improved methods of using instruments  7012  based on aggregated performance data. 
     The cloud-based analytics system may include security features implemented by the cloud  7004 . These security features may be managed by the authorization and security module  7024 . Each surgical hub  7006  can have associated unique credentials such as username, password, and other suitable security credentials. These credentials could be stored in the memory  7010  and be associated with a permitted cloud access level. For example, based on providing accurate credentials, a surgical hub  7006  may be granted access to communicate with the cloud to a predetermined extent (e.g., may only engage in transmitting or receiving certain defined types of information). To this end, the aggregated medical data databases  7011  of the cloud  7004  may comprise a database of authorized credentials for verifying the accuracy of provided credentials. Different credentials may be associated with varying levels of permission for interaction with the cloud  7004 , such as a predetermined access level for receiving the data analytics generated by the cloud  7004 . Furthermore, for security purposes, the cloud could maintain a database of hubs  7006 , instruments  7012 , and other devices that may comprise a “black list” of prohibited devices. In particular, a surgical hubs  7006  listed on the black list may not be permitted to interact with the cloud, while surgical instruments  7012  listed on the black list may not have functional access to a corresponding hub  7006  and/or may be prevented from fully functioning when paired to its corresponding hub  7006 . Additionally or alternatively, the cloud  7004  may flag instruments  7012  based on incompatibility or other specified criteria. In this manner, counterfeit medical devices and improper reuse of such devices throughout the cloud-based analytics system can be identified and addressed. 
     The surgical instruments  7012  may use wireless transceivers to transmit wireless signals that may represent, for example, authorization credentials for access to corresponding hubs  7006  and the cloud  7004 . Wired transceivers may also be used to transmit signals. Such authorization credentials can be stored in the respective memory devices of the surgical instruments  7012 . The authorization and security module  7024  can determine whether the authorization credentials are accurate or counterfeit. The authorization and security module  7024  may also dynamically generate authorization credentials for enhanced security. The credentials could also be encrypted, such as by using hash based encryption. Upon transmitting proper authorization, the surgical instruments  7012  may transmit a signal to the corresponding hubs  7006  and ultimately the cloud  7004  to indicate that the instruments  7012  are ready to obtain and transmit medical data. In response, the cloud  7004  may transition into a state enabled for receiving medical data for storage into the aggregated medical data databases  7011 . This data transmission readiness could be indicated by a light indicator on the instruments  7012 , for example. The cloud  7004  can also transmit signals to surgical instruments  7012  for updating their associated control programs. The cloud  7004  can transmit signals that are directed to a particular class of surgical instruments  7012  (e.g., electrosurgical instruments) so that software updates to control programs are only transmitted to the appropriate surgical instruments  7012 . Moreover, the cloud  7004  could be used to implement system wide solutions to address local or global problems based on selective data transmission and authorization credentials. For example, if a group of surgical instruments  7012  are identified as having a common manufacturing defect, the cloud  7004  may change the authorization credentials corresponding to this group to implement an operational lockout of the group. 
     The cloud-based analytics system may allow for monitoring multiple healthcare facilities (e.g., medical facilities like hospitals) to determine improved practices and recommend changes (via the recommendations module  2030 , for example) accordingly. Thus, the processors  7008  of the cloud  7004  can analyze data associated with an individual healthcare facility to identify the facility and aggregate the data with other data associated with other healthcare facilities in a group. Groups could be defined based on similar operating practices or geographical location, for example. In this way, the cloud  7004  may provide healthcare facility group wide analysis and recommendations. The cloud-based analytics system could also be used for enhanced situational awareness. For example, the processors  7008  may predictively model the effects of recommendations on the cost and effectiveness for a particular facility (relative to overall operations and/or various medical procedures). The cost and effectiveness associated with that particular facility can also be compared to a corresponding local region of other facilities or any other comparable facilities. 
     The data sorting and prioritization module  7032  may prioritize and sort data based on criticality (e.g., the severity of a medical event associated with the data, unexpectedness, suspiciousness). This sorting and prioritization may be used in conjunction with the functions of the other data analytics modules  7034  described above to improve the cloud-based analytics and operations described herein. For example, the data sorting and prioritization module  7032  can assign a priority to the data analysis performed by the data collection and aggregation module  7022  and patient outcome analysis modules  7028 . Different prioritization levels can result in particular responses from the cloud  7004  (corresponding to a level of urgency) such as escalation for an expedited response, special processing, exclusion from the aggregated medical data databases  7011 , or other suitable responses. Moreover, if necessary, the cloud  7004  can transmit a request (e.g., a push message) through the hub application servers for additional data from corresponding surgical instruments  7012 . The push message can result in a notification displayed on the corresponding hubs  7006  for requesting supporting or additional data. This push message may be required in situations in which the cloud detects a significant irregularity or outlier and the cloud cannot determine the cause of the irregularity. The central servers  7013  may be programmed to trigger this push message in certain significant circumstances, such as when data is determined to be different from an expected value beyond a predetermined threshold or when it appears security has been comprised, for example. 
     Additional example details for the various functions described are provided in the ensuing descriptions below. Each of the various descriptions may utilize the cloud architecture as described in  FIGS.  180  and  181    as one example of hardware and software implementation. 
     Usage, Resource, and Efficiency Modeling for Medical Facility 
     Aspects of the present disclosure are presented for a cloud-based analytics system, communicatively coupled to a plurality of hubs and smart medical instruments, and configured to provide customized recommendations to localized medical care facilities regarding usage of medical supplies and other resources to improve efficiency and optimize resource allocation. A medical care facility, such as a hospital or medical clinic, may develop a set of practices for procuring, using, and disposing of various medical supplies that are often derived from routines and traditions maintained over time. The behaviors of a medical facility typically are risk-averse, and generally would be hesitant to adopt new and better practices unless and until convincingly shown of a better practice. Similarly, even if a better usage or efficiency model has been developed in a nearby facility, it is difficult for a local facility to adopt the improved practice because 1) each facility may be more natively resistant to change from the outside and 2) there are many unknowns for how or why the improved practice works in the nearby facility in relation to what the local facility does instead. Furthermore, even if a medical facility desired to improve its practices, it may be unable to do so optimally because it lacks enough knowledge from other similarly situated facilities, either in its region, according to a similar size, and/or according to similar practices or patients, and the like. 
     To help facilitate the dissemination of improved practices across multiple medical facilities, it would be desirable if a common source could have knowledge of the contexts from multiple medical facilities and be able to determine what changes should be made for any particular medical facility, based on the knowledge of the practices of any or all of the multiple facilities. 
     In some aspects, a cloud-based system communicatively coupled to knowledge centers in a medical facility, such as one or more medical hubs, may be configured to aggregate medical resource usage data from multiple medical facilities. The cloud-based system may then correlate the medical resource usage data with outcomes from those facilities, and may be able to derive various patterns within the data. For example, in some aspects, the cloud-based system may find which hospitals generate the least amount of waste per unit cost, based on an aggregation of all waste and procurement data obtained from medical facilities in a wide geographic region (e.g., all surgery centers in Japan). The cloud-based system may be configured to identify which medical facility produced the least amount of waste per unit cost, and then may analyze what practices differentiate that medical facility. If a trend is found, the cloud-based system may disseminate this information to all of the similarly situated medical facilities to improve their practices. This analysis may help improve inventory management, throughput efficiency, or overall efficiency of a medical facility. The improved inventory management may help surgical devices and other medical resources be utilized at their peak performance levels for longer periods of time, compared to if resources were badly managed, and therefore medical devices may be continuously used while they are older and more worn down. 
     In general, the cloud-based system may be configured to aggregate data from multiple medical facilities, something that no single facility alone would be able to accomplish on its own. Furthermore, the cloud-based system may be configured to analyze the large collection of data, controlling for common variables, such as type of practice, type of patient, number of patients, geographic similarity, which facilities use similar types of instruments, etc., that no single facility alone would be able to analyze on its own. 
     In this way, the cloud-based system of the present disclosure may be able to find more accurate causalities that lead to best practices at a particular facility, which can then be disseminated to all of the other facilities. Furthermore, the cloud-based system may be able to provide the data from all of the disparate sources that no single facility may be able to do on its own. 
     Referring to  FIG.  182   , shown is an example illustration of a tabulation of various resources correlated to particular types of surgical categories. There are two bars for each category, with the dashed line bars  7102 ,  7106 , and  7110  representing unused and/or scrap resources, and the solid line bars  7104 ,  7108 , and  7112  showing a totality of resourced in use for that category. In this example, bars  7104 ,  7108 , and  7112  show a total amount of endocutter cartridges, sponges, saline, fibrin sealants, sutures, and stapler buttresses, for thoracic, colorectal, and bariatric procedures, respectively, compared to the lower amounts  7102 ,  7106 , and  7110  representing an amount of unused resources for the thoracic, colorectal, and bariatric procedures, respectively. 
     The cloud system may be configured to identify wasted product that was gathered and not used or gathered and used in a manner that was not beneficial to the patient or the surgery. To do this, the cloud system may record in memory all records of inventory intake and disposal. During each intake, the inventory may be scanned and entered, and the bar codes of each inventory item may identify what type of product it is, as an example. In some aspects, smart disposal bins may be utilized to automatically tabulate when a product is being disposed of. These may be connected to the cloud system ultimately, either through one or more surgical hubs or through a separate inventory management system throughout the entire facility. Each facility may be tracked by its location, for example through a set GPS coordinate, inputted address or the like. This data may be organized in memory using one or more databases with various meta data associated with it, such as date and time of use, location of origin, type of procedure used for if applicable, cost per item, expiration date if applicable, and so on. 
     In addition, the cloud system may be configured to identify misfired or misused product and tracking of where the product was used, and may archive these results. For example, each surgical instrument communicatively coupled to a surgical hub may transmit a record of when the instrument was fired, such as to fire a staple or apply ultrasonic energy. Each record may be transmitted through the instrument and recorded at the cloud system ultimately. The action by the instrument may be tied with an outcome, either at that instant or with an overall outcome stating whether the procedure was successful or not. The action may be associated with a precise timestamp that places the action at an exact point during a surgery, where all of the actions of the surgery are also automatically recorded to the cloud, including start and end times of the surgery. This enables all of the human medical care workers to focus on their respective duties during surgery, rather than worry about an exact instance an action of a medical instrument occurred. The recordings of the medical instruments can be used to identify what products may be wasted during surgery, and the cloud system may be configured to also identify usage trends in this way. 
     In some aspects, the cloud system may be configured to perform trending analysis of the product tied to the overall length or amount of the product to identify short fires, or discarded product. For example, the cloud system may place the use of a product within a known period of when a surgical procedure is occurring, with a time stamp. The cloud system may then record an amount of resources utilized during that procedure, and may compare the materials used in that procedure with similarly situated procedures performed elsewhere. Out of this, several conclusions may be reached by the cloud system. For example, the cloud system may provide recommendations of a mix that provides smaller portions or an alternative usage that results in less wasted product. As another example, the cloud system may provide a suggestion or specified protocol change of specialized kits that would assemble the product in a manner more aligned to the detected institution usage. As yet another example, the cloud system may provide a suggestion or a change in protocol for alternative product mixes that would be more aligned to the detected usage and therefore should result in less wasted product. As yet another example, the cloud system may provide a recommendation on how to adjust a medical procedure during surgery based on timings of actions occurring before or after an event that typically results in wasteful resources, such as misfirings or multiple firings, based on identifying a correlation or pattern that actions during surgery occurring within a certain time interval relative to a prior action tend to result in wasteful actions. These analyses may be derived in part using algorithms that attempt to optimize the available resources with the rates of their disposals, taking into account various factors such as misfirings, native practices of the surgeons or the facility at large, and so forth. 
     Still referring to  FIG.  182   , based on the tabulation of the used and unused product, the cloud system can also generate several other conclusions. For example, the cloud system may be configured to generate a correlation of unused product to cost overhead. The cloud system may also generate a calculation of expired product and how that impacts rates of change with inventory. It may also generate an indication of where in the supply chain the product is being unused and how it is being accounted for. It may also generate ways to reduce costs or inventory space by finding substitutes of some resources over others for the same procedure. This may be based on comparing similar practices at different medical facilities that use different resources to perform the same procedures. 
     In some aspects, the cloud system may be configured to analyze the inventory usage of any and all medical products and conduct procurement management for when to acquire new product. The cloud system may optimize the utilization of inventory space to determine how best to utilize what space is available, in light of rates of usage for certain products compared to others. It may often be the case that inventory is not closely monitored in terms of how long a product remains in storage. If certain products are utilized at slower rates, but there is a large amount of it, it may be determined that the storage space is allocated poorly. Therefore, the cloud system may better apportion the storage space to reflect actual resource usage. 
     To improve in this area, in some aspects, the cloud system may for example, identify missing or insufficient product within an operating room (OR) for a specified procedure. The cloud system may then provide an alert or notification or transmit data to display that deficiency at the surgical hub in the OR. As another example, when a product is used in the OR, it may communicate its usage information to the cloud, such as activate a sensor or activation identification. The product may be registered with a scan or a power on switch. Analysis of this information for a given hospital coupled with its ordering information, may eventually inform the supply status and can enable ordering recommendations. This may occur automatically, once the cloud system registers that products are being used in the OR, or through other means. 
     In some aspects, device utilization within a procedure is monitored by the cloud system and compared for a given segment (e.g., individual surgeon, individual hospital, network of hospitals, region, etc.) against device utilization for similar procedures in other segments. Recommendations are presented to optimize utilization based on unit resource used or expenditure spent to supply such resource. In general, the cloud system may focus on a comparison of product utilization between different institutions that it is connected with. 
       FIG.  183    provides an example illustration of how the data is analyzed by the cloud system to provide a comparison between multiple facilities to compare use of resources. In general, the cloud system  7200  may obtain usage data from all facilities, such as any of the types of data described with respect to  FIG.  182   , and may associate each datum with various other meta data, such as time, procedure, outcome of the procedure, cost, date of acquisition, and so forth.  FIG.  183    shows an example set of data  7202  being uploaded to the cloud  7200 , each circle in the set  7202  representing an outcome and one or more resources and contextual metadata that may be relevant to leading to the outcome. In addition, high performing outcomes  7204  and their associated resources and contextual metadata are also uploaded to the cloud  7200 , though at the time of upload, it may not be known which data has very good outcomes or simply average (or below average) outcomes. The cloud system may identify which use of resources is associated with better results compared to an average or expected outcome. This may be based on determining which resources last longer, are not wasted as often, ultimately cost less per unit time or unit resource, as some examples. The cloud system may analyze the data to determine best outcomes based on any and all of these variables, or even one or more combinations of them. The trends identified may then be used to find a correlation or may prompt request of additional data associated with these data points. If a pattern is found, these recommendations may be alerted to a user to examine as possible ways to improve resource usage and efficiency. 
     The example graph  7206  provides a visual depiction of an example trend or pattern that the cloud may derive from examining the resource and outcome data, according to some aspects. In this example, the cloud system may have analyzed resource and outcome data of number of stapler firings and their relation to performance in surgery. The cloud system may have gathered the data from multiple medical facilities, and multiple surgeons within each facility, based on automatically recorded firing data during each surgery that is generated directly from the operation of the surgical staplers themselves. The performance outcomes may be based on post-op examinations and evaluations, and/or immediate outcomes during surgery, such as whether there is a bleeding event or a successful wound closure. Based on all of the data, trends may be determined, and here, it may be discovered that there is a small window of the number of firings that results in the best performance outcomes, at interval “a” as shown. The magnitude of this performance compared to the most common number of firings is shown as interval “b.” Because the number of firings that results in the best outcomes may not be what is commonly practiced, it may not be readily easily to have discovered these outcomes without the aggregation and analytical abilities of the cloud system. 
     As another example: cartridge type, color, and adjunct usage that are monitored for sleeve gastrectomy procedures for individual surgeons within the same hospital may be obtained. The data may reveal an average procedure cost for one surgeon is higher for this surgeon when compared to others within the same hospital, yet short term patient outcomes remain the same. The hospital is then informed and is encouraged to look into differences in device utilization, techniques, etc. in search of optimizing costs potentially through the elimination of adjuncts. 
     In some aspects, the cloud system may also identify specialty cases. For example, specific cost information provided within the hospital, including OR time, device utilization, and staff, may be identified. These aspects may be unique to a particular OR, or facility. The cloud system may be configured to suggest efficiencies in OR time usage (scheduling), device inventory, etc. across specialties (orthopedics, thoracic, colorectal, bariatric, etc.) for these specialty cases. 
     In some aspects, the cloud system may also be configured to compare cost-benefit of robotic surgery vs traditional methods, such as laparoscopic procedures for given procedure type. The cloud system may compare device costs, OR time, patient discharge times, efficacy of the procedure done by the robot vs performed by surgeons exclusively, and the like. 
     Linking of Local Usage Trends With the Resource Acquisition Behaviors of the Larger Data Set 
     Individualized Change 
     According to some aspects of the cloud system, whereas the above disclosure focuses on a determination of efficiency (i.e., value) and optimizing based on that, here, this section centers around on identifying which local practices may be best disseminated to other similarly situated medical facilities. 
     A medical care facility, such as a hospital or medical clinic, may develop a set of practices for how to utilize medical devices for aiding medical procedures that are often derived from routines and traditions maintained over time. The behaviors of a medical facility typically are risk-averse, and generally would be hesitant to adopt new and better practices unless and until convincingly shown of a better practice. Similarly, even if a better practice for utilizing a device or for adjusting a procedure has been developed in a nearby facility, it is difficult for a local facility to adopt the improved practice because 1) each facility may be more natively resistant to change from the outside and 2) there are many unknowns for how or why the improved practice works in the nearby facility in relation to what the local facility does instead. Furthermore, even if a medical facility desired to improve its practices, it may be unable to do so optimally because it lacks enough knowledge from other similarly situated facilities, either in its region, according to a similar size, and/or according to similar practices or patients, and the like. 
     To help facilitate the dissemination of improved practices across multiple medical facilities, it would be desirable if a common source could have knowledge of the contexts from multiple medical facilities and be able to determine what changes should be made for any particular medical facility, based on the knowledge of the practices of any or all of the multiple facilities. 
     In some aspects, a cloud-based system communicatively coupled to knowledge centers in a medical facility, such as one or more medical hubs, may be configured to aggregate resource utilization data and patient outcomes from multiple medical facilities. The cloud-based system may then correlate the resource utilization data with the outcomes from those facilities, and may be able to derive various patterns within the data. For example, in some aspects, the cloud-based system may find which hospitals produce better outcomes for a particular type of procedure, based on an aggregation of all the patient outcome data for that particular procedure collected in a wide geographic region (e.g., all surgery centers in Germany). The cloud-based system may be configured to identify which medical facility produced a better procedural outcome compared to the average across the geographic region, and then may analyze what differences in that procedure occur in that medical facility. If a trend is found and one or more differences are identified, the cloud-based system may disseminate this information to all of the similarly situated medical facilities to improve their practices. 
     In general, the cloud-based system may be configured to aggregate data from multiple medical facilities, something that no single facility alone would be able to accomplish on its own. Furthermore, the cloud-based system may be configured to analyze the large collection of data, controlling for common variables, such as type of practice, type of patient, number of patients, geographic similarity, which facilities use similar types of instruments, etc., that no single facility alone would be able to analyze on its own. 
     In this way, the cloud-based system of the present disclosure may be able to find more accurate causalities that give rise to best practices at a particular facility, which can then be disseminated to all of the other facilities. Furthermore, the cloud-based system may be able to provide the data from all of the disparate sources that no single facility may be able to do on its own. 
     The cloud system may be configured to generate conclusions about the efficacy of any local facility in a number of ways. For example, the cloud system may determine if a local treatment facility is using a product mixture or usage that differs from the larger community and their outcomes are superior. The cloud system may then correlate the differences and highlight them for use in other facilities, other surgical hub, or in clinical sales as some examples. In general, this information may be disseminated widely in a way that no single facility may have had access or knowledge of, including the facility that practiced this improve procedure. 
     As another example, the cloud system may determine if the local facility has equal to or inferior outcomes to the larger community. The cloud system may then correlate suggestions and provide that information back to the local facility as recommendations. The system may display data showing their performance in relation to others, and may also display suggestions on what that facility is doing compared to what everybody else is doing. Again, the local facility may not even know they have an inefficiency in that respect, nor may everybody else realize they are utilizing their resources more efficiently, and thus nobody would ever know to examine these issues without the cloud system having a bigger picture of all of the data. 
     These suggestions can come in various forms. For example, the cloud system may provide recommendations at the purchasing level that suggest improvements in cost for similar outcomes. As another example, the cloud system may provide recommendations at the OR level when the procedure is being planned and outfitted as the less desirable products are being pulled suggest other techniques and product mixes that would be in line with the broader community which is achieving higher outcomes. As yet another example, the cloud system may display outcomes comparison needs to account for surgeon experience, possibly through a count of similar cases performed by that surgeon from cloud data. In some aspects, the learning curve of an individual may be reported against an aggregated larger dataset, as expectation of improved outcomes, or of surgeon performance relative to peers in obtaining a steady state outcome level. 
       FIG.  184    illustrates one example of how the cloud system  7300  may determine efficacy trends from an aggregated set of data  7302  across whole regions, according to some aspects. Here, for each circle of the set of data  7302 , device utilization, cost, and procedure outcomes for a procedure is monitored and compared for a given segment (e.g., individual surgeon, individual hospital, network of hospitals, region, etc.) against device utilization, cost, and procedure outcomes for similar procedures in other segments. These data may possess metadata that associates it to a particular facility. In general, an outcome of a procedure may be linked to multiple types of data associated with it, such as what resources were used, what procedure was performed, who performed the procedure, where the procedure was performed, and so on. The data linked to the outcome may then be presented as a data pair. The data may be subdivided in various ways, such as between good and inferior outcomes, filtered by particular facilities, particular demographics, and so forth. A regional filter  7304  is visually depicted as an example. The data set  7302  contains both good outcomes and inferior outcomes, with the inferior outcomes being darkened for contrast. 
       FIG.  184    also shows examples of charts that have these distinctions made and may be derived from the aggregated data set  7302 , using one or more data pairs. Chart  7306  shows a global analysis in one example, while a regionally segmented analysis is provided in the other chart  7308 . Statistical analysis may be performed to determine whether the outcomes are statistically significant. In chart  7306 , the cloud system may determine that no statistical difference was found between good outcomes and inferior outcomes based on rates of occurrence. In contrast, in chart  7308 , the cloud system may determine that there is a statistically higher occurrence of inferior outcomes for a given region, when filtering for a particular region. Recommendations are presented to share outcomes vs. cost vs. device utilization and all combinations therein to help inform optimization of outcomes against procedure costs with device utilization potentially being a key contributor of differences, according to some aspects. 
     As another example, a cartridge type and color are monitored for lobectomy procedures for individual surgeons within the same hospital. The data reveals average cost for one surgeon is higher on average for this surgeon, yet average length of stay is less. The hospital is informed by the cloud system and is encouraged to look into differences in device utilization, techniques, etc. in search of improving patient outcomes. 
     In some aspects, the cloud system may also be configured to provide predictive modeling of changes to procedures, product mixes, and timing for a given localized population or for the general population as a whole. The predictive modeling may be used to assess impact on resource utilization, resource efficiency, and resource performance, as some examples. 
       FIG.  185    provides an example illustration of some types of analysis the cloud system may be configured to perform to provide the predicting modeling, according to some aspects. The cloud system may combine its knowledge of the required steps and instruments for performing a procedure, and may compare the different avenues via various metrics, such as resources utilized, time, procedural cost, and the like. In this example of chart  7400 , a thoracic lobectomy procedure is analyzed using two different types of methods to perform the same procedure. Option A describes a disposable ultrasonic instrument as the method for performing the procedure, while Option B shows a combination of different methods that in the aggregate perform the same procedure. The graphical illustration may help a surgeon or administrator see how the resources are utilized and their cost. Option B is broken down into multiple sections, including sterilization cost, reusable dissectors and additional time in the OR for performing the procedure. The cloud system may be configured to convert these somewhat abstract notions into a quantitative cost value based on combining its knowledge of time spent in the OR, staff salaries and resource costs per unit time in the OR, and resources utilized for sterilization and reusable dissectors and their associated costs. The cloud system may be configured to associate the various amounts of resources and costs with its knowledge of the required steps to perform the thoracic lobectomy procedure using the prescribed method in Option B. 
     As another example, chart  7404  in  FIG.  185    shows a comparison between using an ultrasonic long dissector and a monopolar reusable dissector to perform various portions of a procedure. Chart  7404  shows a comparison in terms of time needed to perform each portion of the procedure for each instrument. The surgeon may then be able to select which instrument may be desired for a particular procedure. The breakout times may be automatically recorded empirically during live procedures, with the times for each portion of the overall procedure broken out due to the cloud system’s knowledge of the expected sequence to perform the procedure. Demarcations between each portion may be set by a surgeon providing an input to manually denote when each change occurs. In other cases, the cloud system may utilize situational awareness to determine when a portion of the procedure has ended based on the way the devices are used and not used. The cloud system may aggregate a number of these procedures, performed across multiple surgeons and multiple facilities, and then compute an average time for each section, as an example. 
     As another example, chart  7402  in  FIG.  185    shows an example graphical interface for comparing relative cost when utilizing the ultrasonic long dissector or a monopolar reusable dissector, according to some aspect. The value of each instrument per unit time is displayed for a particular procedure. The data used to generate these values may be similar to those obtained for charts  7400  and  7404 , as some examples. The graphical display may allow for a succinct description of the key points of efficiency that would be most useful to make a determination. This analysis may help a surgeon see how valuable each instrument is for a given procedure. 
     In general, to perform the predictive modeling, the cloud system may combine its knowledge of the exact steps to perform a procedure, what instruments may be used to perform each step, and its aggregated data for how each instrument performs each particular step. A surgeon may not have the combination of such knowledge in order to provide such an assessment alone. The predictive modeling therefore may be the result of continued monitoring and acquisition of data across multiple facilities, the likes of which would not be possible without the cloud system. 
     In some aspects, the cloud system may also derive the distilled information from multiple sources (e.g., HUB data collection sources, literature, etc.) to identify the optimal procedure technique. Various other examples for how predictive modeling may be utilized include:
     (1) sigmoidectomy: multi-quadrant surgery; which is the best order of operations, etc.;   (2) RYGB: what is the ideal limb length, etc. based on the circumstances for this patient;   (3) Lobectomy: how many and which lymph nodes should be removed; and   (4) VSG: Bougie size and distance from pylorus.   

     In some aspects, when a suggestion is made to a surgeon, the surgeon is given the option to decline future suggestions like this, or to continue. In addition, through interface with the hub, the surgeon may inquire to the cloud system additional information to inform his or her decision. For example, the surgeon may want to isolate the times to a more localized set of data, such as the particular facility or a certain demographic that better caters to the patient undergoing the surgery. The data may change, for example, if the patient is a child or the patient is a woman. 
     Device Setup Modifications Based on Surgeon, Regional, Hospital, or Patient Parameters 
     Preoperatively 
     Similar to the above section, the cloud-based system may also be configured to monitor smart instrument configurations and, more generally, configurations that utilize multiple smart instruments, such as an operating room preparing for surgery. For similar reasons as described above, such as to improve medical efficacy and efficiency, it may be useful to compare a procedural setup at any particular medical facility to aggregate data pertaining to the procedural setups at multiple other medical facilities. 
     The cloud-based system of the present disclosure may be configured to aggregate data pertaining to smart medical instrument configurations and operating room (OR) setups that utilize multiple smart medical instruments. The smart medical instruments may include: manual devices that are communicatively coupled to a medical data tower and are configured to generate sensor data; and robotic instruments that perform procedures in a more automated fashion. The cloud-based system may be configured to detect irregularities in an OR setup, either pertaining to what devices are present in the room and/or what materials are used to create a product mix for a medical procedure. The irregularities may be based on comparing the materials and equipment present in the OR with other setups from other medical facilities for a similar situation. The cloud system may then generate a change in firmware, software, or other settings and transmit those changes to the surgical devices like a device update. 
     In this way, the cloud-based system of the present disclosure may be able to identify errors and find more accurate causalities that give rise to best practices at a particular facility, which can then be disseminated to all of the other facilities. Furthermore, the cloud-based system may be able to provide the data from all of the disparate sources that no single facility may be able to do on its own. This can lead to safe and more efficient operating room procedures and medical practices in general. 
     In some aspects, the cloud system may be configured to provide recommendations of instrument configurations, and even generate the appropriate device settings changes, to customize performance to that of a pre-specified user. 
     For example, the cloud system may focus on a surgical device user or surgeon based on a comparison of current usage of a device with the historic trends of a larger data set. As some examples, the cloud system may provide recommendations of what type of cartridge to use based on what the user has previously used for the particular procedure or just what the particular surgeon desires in general. The cloud system may access data based on the particular surgeon, the type of procedure, and the type of instruments used in order to make this determination. 
     As another example, the cloud system may provide a recommendation based on an identified anatomy indicated in a display of the cartridge. As another example, the cloud system may provide a recommendation by referring to a baseline surgical device clamping and firing speed, based on local previous usage data that it has stored in its memory. 
     As yet another example, the cloud system may conduct a comparison of current device tissue interaction against a historical average for the same surgeon, or for the same step in the same procedure for a segment of surgeons in the database. The cloud system again may have access to all steps used to perform a procedure, and may access a catalog of all data when performing a particular step in a procedure across all surgeons who have ever performed that procedure in its network. The recommendation may also come from an analysis of how the current surgical device has been observed to interact with tissue historically. This type of analysis may be useful because it is often not the case that large amounts of live patient data can be collected for how a surgical device interacts precisely with the tissue. Furthermore, a surgeon typically knows only his or her experience, and does not have outside knowledge of what other surgeons experience for the same procedure. The cloud, on the other hand, is capable of collecting all of this data and providing new insights that any individual surgeon would not know alone. 
     As another example: In stapling, more than one of the following are known: cartridge color, stapler type, procedure, procedure step, patient information, clamp force over time, prior firing information, end effector deformations, etc. This information is compared against a historical average for a similar dataset. The current situation is compared against this average, informing the user about the nature of the current firing. 
       FIG.  186    provides a graphical illustration of a type of example analysis the cloud system may perform to provide these recommendations, according to some aspects. In this example, chart  7500  shows data for parenchyma staple firing analysis. In the bar graphs  7502  are various types of staples used, where each color of staple reflects a different amount of force applied to the surgical site. The y axis (on the left) associated with the bar graphs  7502  reflects a percent level of usage of that type of staple color, and each color shows bar graphs for three different categories: regional average usage (in Japan in this case), global average usage with best outcomes, and the local facility average usage. Based on this data, the cloud system may be configured to develop a recommendation for what staples to change to for a given situation. A series of suggested actions is shown in chart  7506  as a result. The chart  7500  also shows a set of line graphs  7504  that reflect a percentage of prolonged air leaks (the y axis on the right) for each color used, and for each type of category (regional, global average, facility average). If staples are too thick and do not match the level of tissue thickness, there could be holes in the staples that lead to undesirable air leaks. Here, the cloud system may provide a recommendation based on all of the data shown as well as data not shown, according to some aspects. The cloud system may simply provide a recommendation in the form of a letter as the label, and the surgeon may verify whether the data supports such a finding and decide to accept the cloud system’s recommendation. 
     As another example, the cloud system may be configured to provide a recommendation of ultrasonic blade lengths or capacities based on likely to encounter vascular structures in a procedure. Similar to what is described above in reference to  FIG.  186   , the cloud system may collect the relevant data for blade lengths, and their outcomes that have been obtained from multiple surgical hubs, and illustrate the various outcomes for using different blade lengths on a particular procedure. A recommendation may be provided in a graphical display where the surgeon can verify the recommendation using the graphical presentation created by the cloud system. 
     In some aspects, the cloud system is also configured to provide recommendations to the staff about which devices to pull for an upcoming procedure. These recommendations may be based on a combination of surgeon preference (pick list) against historical device utilization rates for the same procedures performed by some segment of the larger database, as well as average recommendations or utilizations across different facilities that produce the best results. The data may be obtained by pairing good outcomes with the metadata, such as what devices were used to achieve those good outcomes. Recommendations can be influenced by other factors, including patient information, demographic data, etc. 
     Relatedly, in some aspects, the cloud system may also provide identification of pulled instruments that might not be the preferred device for a given procedure. The blacklisting of sorts can more clearly eliminate any obviously flaw uses of devices to help surgeons make the best decisions. This data may be obtained from manufacturer input, analysis of poor outcomes, specific input provided to the cloud system, and so on. 
     In addition, based on interrogating tissue for properties (elasticity, impedance, perfusion rate), a specific device with a given parameter set (clamp preload) could be suggested to be used from current stock in inventory by the cloud system. Some of the metadata associated with the outcomes of past procedures may include a description of the type of tissue being operated on, and an associated description of the physical characteristics of that tissue. The cloud system may then draw trends or patterns based on different types of procedures, but having in common all procedures that deal with similar types of tissue. This kind of analysis may be used as a secondary recommendation, when a new or unknown procedure must take place and new suggestions are welcome. If the recommendation is accepted, the cloud system may be configured to generate the change in parameters and transmit them to the interconnected medical device, through the surgical hub, to make the medical device readily available for use in the adjusted procedure. 
     In some aspects, the device setup recommendations can include suggestions of adjuncts for devices based on the pre-surgery imaging or locally collected data during the beginning of a procedure. That is, this suggestion of adjuncts may be for use on or with devices based on the local correlation of use to efficacy of the device. As an example, based on a given procedure, surgeon, and patient information, bleeding in a case must be tightly controlled, and therefore the cloud system may conclude that a buttress is recommended on all staple firings. 
     In some aspects, the cloud system may also be configured to provide awareness of any newly-launched products that are available and suitable for operation as well as instructions for use (IFU). The data may be gathered from one or more surgical hubs, or from direct factory input for the newly-launched products. The cloud system can download the information and make the information displayable to multiple medical hubs across multiple facilities. 
     In some aspects, regarding any of the above examples for recommendations being provided by the cloud system, the cloud system may also conversely provide alerts or other signals when a device or suggested setup is not followed or is disregarded. The cloud system may be configured to access procedural data from a surgical hub during a surgical procedure, for example. The surgical hub may collect data for what type of devices are in use during a procedure. The cloud system may monitor the progress of the procedure by verifying if an accepted method or device is used in the correct or prescribed order for the procedure. If there is a deviation, in that a particular device is not expected or a step is missed, the cloud system may send an alert to the surgical hub that a particular device is not being used properly, as an example. This would occur in real time, as the timing of the procedure is important for the patient’s safety. 
     Medical Facility Segmented Individualization of Instrument Function 
     In some aspects, the cloud-based system may also be configured to provide recommendations or automatically adjust surgical instrument settings to account for specific differences at a medical facility. While there are a number of similarities that can be normalized across multiple facilities, there may also be particular differences that should be accounted for. For example, patient demographic differences, patient physiological differences more native to a local population, procedural differences - for example preferences by each individual surgeon -and region specific instrument availability or other differences may inspire certain adjustments to be made at any particular medical facility. 
     The cloud-based system of the present disclosure may be configured to aggregate not only data pertaining to smart medical instrument configurations and operating room (OR) setups that utilize multiple smart medical instruments, but also data that highlight specific differences that may be unique to that region or that particular medical facility. The cloud-based system may then factor in adjustments to device settings or recommendations to changes in procedures based on these differences. For example, the cloud-based system may first provide a baseline recommendation for how a smart instrument should be used, based on best practices discovered in the aggregate data. Then, the cloud-based system may augment the recommendation to account for one or more unique differences specific to a medical facility. Examples of these differences are described above. The cloud-based system may be made aware of what demographics and patient data gave rise to the optimal baseline procedure, and then compare the local facility demographics and patient data against that. The cloud-based system may develop or extrapolate a correlation from that baseline setting in order to develop an adjustment or offset that accounts for the differences in demographics and patient data. 
     In this way, the cloud-based system of the present disclosure may be able to make optimal adjustments specific to each medical facility or even specific to each operating room, or surgeon. The adjustments may offer improved performance that take into account the observed best practices as well as any unique differences. 
     In some aspects, the cloud system may be configured to provide changes to instrument variation of usage to improve outcomes. For example, the cloud system may determine a localized undesirable effect that is due to a specific manner of utilizing a surgical device.  FIG.  187    provides an illustration of how the cloud system may conduct analysis to identify a statistical correlation to a local issue that is tied to how a device is used in the localized setting. The cloud  7600  may aggregate usage data of all types of devices and record their outcomes. The data set may be filtered down to only those outcomes that utilized the particular device in question. The cloud system may then perform statistical analysis to determine if there is a trend in how the procedures are performed at a particular facility when utilizing that device. A pattern may emerge that suggests there is a consistent flaw in how the device is used at that facility, represented as the data points  7602  that demonstrate the statistical correlation. Additional data may then be examined, to see if a second pattern may arise in comparison to how others are using the device in the aggregate. A suggestion may be provided once a pattern is identified and addressed to the local outlier  7604 . In other cases, the cloud system may provide a facility-specific update to the device to offset the local practice of how that device is used. 
     In some aspects, the cloud system may be configured to communicate the deviation to the specific user and the recommendation of a differing technique or usage to improve outcomes from the specific device. The cloud system may transmit the data for display at the surgical hub to illustrate what changes ought to be made. 
     As an example: A stapler configured with a means to sense the force required to clamp the device transmits data indicating that the clamp force is still rapidly changing (viscoelastic creep) when the surgeon initiates firing of the staple, and it is observed that the staple line bleeds more often than expected. The cloud system and/or device is able to communicate a need to wait longer (e.g., 15 seconds) before firing the device to improve outcomes. This may be based on performing the statistical analysis described in  FIG.  187    using data points from similar procedures aggregated from multiple surgeons and multiple facilities. In the moment of the surgery, it would be infeasible or impractical for anybody on the surgery team to come to these conclusions without the help of the cloud system aggregating such knowledge and arriving at such conclusions. 
     In some aspects, the cloud system may also be configured for intentional deployment of control algorithms to devices with an in-use criteria meeting specific criteria. For regional differences, the cloud system may adjust the control algorithms of various surgical devices. A different amount of force may be applied to a device for patients in a different demographic, for example. As another example, surgeons may have different uses for a type of surgical device, and control algorithms can be adjusted to account for this. The cloud system may be configured to send out a wide area update to a device, and may target the regional and specific instrument IDs which allow for targeted updates to their control programs. 
     In some aspects, the cloud system may provide for coding of the serial numbers of sales units and/or individual devices, which enables updated control programs to be pushed to a specific device or specific groups of devices based on meeting a specific criteria or threshold. 
     In addition, according to some aspects, the cloud system may be configured to perform analysis of peri-operative data against outcomes data seeking correlations that identify exceptional results (positive and negative). The analysis may be performed at multiple levels (e.g., individual, hospital, and geographic (e.g., city, county, state, country, etc.) filters). Furthermore, regional corroboration of improved outcomes may be target for only a limited geographic area, as it is known that the changes occur only within a limited area. The ability to tune devices to regional preferences, techniques, and surgical preferences may allow for nuanced improvements for regionally specific areas. 
     In addition to directly changing instrument settings, the cloud system may also be configured to provide recommendations on different instruments or equivalent device suggestions due to regional availability. That is, an equivalent suggestion to a device to perform a particular function may be recommended by the cloud system, in the event a device is lacking and a particular region has an excess or general availability of the different device that may be used to serve an equivalent purpose. 
     For example, the cloud system may determine that PPH hemorrhoid stapling devices or curved cutter  30  devices are only available in Italy due to a unique procedure configuration or teaching hospital procedure design. As another example, the cloud system may determine that there is an Asia-specific TX and open vascular stapler use due to cost sensitivity, lack of laparoscopic adoption, and teaching hospital preferred techniques and patient thoracic cavity size. As another example, the cloud system may provide awareness messages to OR staff of substandard knock-off products available in a certain region. This data may be derived from an ingestion of information from multiple sources, such as inputs provided by experts and doctors, and employing machine learning and natural language processing to interpret trends and news related to a local area.  FIG.  188    provides a graphical illustration of an example of how some devices may satisfy an equivalent use compared to an intended device. Here, a circular stapling device  7702  is compared to a compression ring  7704  for use in a PPH stapler  7700  for hemorrhoidopexy procedures. The type of analysis performed to reach the recommendations by the cloud system may be similar to those described in  FIG.  187   . The cloud system may provide a display of this suggestion, as well as an analysis of its efficiency and resource utilization, in example display  7706  that may be shown at a display in a surgical hub. In this case, the instrument cost is compared, as well as time and efficacy for each type of instrument. The cloud system may derive these recommendations by obtaining usage examples from different facilities, observing how other facilities and doctors treat the same procedure. 
     In some aspects, the cloud system may also be configured to provide a surgical hub decision tree and local suggestions of post-operative care, based on data processed during the procedure and Cloud Analytics trending of results or performance of the devices aggregated from larger population sets. 
     In some aspects, the cloud system may provide update-able decision trees for post-operative care suggestions, based on device measured situational usage. The post-operative care decisions may initially be derived from traditionally known responses that doctors would normally recommend. Once additional data becomes available, say from aggregating types of post-operative care from other facilities, or from analyzing new types of care from literature or from research on new surgical devices, the decision can be updated by the cloud system. The decision tree may be displayable at a surgical hub and in a graphical form. 
     In using this decision tree, feedback can be provided for each node to state how effective the current solutions are. The data may be inputted based on whatever feedback patients may provide. A doctor or data admin need not perform any analysis at the time, but the cloud system can aggregate all of the data and observe what trends may arise. Feedback can then be provided to update the decision tree. 
     In some aspects, the cloud system may incorporate operative data &amp; device performance to propose post-operative monitoring &amp; activities. For example, various patient measures may change what decisions in post-operative care should be taken. These measurements can include but are not limited to: (a) blood pressure; (b) low hematocrit; (c) PTT (partial thromboplastin time); (d) INR (international normalized ratio); (e) Oxygen saturation; (f) Ventilation changes; and (g) X-Ray data. 
     As another example, anesthesia protocol can dictate what post-operative decisions should be taken. This may account for: (a) any fluids administered; (b) Anesthesia time; and (3) Medications, as some non-limiting examples. 
     As another example, the types of medications may also play a role. The application of Warfarin is one notable example. A patient post-operatively has abnormal PTT and INR, for example. Because the patient is on Warfarin, potential treatments could include vitamin K, factor 7, or the delivery of plasma (fpp). Plavix can be another example. A patient post-operatively has abnormal PTT and INR. Because patient is on Plavix, potential treatments for Warfarin would be ineffective. Deliver platelets instead may be the suggestion in the decision tree. 
     As a fourth example, post-operative instructions may be provided that are dependent on the type of procedure. Some non-limiting examples include colorectal time to solid food (motility); and (b) time to physical activity &amp; PT. These varying decisions can be reflected in the decision tree, and all of the types of branching decisions may be stored in the cloud system and updated when additional data is gained from any connected facility. 
       FIG.  189    provides various examples of how some data may be used as variables in deciding how the post-operative decision tree may branch out. As shown, some factors  7802  may include the parameters used in surgical devices, such as the force to fire (FTF) used in an operation, or the force to close (FTC) used in a surgical device. Graph  7800  shows a visual depiction of how the FTC and FTF curves may interrelate with one another. Other factors include compression rate, wait time, and staple adaptability. Based on some of these variables, a type of post-operative care should be adjusted. In this case, a multi-factored analysis is applied, which may be too complex to calculate or modify without the aid of the processing power of a system like the cloud system. This example suggests that a decision tree  7804  provided by the cloud system can be more than a simple two dimensional decision tree. To account for multiple variables to make a single decision, the decision tree generated by the cloud may be visually available for perhaps just a portion, and the ultimate conclusion may have to be displayed without a full display of all of the other branches that were not considered. The chart  7806  may be an example of providing additional information of how to respond within the decision tree. 
     Adaptive Control Program Updates for Surgical Devices 
     Modular devices include the modules (as described in connection with  FIGS.  3  and  9   , for example) that are receivable within a surgical hub and the surgical devices or instruments that can be connected to the various modules. The modular devices include, for example, intelligent surgical instruments, medical imaging devices, suction/irrigation devices, smoke evacuators, energy generators, ventilators, and insufflators. Various operations of the modular devices described herein can be controlled by one or more control algorithms. The control algorithms can be executed on the modular device itself, on the surgical hub to which the particular modular device is paired, or on both the modular device and the surgical hub (e.g., via a distributed computing architecture). In some exemplifications, the modular devices’ control algorithms control the devices based on data sensed by the modular device itself (i.e., by sensors in, on, or connected to the modular device). This data can be related to the patient being operated on (e.g., tissue properties or insufflation pressure) or the modular device itself (e.g., the rate at which a knife is being advanced, motor current, or energy levels). For example, a control algorithm for a surgical stapling and cutting instrument can control the rate at which the instrument’s motor drives its knife through tissue according to resistance encountered by the knife as it advances. 
     Although an “intelligent” device including control algorithms that respond to sensed data can be an improvement over a “dumb” device that operates without accounting for sensed data, if the device’s control program does not adapt or update over time in response to collected data, then the devices may continue to repeat errors or otherwise perform suboptimally. One solution includes transmitting operational data collected by the modular devices in combination with the outcomes of each procedure (or step thereof) to an analytics system. In one exemplification, the procedural outcomes can be inferred by a situational awareness system of a surgical hub to which the modular devices are paired, as described in U.S. Pat. Application Serial No. 15/940,654, titled SURGICAL HUB SITUATIONAL AWARENESS, which is herein incorporated by reference in its entirety. The analytics system can analyze the data aggregated from a set of modular devices or a particular type of modular device to determine under what conditions the control programs of the analyzed modular devices are controlling the modular devices suboptimally (i.e., if there are repeated faults or errors in the control program or if an alternative algorithm performs in a superior manner) or under what conditions medical personnel are utilizing the modular devices suboptimally. The analytics system can then generate an update to fix or improve the modular devices’ control programs. Different types of modular devices can be controlled by different control programs; therefore, the control program updates can be specific to the type of modular device that the analytics system determines is performing suboptimally. The analytics system can then push the update to the appropriate modular devices connected to the analytics system through the surgical hubs. 
       FIG.  190    illustrates a block diagram of a computer-implemented adaptive surgical system  9060  that is configured to adaptively generate control program updates for modular devices  9050 , in accordance with at least one aspect of the present disclosure. In one exemplification, the surgical system includes a surgical hub  9000 , multiple modular devices  9050  communicably coupled to the surgical hub  9000 , and an analytics system  9100  communicably coupled to the surgical hub  9000 . Although a single surgical hub  9000  is depicted, it should be noted that the surgical system  9060  can include any number of surgical hubs  9000 , which can be connected to form a network of surgical hubs  9000  that are communicably coupled to the analytics system  9010 . In one exemplification, the surgical hub  9000  includes a processor  9010  coupled to a memory  9020  for executing instructions stored thereon and a data relay interface  9030  through which data is transmitted to the analytics system  9100 . In one exemplification, the surgical hub  9000  further includes a user interface  9090  having an input device  9092  (e.g., a capacitive touchscreen or a keyboard) for receiving inputs from a user and an output device  9094  (e.g., a display screen) for providing outputs to a user. Outputs can include data from a query input by the user, suggestions for products or mixes of products to use in a given procedure, and/or instructions for actions to be carried out before, during, or after surgical procedures. The surgical hub  9000  further includes an interface  9040  for communicably coupling the modular devices  9050  to the surgical hub  9000 . In one aspect, the interface  9040  includes a transceiver that is communicably connectable to the modular device  9050  via a wireless communication protocol. The modular devices  9050  can include, for example, surgical stapling and cutting instruments, electrosurgical instruments, ultrasonic instruments, insufflators, respirators, and display screens. In one exemplification, the surgical hub  9000  can further be communicably coupled to one or more patient monitoring devices  9052 , such as EKG monitors or BP monitors. In another exemplification, the surgical hub  9000  can further be communicably coupled to one or more databases  9054  or external computer systems, such as an EMR database of the medical facility at which the surgical hub  9000  is located. 
     When the modular devices  9050  are connected to the surgical hub  9000 , the surgical hub  9000  can sense or receive perioperative data from the modular devices  9050  and then associate the received perioperative data with surgical procedural outcome data. The perioperative data indicates how the modular devices  9050  were controlled during the course of a surgical procedure. The procedural outcome data includes data associated with a result from the surgical procedure (or a step thereof), which can include whether the surgical procedure (or a step thereof) had a positive or negative outcome. For example, the outcome data could include whether a patient suffered from postoperative complications from a particular procedure or whether there was leakage (e.g., bleeding or air leakage) at a particular staple or incision line. The surgical hub  9000  can obtain the surgical procedural outcome data by receiving the data from an external source (e.g., from an EMR database  9054 ), by directly detecting the outcome (e.g., via one of the connected modular devices  9050 ), or inferring the occurrence of the outcomes through a situational awareness system. For example, data regarding postoperative complications could be retrieved from an EMR database  9054  and data regarding staple or incision line leakages could be directly detected or inferred by a situational awareness system. The surgical procedural outcome data can be inferred by a situational awareness system from data received from a variety of data sources, including the modular devices  9050  themselves, the patient monitoring device  9052 , and the databases  9054  to which the surgical hub  9000  is connected. 
     The surgical hub  9000  can transmit the associated modular device  9050  data and outcome data to the analytics system  9100  for processing thereon. By transmitting both the perioperative data indicating how the modular devices  9050  are controlled and the procedural outcome data, the analytics system  9100  can correlate the different manners of controlling the modular devices  9050  with surgical outcomes for the particular procedure type. In one exemplification, the analytics system  9100  includes a network of analytics servers  9070  that are configured to receive data from the surgical hubs  9000 . Each of the analytics servers  9070  can include a memory and a processor coupled to the memory that is executing instructions stored thereon to analyze the received data. In some exemplifications, the analytics servers  9070  are connected in a distributed computing architecture and/or utilize a cloud computing architecture. Based on this paired data, the analytics system  9100  can then learn optimal or preferred operating parameters for the various types of modular devices  9050 , generate adjustments to the control programs of the modular devices  9050  in the field, and then transmit (or “push”) updates to the modular devices’  9050  control programs. 
     Additional detail regarding the computer-implemented interactive surgical system  9060 , including the surgical hub  9000  and various modular devices  9050  connectable thereto, are described in connection with  FIGS.  9 - 10   . 
       FIG.  191    illustrates a logic flow diagram of a process  9200  for updating the control program of a modular device  9050 , in accordance with at least one aspect of the present disclosure. In the following description of the process  9200 , reference should also be made to  FIG.  190   . The process  9200  can be executed by, for example, one or more processors of the analytics servers  9070  of the analytics system  9100 . In one exemplification, the analytics system  9100  can be a cloud computing system. For economy, the following description of the process  9200  will be described as being executed by the analytics system  9100 ; however, it should be understood that the analytics system  9100  includes processor(s) and/or control circuit(s) that are executing the describe steps of the process  9200 . 
     The analytics system  9100  receives  9202  modular device  9050  perioperative data and surgical procedural outcome data from one or more of the surgical hubs  9000  that are communicably connected to the analytics system  9100 . The perioperative data includes preoperative data, intraoperative data, and/or postoperative data detected by a modular device  9050  in association with a given surgical procedure. For modular devices  9050  or particular functions of modular devices  9050  that are manually controlled, the perioperative data indicates the manner in which a surgical staff member operated the modular devices  9050 . For modular devices  9050  or particular functions of modular devices  9050  that are controlled by the modular devices’ control programs, the perioperative data indicates the manner in which the control programs operated the modular devices  9050 . The manner in which the modular devices  9050  function under particular sets of conditions (either due to manual control or control by the modular devices’  9050  control programs) can be referred to as the “operational behavior” exhibited by the modular device  9050 . The modular device  9050  perioperative data includes data regarding the state of the modular device  9050  (e.g., the force to fire or force to close for a surgical stapling and cutting instrument or the power output for an electrosurgical or ultrasonic instrument), tissue data measured by the modular device  9050  (e.g., impedance, thickness, or stiffness), and other data that can be detected by a modular device  9050 . The perioperative data indicates the manner in which the modular devices  9050  were programmed to operate or were manually controlled during the course of a surgical procedure because it indicates how the modular devices  9050  functioned in response to various detected conditions. 
     The surgical procedural outcome data includes data pertaining to an overall outcome of a surgical procedure (e.g., whether there was a complication during the surgical procedure) or data pertaining to an outcome of a specific step within a surgical procedure (e.g., whether a particular staple line bled or leaked). The procedural outcome data can, for example, be directly detected by the modular devices  9050  and/or surgical hub  9000  (e.g., a medical imaging device can visualize or detect bleeding), determined or inferred by a situational awareness system of the surgical hub  9000  as described in U.S. Pat. Application Serial No. 15/940,654, or retrieved from a database  9054  (e.g., an EMR database) by the surgical hub  9000  or the analytics system  9100 . The procedural outcome data can include whether each outcome represented by the data was a positive or negative result. Whether each outcome was positive or negative can be determined by the modular devices  9050  themselves and included in the perioperative data transmitted to the surgical hubs  9000  or determined or inferred by the surgical hubs  9000  from the received perioperative data. For example, the procedural outcome data for a staple line that bled could include that the bleeding represented a negative outcome. Similarly, the procedural outcome data for a staple line that did not bleed could include that the lack of bleeding represented a positive outcome. In another exemplification, the analytics system  9100  can be configured to determine whether a procedural outcome is a positive or negative outcome based upon the received procedural outcome data. In some exemplifications, correlating the modular device  9050  data to positive or negative procedural outcomes allows the analytics system  9100  to determine whether a control program update should be generated  9208 . 
     Upon the analytics system  9100  receiving  9202  the data, the analytics system  9100  analyzes the modular device  9050  and procedural outcome data to determine  9204  whether the modular devices  9050  are being utilized suboptimally in connection with the particular procedure or the particular step of the procedure. A modular device  9050  can be controlled suboptimally if the particular manner in which the modular device  9050  is being controlled is repeatedly causing an error or if an alternative manner of controlling the modular device  9050  is superior under the same conditions. The analytics system  9100  can thus determine whether a modular device  9050  is being controlled suboptimally (either manually or by its control program) by comparing the rate of positive and/or negative outcomes produced by the modular device  9050  relative to set thresholds or the performance of other modular devices  9050  of the same type. 
     For example, the analytics system  9100  can determine whether a type of modular device  9050  is being operated suboptimally if the rate of negative procedural outcomes produced by the modular device  9050  under a particular set of conditions in association with a particular operational behavior exceeds an average or threshold level. As a specific example, the analytics system  9100  can analyze  9204  whether a control program for a surgical stapling instrument that dictates a particular force to fire (or ranges of forces to fire) is suboptimal for a particular tissue thickness and tissue type. If the analytics system  9100  determines that the instrument generates an abnormally high rate of leaky staple lines when fired at the particular force (e.g., causing the staples to be malformed, not fully penetrate the tissue, or tear the tissue) relative to an average or threshold staple line leakage rate, then the analytics system  9100  can determine that the control program for the surgical stapling instrument is performing suboptimally given the tissue conditions. 
     As another example, the analytics system  9100  can determine whether a type of modular device  9050  is being operated suboptimally if the rate of positive outcomes produced by an alternative manner of control under a particular set of conditions in association with a particular operational behavior exceeds the rate of positive outcomes generated by the analyzed manner of control under the same conditions. In other words, if one subpopulation of the type of modular device  9050  exhibits a first operational behavior under a certain set of conditions and a second subpopulation of the same type of modular device  9050  exhibits a second operational behavior under the same set of conditions, then the analytics system  9100  can determine whether to update the control programs of the modular devices  9050  according to whether the first or second operational behavior is more highly correlated to a positive procedural outcome. As a specific example, the analytics system  9100  can analyze  9204  whether a control program for an RF electrosurgical or ultrasonic instrument that dictates a particular energy level is suboptimal for a particular tissue type and environmental conditions. If the analytics system  9100  determines that a first energy level given a set of tissue conditions and environmental conditions (e.g., the instrument being located in a liquid-filled environment, as in an arthroscopic procedure) produces a lower rate of hemostasis than a second energy level, then the analytics system  9100  can determine that the control program for the electrosurgical or ultrasonic instrument dictating the first energy level is performing suboptimally for the given tissue and environmental conditions. 
     After analyzing  9204  the data, the analytics system  9100  determines  9206  whether to update the control program. If the analytics system  9100  determines that the modular device  9050  is not being controlled suboptimally, then the process  9200  continues along the NO branch and the analytics system  9100  continues analyzing  9204  received  9202  data, as described above. If the analytics system  9100  determines that the modular device  9050  is being controlling suboptimally, then the process  9200  continues along the YES branch and the analytics system  9100  generates  9208  a control program update. The generated  9208  control program update includes, for example, a new version of the control program for the particular type of modular device  9050  to overwrite the prior version or a patch that partially overwrites or supplements the prior version. 
     The type of control program update that is generated  9208  by the analytics system  9100  depends upon the particular suboptimal behavior exhibited by the modular device  9050  that is identified by the analytics system  9100 . For example, if the analytics system  9100  determines that a particular force to fire a surgical stapling instrument results in an increased rate of leaking staple lines, then the analytics system  9100  can generate  9208  a control program update that adjusts the force to fire from a first value to a second value that corresponds to a higher rate of non-leaking staple lines or a lower rate of leaking staple lines. As another example, if the analytics system  9100  determines that a particular energy level for an electrosurgical or ultrasonic instrument produces a low rate of hemostasis when the instrument is used in a liquid-filled environment (e.g., due to the energy dissipating effects of the liquid), then the analytics system  9100  can generated  9208  a control program update that adjusts the energy level of the instrument when it is utilized in surgical procedures where the instrument will be immersed in liquid. 
     The type of control program update that is generated  9208  by the analytics system  9100  also depends upon whether the suboptimal behavior exhibited by the modular device  9050  is caused by manual control or control by the control program of the modular device  9050 . If the suboptimal behavior is caused by manual control, the control program update can be configured to provide warnings, recommendations, or feedback to the users based upon the manner in which they are operating the modular devices  9050 . Alternatively, the control program update can change the manually controlled operation of the modular device  9050  to an operation that is controlled by the control program of the modular device  9050 . The control program update may or may not permit the user to override the control program’s control of the particular function. In one exemplification, if the analytics system  9100  determines  9204  that surgeons are manually setting an RF electrosurgical instrument to a suboptimal energy level for a particular tissue type or procedure type, then the analytics system  9100  can generate  9208  a control program update that provides an alert (e.g., on the surgical hub  9000  or the RF electrosurgical instrument itself) recommending that the energy level be changed. In another exemplification, the generated  9208  control program update can automatically set the energy level to a default or recommended level given the particular detected circumstances, which could then be changed as desired by the medical facility staff. In yet another exemplification, the generated  9208  control program update can automatically set the energy level to a set level determined by the analytics system  9100  and not permit the medical facility staff to change the energy level. If the suboptimal behavior is caused by the control program of the modular device  9050 , then the control program update can alter how the control program functions under the particular set of circumstances that the control program is performing suboptimally under. 
     Once the control program update has been generated  9208  by the analytics system  9100 , the analytics system  9100  then transmits  9210  or pushes the control program update to all of the modular devices  9050  of the relevant type that are connected to the analytics system  9100 . The modular devices  9050  can be connected to the analytics system  9100  through the surgical hubs  900 , for example. In one exemplification, the surgical hubs  9000  are configured to download the control program updates for the various types of modular devices  9050  from the analytics system  9100  each time an update is generated  9208  thereby. When the modular devices  9050  subsequently connect to or pair with a surgical hub  9000 , the modular devices  9050  then automatically download any control program updates therefrom. In one exemplification, the analytics system  9100  can thereafter continue receiving  9202  and analyzing  9204  data from the modular devices  9050 , as described above. 
     In one exemplification, instead of the modular devices  9050  transmitting recorded data to a surgical hub  9000  to which the modular devices  9050  are connected, the modular devices  9050  are configured to record the perioperative data and the procedural outcome data on a memory of the modular device  9050 . The data can be stored for indefinitely or until the data is downloaded from the modular devices  9050 . This allows the data to be retrieved at a later time. For example, the modular devices  9050  could be returned to the manufacturer after they are utilized in a surgical procedure. The manufacturer could then download the data from the modular devices  9050  and then analyze the data as described above to determine whether a control program update should be generated for the modular devices  9050 . In one exemplification, the data could be uploaded to an analytics system  9100  for analysis, as described above. The analytics system  9100  could then generate update control programs according to the recorded data and then either incorporate that update in future manufactured product or push the update to modular devices  9050  currently in the field. 
     In order to assist in the understanding of the process  9200  illustrated in  FIG.  191    and the other concepts discussed above,  FIG.  192    illustrates a diagram of an illustrative analytics system  9100  updating a surgical instrument control program, in accordance with at least one aspect of the present disclosure. In one exemplification, a surgical hub  9000  or network of surgical hubs  9000  is communicably coupled to an analytics system  9100 , as illustrated above in  FIG.  190   . The analytics system  9100  is configured to filter and analyze modular device  9050  data associated with surgical procedural outcome data to determine whether adjustments need to be made to the control programs of the modular devices  9050 . The analytics system  9100  can then push updates to the modular devices  9050  through the surgical hubs  9000 , as necessary. In the depicted exemplification, the analytics system  9100  comprises a cloud computing architecture. The modular device  9050  perioperative data received by the surgical  9000  hubs from their paired modular devices  9050  can include, for example, force to fire (i.e., the force required to advance a cutting member of a surgical stapling instrument through a tissue), force to close (i.e., the force required to clamp the jaws of a surgical stapling instrument on a tissue), the power algorithm (i.e., change in power over time of electrosurgical or ultrasonic instruments in response to the internal states of the instrument and/or tissue conditions), tissue properties (e.g., impedance, thickness, stiffness, etc.), tissue gap (i.e., the thickness of the tissue), and closure rate (i.e., the rate at which the jaws of the instrument clamped shut). It should be noted that the modular device  9050  data that is transmitted to the analytics system  9100  is not limited to a single type of data and can include multiple different data types paired with procedural outcome data. The procedural outcome data for a surgical procedure (or step thereof) can include, for example, whether there was bleeding at the surgical site, whether there was air or fluid leakage at the surgical site, and whether the staples of a particular staple line were formed properly. The procedural outcome data can further include or be associated with a positive or negative outcome, as determined by the surgical hub  9000  or the analytics system  9100 , for example. The modular device  9050  data and the procedural outcome data corresponding to the modular device  9050  perioperative data can be paired together or otherwise associated with each other when they are uploaded to the analytics system  9100  so that the analytics system  9100  is able to recognize trends in procedural outcomes based on the underlying data of the modular devices  9050  that produced each particular outcome. In other words, the analytics system  9100  can aggregate the modular device  9050  data and the procedural outcome data to search for trends or patterns in the underlying device modular data  9050  that can indicate adjustments that can be made to the modular devices’  9050  control programs. 
     In the depicted exemplification, the analytics system  9100  executing the process  9200  described in connection with  FIG.  190    is receiving  9202  modular device  9050  data and procedural outcome data. When transmitted to the analytics system  9100 , the procedural outcome data can be associated or paired with the modular device  9050  data corresponding to the operation of the modular device  9050  that caused the particular procedural outcome. The modular device  9050  perioperative data and corresponding procedural outcome data can be referred to as a data pair. The data is depicted as including a first group  9212  of data associated with successful procedural outcomes and a second group  9214  of data associated with negative procedural outcomes. For this particular exemplification, a subset of the data  9212 ,  9214  received  9202  by the analytics system  9100  is highlighted to further elucidate the concepts discussed herein. 
     For a first data pair  9212   a , the modular device  9050  data includes the force to close (FTC) over time, the force to fire (FTF) over time, the tissue type (parenchyma), the tissue conditions (the tissue is from a patient suffering from emphysema and had been subject to radiation), what number firing this was for the instrument (third), an anonymized time stamp (to protect patient confidentiality while still allowing the analytics system to calculate elapsed time between firings and other such metrics), and an anonymized patient identifier ( 002 ). The procedural outcome data includes data indicating that there was no bleeding, which corresponds to a successful outcome (i.e., a successful firing of the surgical stapling instrument). For a second data pair  9212   b , the modular device  9050  data includes the wait time prior the instrument being fired (which corresponds to the first firing of the instrument), the FTC over time, the FTF over time (which indicates that there was a force spike near the end of the firing stroke), the tissue type (1.1 mm vessel), the tissue conditions (the tissue had been subject to radiation), what number firing this was for the instrument (first), an anonymized time stamp, and an anonymized patient identifier ( 002 ). The procedural outcome data includes data indicating that there was a leak, which corresponds to a negative outcome (i.e., a failed firing of the surgical stapling instrument). For a third data pair  9212   c , the modular device  9050  data includes the wait time prior the instrument being fired (which corresponds to the first firing of the instrument), the FTC over time, the FTF over time, the tissue type (1.8 mm vessel), the tissue conditions (no notable conditions), what number firing this was for the instrument (first), an anonymized time stamp, and an anonymized patient identifier ( 012 ). The procedural outcome data includes data indicating that there was a leak, which corresponds to a negative outcome (i.e., a failed firing of the surgical stapling instrument). It should be noted again that this data is intended solely for illustrative purposes to assist in the understanding of the concepts discussed herein and should not be interpreted to limit the data that is received and/or analyzed by the analytics system  9100  to generate control program updates. 
     When the analytics system  9100  receives  9202  perioperative data from the communicably connected surgical hubs  9000 , the analytics system  9100  proceeds to aggregate and/or store the data according to the procedure type (or a step thereof) associated with the data, the type of the modular device  9050  that generated the data, and other such categories. By collating the data accordingly, the analytics system  9100  can analyze the data set to identify correlations between particular ways of controlling each particular type of modular device  9050  and positive or negative procedural outcomes. Based upon whether a particular manner of controlling a modular device  9050  correlates to positive or negative procedural outcomes, the analytics system  9100  can determine  9204  whether the control program for the type of modular device  9050  should be updated. 
     For this particular exemplification, the analytics system  9100  performs a first analysis  9216   a  of the data set by analyzing the peak FTF  9213  (i.e., the maximum FTF for each particular firing of a surgical stapling instrument) relative to the number of firings  9211  for each peak FTF value. In this exemplary case, the analytics system  9100  can determine that there is no particular correlation between the peak FTF  9213  and the occurrence of positive or negative outcomes for the particular data set. In other words, there are not distinct distributions for the peak FTF  9213  for positive and negative outcomes. As there is no particular correlation between peak FTF  9213  and positive or negative outcomes, the analytics system  9100  would thus determine that a control program update to address this variable is not necessary. Further, the analytics system  9100  performs a second analysis  9216   b  of the data set by analyzing the wait time  9215  prior to the instrument being fired relative to the number of firings  9211 . For this particular analysis  9216   b , the analytics system  9100  can determine that there is a distinct negative outcome distribution  9217  and a positive outcome distribution  9219 . In this exemplary case, the negative outcome distribution  9217  has a mean of 4 seconds and the positive outcome distribution has a mean of 11 seconds. Thus, the analytics system  9100  can determine that there is a correlation between the wait time  9215  and the type of outcome for this surgical procedure step. Namely, the negative outcome distribution  9217  indicates that there is a relatively large rate of negative outcomes for wait times of 4 seconds or less. Based on this analysis  9216   b  demonstrating that there is a large divergence between the negative outcome distribution  9217  and the positive outcome distribution  9219 , the analytics system  9100  can then determine  9204  that a control program update should be generated  9208 . 
     Once the analytics system  9100  analyzes the data set and determines  9204  that an adjustment to the control program of the particular module device  9050  that is the subject of the data set would improve the performance of the modular device  9050 , the analytics system  9100  then generates  9208  a control program update accordingly. In this exemplary case, the analytics system  9100  can determine based on the analysis  9216   b  of the data set that a control program update  9218  recommending a wait time of more than 5 seconds would prevent 90% of the distribution of the negative outcomes with a 95% confidence interval. Alternatively, the analytics system  9100  can determine based on the analysis  9216   b  of the data set that a control program update  9218  recommending a wait time of more than 5 seconds would result in the rate of positive outcomes being greater than the rate of negative outcomes. The analytics system  9100  could thus determine that the particular type of surgical instrument should wait more than 5 seconds before being fired under the particular tissue conditions so that negative outcomes are less common than positive outcomes. Based on either or both of these constraints for generating  9208  a control program update that the analytics system  9100  determines are satisfied by the analysis  9216   b , the analytics system  9100  can generate  9208  a control program update  9218  for the surgical instrument that causes the surgical instrument, under the given circumstances, to either impose a 5 second or longer wait time before the particular surgical instrument can be fired or causes the surgical instrument to display a warning or recommendation to the user that indicates to the user that the user should wait at least 5 seconds before firing the instrument. Various other constraints can be utilized by the analytics system  9100  in determining whether to generate  9208  a control program update, such as whether a control program update would reduce the rate of negative outcomes by a certain percentage or whether a control program update maximizes the rate of positive outcomes. 
     After the control program update  9218  is generated  9208 , the analytics system  9100  then transmits  9210  the control program update  9218  for the appropriate type of modular devices  9050  to the surgical hubs  9000 . In one exemplification, when a modular device  9050  that corresponds to the control program update  9218  is next connected to a surgical hub  9000  that has downloaded the control program update  9218 , the modular device  9050  then automatically downloads the update  9218 . In another exemplification, the surgical hub  9000  controls the modular device  9050  according to the control program update  9218 , rather than the control program update  9218  being transmitted directly to the modular device  9050  itself. 
     In one aspect, the surgical system  9060  is configured to push down verification of software parameters and updates if modular devices  9050  are detected to be out of date in the surgical hub  9000  data stream.  FIG.  193    illustrates a diagram of an analytics system  9100  pushing an update to a modular device  9050  through a surgical hub  9000 , in accordance with at least one aspect of the present disclosure. In one exemplification, the analytics system  9000  is configured to transmit a generated control program update for a particular type of modular device  9050  to a surgical hub  9000 . In one aspect, each time a modular device  9050  connects to a surgical hub  9000 , the modular device  9050  determines whether there is an updated version of its control program on or otherwise accessible via the surgical hub  9000 . If the surgical hub  9000  does have an updated control program (or the updated control program is otherwise available from the analytics system  9100 ) for the particular type of modular device  9050 , then the modular device  9050  downloads the control program update therefrom. 
     In one exemplification, any data set being transmitted to the analytics systems  9100  includes a unique ID for the surgical hub  9000  and the current version of its control program or operating system. In one exemplification, any data set being sent to the analytics systems  9100  includes a unique ID for the modular device  9050  and the current version of its control program or operating system. The unique ID of the surgical hub  9000  and/or modular device  9050  being associated with the uploaded data allows the analytics system  9100  to determine whether the data corresponds to the most recent version of the control program. The analytics system  9100  could, for example, elect to discount (or ignore) data generated by a modular device  9050  or surgical hub  9000  being controlled by an out of date control program and/or cause the updated version of the control program to be pushed to the modular device  9050  or surgical hub  9000 . 
     In one exemplification, the operating versions of all modular devices  9050  the surgical hub  9000  has updated control software for could also be included in a surgical hub  9000  status data block that is transmitted to the analytics system  9100  on a periodic basis. If the analytics system  9100  identifies that the operating versions of the control programs of the surgical hub  9100  and/or any of the connectable modular devices  9050  are out of date, the analytics system  9100  could push the most recent revision of the relevant control program to the surgical hub  9000 . 
     In one exemplification, the surgical hub  9000  and/or modular devices  9050  can be configured to automatically download any software updates. In another exemplification, the surgical hub  9000  and/or modular devices  9050  can be configured to provide a prompt for the user to ask at the next setup step (e.g., between surgical procedures) if the user wants to update the out of date control program(s). In another exemplification, the surgical hub  9000  could be programmable by the user to never allow updates or only allow updates of the modular devices  9050  and not the surgical hub  9000  itself. 
     Adaptive Control Program Updates for Surgical Hubs 
     As with the modular devices  9050  described above, the surgical hubs  9000  can likewise include control programs that control the various operations of the surgical hub  9000  during the course of a surgical procedure. If the surgical hubs’  9000  control programs do not adapt over time in response to collected data, then the surgical hubs  9000  may continue to repeat errors, not provide warnings or recommendations to the surgical staff based on learned information, and not adjust to the surgical staff’s preferences. One solution includes transmitting operational data from the surgical hubs  9000  that indicates how the surgical hubs  9000  are being utilized or controlled during the course of a surgical procedure to an analytics system  9100 . The analytics system  9100  can then analyze the data aggregated from the network of surgical hubs  9000  connected to the analytics system  9100  to determine if a particular manner of operating the surgical hubs  9000  corresponds to improved patient outcomes or is otherwise preferred across the population of the surgical hubs  9000 . In one exemplification, if a particular manner in which the surgical hubs  9000  are operated satisfies a defined condition or set of conditions, then the analytics system  9100  can determine that this particular manner should be implemented across the network of surgical hubs  9000 . The analytics system  9100  can generate an update to the surgical hubs’  9000  control program to fix or improve the control program and then push the update to the surgical hubs  9000  so that the improvement is shared across every surgical hub  9000  that is connected to the analytics system  9100 . For example, if a threshold number of the surgical hubs  9000  are controlled in a particular manner and/or if a particular manner of controlling the surgical hubs  9000  correlates to an improvement in the surgical procedure outcomes that exceeds a threshold level, then the analytics system  9100  can generate a control program update that controls the surgical hubs  9000  in a manner corresponding to the preferred or improved manner of control. The control program update can then be pushed to the surgical hubs  9000 . 
     In one exemplification, an analytics system  9100  is configured to generate and push control program updates to surgical hubs  9000  in the field based on perioperative data relating to the manner in which the surgical hubs  9000  are controlled or utilized. In other words, the surgical hubs  9000  can be updated with improved decision-making abilities according to data generated from the hub network. In one aspect, external and perioperative data is collected by an analytics system. The data is then analyzed to generate a control update to improve the performance of the surgical hubs  9000 . The analytics system  9100  can analyze the data aggregated from the surgical hubs  9000  to determine the preferred manner for the surgical hubs  9000  to operate, under what conditions the surgical hubs’  9000  control programs are controlling the surgical hubs  9000  suboptimally (i.e., if there are repeated faults or errors in the control program or if an alternative algorithm performs in a superior manner), or under what conditions medical personnel are utilizing the surgical hubs  9000  suboptimally. The analytics system  9100  can then push the update to the surgical hubs  9000  connected thereto. 
       FIG.  194    illustrates a diagram of a computer-implemented adaptive surgical system  9060  that is configured to adaptively generate control program updates for surgical hubs  9000 , in accordance with at least one aspect of the present disclosure. The surgical system  9060  includes several surgical hubs  9000  that are communicably coupled to the analytics system  9100 . Subpopulations of surgical hubs  9000  (each of which can include individual surgical hubs  9000  or groups of surgical hubs  9000 ) within the overall population connected to the analytics system  9100  can exhibit different operational behaviors during the course of a surgical procedure. The differences in operational behavior between groups of surgical hubs  9000  within the population can result from the surgical hubs  9000  running different versions of their control program, by the surgical hubs’  9000  control programs being customized or programmed differently by local surgical staff, or by the local surgical staff manually controlling the surgical hubs  9000  differently. In the depicted example, the population of surgical hubs  9000  includes a first subpopulation  9312  that is exhibiting a first operational behavior and a second subpopulation  9314  that is exhibiting a second operational behavior for a particular task. Although the surgical hubs  9000  are divided into a pair of subpopulations  9312 ,  9314  in this particular example, there is no practical limit to the number of different behaviors exhibited within the population of surgical hubs  9000 . The tasks that the surgical hubs  9000  can be executing include, for example, controlling a surgical instrument or analyzing a dataset in a particular manner. 
     The surgical hubs  9000  can be configured to transmit perioperative data pertaining to the operational behavior of the surgical hubs  9000  to the analytics system  9100 . The perioperative data can include preoperative data, intraoperative data, and postoperative data. The preoperative data can include, for example, patient-specific information, such as demographics, health history, preexisting conditions, preoperative workup, medication history (i.e., medications currently and previously taken), genetic data (e.g., SNPs or gene expression data), EMR data, advanced imaging data (e.g., MRI, CT, or PET), metabolomics, and microbiome. Various additional types of patient-specific information that can be utilized by the analytics system  9100  are described by U.S. Pat. No. 9,250,172, U.S. Pat. Application No. 13/631,095, U.S. Pat. Application No. 13/828,809, and U.S. Pat. No. 8,476,227, each of which is incorporated by reference herein to the extent that they describe patient-specific information. The preoperative data can also include, for example, operating theater-specific information, such as geographic information, hospital location, operating theater location, operative staff performing the surgical procedure, the responsible surgeon, the number and type of modular devices  9050  and/or other surgical equipment that could potentially be used in the particular surgical procedure, the number and type of modular devices  9050  and/or other surgical equipment that are anticipated to be used in the particular surgical procedure, patient identification information, and the type of procedure being performed. 
     The intraoperative data can include, for example, modular device  9050  utilization (e.g., the number of firings by a surgical stapling instrument, the number of firings by an RF electrosurgical instrument or an ultrasonic instrument, or the number and types of stapler cartridges utilized), operating parameter data of the modular devices  9050  (e.g., the FTF curve for a surgical stapling instrument, a FTC curve for a surgical stapling instrument, the energy output of a generator, the internal pressure or pressure differential of a smoke evacuator), unexpected modular device  9050  utilization (i.e., the detection of the utilization of a modular device that is nonstandard for the procedure type), adjunctive therapies administered to the patient, and utilization of equipment other than the modular devices  9050  (e.g., sealants to address leaks). The intraoperative data can also include, for example, detectable misuse of a modular device  9050  and detectable off-label use of a modular device  9050 . 
     The postoperative data can include, for example, a flag if the patient does not leave the operating theater and/or is sent for nonstandard postoperative care (e.g., a patient undergoing a routine bariatric procedure is sent to the ICU after the procedure), a postoperative patient evaluation relating to the surgical procedure (e.g., data relating to a spirometric performance after a thoracic surgery or data relating to a staple line leakage after bowel or bariatric procedures), data related to postoperative complications (e.g., transfusions or air leaks), or the patient’s length of stay in the medical facility after the procedure. Because hospitals are increasingly being graded on readmission rates, complication rates, average length of stay, and other such surgical quality metrics, the postoperative data sources can be monitored by the analytics system  9100  either alone or in combination with surgical procedural outcome data (discussed below) to assess and institute updates to the controls programs of the surgical hubs 9000 and/or modular devices  9050 . 
     In some exemplifications, the intraoperative and/or postoperative data can further include data pertaining to the outcome of each surgical procedure or a step of the surgical procedure. The surgical procedural outcome data can include whether a particular procedure or a particular step of a procedure had a positive or negative outcome. In some exemplifications, the surgical procedural outcome data can include procedure step and/or time stamped images of modular device  9050  performance, a flag indicating whether a modular device  9050  functioned properly, notes from the medical facility staff, or a flag for poor, suboptimal, or unacceptable modular device  9050  performance. The surgical procedural outcome data can, for example, be directly detected by the modular devices  9050  and/or surgical hub  9000  (e.g., a medical imaging device can visualize or detect bleeding), determined or inferred by a situational awareness system of the surgical hub  9000  as described in U.S. Pat. Application Serial No. 15/940,654, or retrieved from a database  9054  (e.g., an EMR database) by the surgical hub  9000  or the analytics system  9100 . In some exemplifications, perioperative data including a flag indicating that a modular device  9050  failed or otherwise performed poorly during the course of a surgical procedure can be prioritized for communication to and/or analysis by the analytics system  9100 . 
     In one exemplification, the perioperative data can be assembled on a procedure-by-procedure basis and uploaded by the surgical hubs  9000  to the analytics system  9100  for analysis thereby. The perioperative data indicates the manner in which the surgical hubs  9000  were programmed to operate or were manually controlled in association with a surgical procedure (i.e., the operational behavior of the surgical hubs  9000 ) because it indicates what actions the surgical hub  9000  took in response to various detected conditions, how the surgical hubs  9000  controlled the modular devices  9050 , and what inferences the situationally aware surgical hubs  9000  derived from the received data. The analytics system  9100  can be configured to analyze the various types and combinations of preoperative, intraoperative, and post-operative data to determine whether a control program update should be generated and then push the update to the overall population or one or more subpopulations of surgical hubs  9000 , as necessary. 
       FIG.  195    illustrates a logic flow diagram of a process  9300  for updating the control program of a surgical hub  9000 , in accordance with at least one aspect of the present disclosure. During the following description of the process  9300 , reference should also be made to  FIGS.  190  and  194   . The process  9200  can be executed by, for example, one or more processors of the analytics servers  9070  of the analytics system  9100 . In one exemplification, the analytics system  9100  can be a cloud computing system. For economy, the following description of the process  9300  will be described as being executed by the analytics system  9100 ; however, it should be understood that the analytics system  9100  includes processor(s) and/or control circuit(s) that are executing the describe steps of the process  9300 . 
     The analytics system  9100  executing the process  9300  receives  9302  perioperative data from the surgical hubs  9000  that are communicably connected to the analytics system  9100 . The perioperative data indicates the manner in which the surgical hubs  9000  are programmed to operate by their control programs or are controlled by the surgical staff during a surgical procedure. In some aspects, the perioperative data can include or being transmitted to the analytics system  9100  in association with surgical procedural outcome data. The surgical procedural outcome data can include data pertaining to an overall outcome of a surgical procedure (e.g., whether there was a complication during the surgical procedure) or data pertaining to a specific step within a surgical procedure (e.g., whether a particular staple line bled or leaked). 
     After an analytics system  9100  executing the process  9300  has received  9302  the perioperative data, the analytics system  9100  then analyzes  9304  the data to determine whether an update condition has been satisfied. In one exemplification, the update condition includes whether a threshold number or percentage of surgical hubs  9000  within the population exhibit a particular operational behavior. For example, the analytics system  9100  can determine that a control program update should be generated to automatically active an energy generator at a particular step in a type of surgical procedure when a majority of the surgical hubs  9000  are utilized to active the energy generator at that procedural step. In another exemplification, the update condition includes whether the rate of positive procedural outcomes (or lack of negative procedural outcomes) correlated to a particular operational behavior exceeds a threshold value (e.g., an average rate of positive procedural outcomes for a procedure step). For example, the analytics system  9100  can determine that a control program update should be generated to recommend that the energy generator be set at a particular energy level when the associated rate of hemostasis (i.e., lack of bleeding) at that energy level for the particular tissue type exceeds a threshold rate. In another exemplification, the update condition includes whether the rate of positive procedural outcomes (or lack of negative procedural outcomes) for a particular operational behavior is higher than the rate of positive procedural outcomes (or a lack of negative procedural outcomes) for related operational behaviors. In other words, if one subpopulation of surgical hubs  9000  exhibits a first operational behavior under a certain set of conditions and a second subpopulation of surgical hubs  9000  exhibits a second operational behavior under the same set of conditions, then the analytics system  9100  can determine whether to update the control programs of the surgical hubs  9000  according to whether the first or second operational behavior is more highly correlated to a positive procedural outcome. In another exemplification, the analytics system  9100  analyzes  9304  the data to determine whether multiple update conditions have been satisfied. 
     If an update condition has not been satisfied, the process  9300  continues along the NO branch and the analytics system  9100  continues receiving  9302  and analyzing  9304  perioperative data from the surgical hubs  9000  to monitor for the occurrence of an update condition. If an update condition has been satisfied, the process  9300  continues along the YES branch and the analytics system  9100  proceeds to generate  9308  a control program update. The nature of the generated  9308  control program update corresponds to the particular operational behavior of the surgical hub  9000  that is identified by the analytics system  9100  as triggering the update condition. In other words, the control program update adds, removes, or otherwise alters functions performed by the surgical hub  9000  so that the surgical hub  9000  operates differently under the conditions that gave rise to the identified operational behavior. Furthermore, the type of control program update also depends upon whether the identified operational behavior results from manual control or control by the control program of the surgical hub  9000 . If the identified operational behavior results from manual control, the control program update can be configured to provide warnings, recommendations, or feedback to the users based upon the manner in which they are operating the surgical hub  9000 . For example, if the analytics system  9100  determines that taking a particular action or utilizing a particular instrument for a step in a surgical procedure improves outcomes, then the analytics system  9100  can generate  9308  a control program update that provides a prompt or warning to the surgical staff when the surgical hub  9000  determines that the designated step of the surgical procedure is occurring or will subsequently occur. Alternatively, the control program update can change one or more functions of the surgical hub  9000  from being manually controllable to being controlled by the control program of the surgical hub  9000 . For example, if the analytics system  9100  determines that a display of the visualization system  108  ( FIG.  2   ) is set to a particular view by the surgical staff in a predominant number of surgical procedures at a particular step, the analytics system  9100  can generate a control program update that causes the surgical hub  9000  to automatically change the display to that view under those conditions. If the identified operational behavior results from the control program of the surgical hub  9000 , then the control program update can alter how the control program functions under the set of circumstances that cause the identified operational behavior. For example, if the analytics system  9100  determines that a particular energy level for an RF electrosurgical or ultrasonic instrument correlates to poor or negative outcomes under a certain set of conditions, then the analytics system  9100  can generate  9308  a control program update that causes the surgical hub  9000  to adjust the energy level of the connected instrument to a different value when the set of conditions is detected (e.g., when the surgical hub  9000  determines that an arthroscopic procedure is being performed). 
     The analytics system  9100  then transmits  9310  the control program update to the overall population of surgical hubs  9000  or the subpopulation(s) of surgical hubs  9000  that are performing the operational behavior that is identified by the analytics system  9100  as triggering the update condition. In one exemplification, the surgical hubs  9000  are configured to download the control program updates from the analytics system  9100  each time an update is generated  9308  thereby. In one exemplification, the analytics system  9100  can thereafter continue the process  9300  of analyzing  9304  the data received  9302  from the surgical hubs  9000 , as described above. 
       FIG.  196    illustrates a representative implementation of the process  9300  depicted in  FIG.  195   .  FIG.  196    illustrates a logic flow diagram of a process  9400  for updating the data analysis algorithm of a control program of a surgical hub  9000 , in accordance with at least one aspect of the present disclosure. As with the process  9300  depicted in  FIG.  195   , the process  9400  illustrated in  FIG.  196    can, in one exemplification, be executed by the analytics system  9100 . In the following description of the process  9400 , reference should also be made to  FIG.  194   . In one exemplification of the adaptive surgical system  9060  depicted in  FIG.  194   , the first surgical hub subpopulation  9312  is utilizing a first data analysis algorithm and the second surgical hub subpopulation  9314  is utilizing a second data analysis algorithm. For example, the first surgical hub subpopulation  9312  can be utilizing a normal continuous probability distribution to analyze a particular dataset, whereas the second surgical hub subpopulation  9314  can be utilizing a bimodal distribution for analyzing the particular dataset. In this exemplification, the analytics system  9100  receives  9402 ,  9404  the perioperative data from the first and second surgical hub subpopulations  9312 ,  9314  corresponding to the respective data analysis algorithms. The analytics system  9100  then analyzes  9406  the perioperative datasets to determine whether one of the perioperative datasets satisfies one or more update conditions. The update conditions can include, for example, a particular analysis method being utilized by a threshold percentage (e.g., 75%) of the surgical hubs  9000  in the overall population and a particular analysis method being correlated to positive surgical procedural outcomes in a threshold percentage (e.g., 50%) of cases. 
     In this exemplification, the analytics system  9100  determines  9408  whether one of the data analysis algorithms utilized by the first and second surgical hub subpopulations  9312 ,  9314  satisfies both of the update conditions. If the update conditions are not satisfied, then the process  9400  proceeds along the NO branch and the analytics system  9100  continues receiving  9402 ,  9404  and analyzing  9406  perioperative data from the first and second surgical hub subpopulations  9312 ,  9314 . If the update conditions are satisfied, the process  9400  proceeds along the YES branch and the analytics system  9100  generates  9412  a control program update according to which of the data analysis algorithms the analysis  9406  determined satisfied the update conditions. In this exemplification, the control program update would include causing the surgical hub  9000  to utilize the data analysis algorithm that satisfied the update conditions when performing the corresponding analysis type. The analytics system  9100  then transmits  9414  the generated  9412  control program update to the population of surgical hubs  9000 . In one exemplification, the control program update is transmitted  9414  to the entire population of surgical hubs  9000 . In another exemplification, the control program update is transmitted  9414  to the subpopulation of surgical hubs  9000  that did not utilize the data analysis algorithm that satisfied the update conditions. In other words, if the analytics system  9100  analyzes  9406  the perioperative data and determines  9408  that the second (bimodal) data analysis method satisfies the update conditions, then the generated  9412  control program update is transmitted  9414  to the first subpopulation of surgical hubs  9000  in this exemplification. Furthermore, the control program update can either force the updated surgical hubs  9000  to utilize the second (bimodal) data analysis algorithm when analyzing the particular dataset or cause the updated surgical hubs  9000  to provide a warning or recommend to the user that the second (bimodal) data analysis algorithm be used under the given conditions (allowing the user to choose whether to follow the recommendation). 
     This technique improves the performance of the surgical hubs  9000  by updating their control programs generated from data aggregated across the entire network of surgical hubs  9000 . In effect, each surgical hub  9000  can be adjusted according to shared or learned knowledge across the surgical hub  9000  network. This technique also allows the analytics system  9100  to determine when unexpected devices (e.g., modular devices  9050 ) are utilized during the course of a surgical procedure by providing the analytics system  9100  with knowledge of the devices being utilized in each type of surgical procedure across the entire surgical hub  9000  network. 
     Security and Authentication Trends and Reactive Measures 
     In a cloud-based medical system communicatively coupled to multiple communication and data gathering centers located in different geographical areas, security risks are ever present. The cloud-based medical system may aggregate data from the multiple communication and data gathering centers, where the data collected by any data gathering center may originate from one or more medical devices communicatively coupled to the data gathering center. It may be possible to connect an unauthorized medical device to the data gathering center, such as a pirated device, a knock-off or counterfeit device, or a stolen device. These devices may contain viruses, may possess faulty calibration, lack the latest updated settings, or otherwise fail to pass safety inspections that can be harmful to a patient if used during surgery. Furthermore, the multiple data gathering centers may contain multiple points of entry, such as multiple USB or other input ports, or opportunities to enter user passwords, that if improperly accessed could represent security breaches that can reach the cloud-based medical system, other data gathering centers, and connected medical devices. The risk of devices being tampered with, or data being stolen or manipulated, can lead to severe consequences, particularly because the entire system is purposed for improving medical care. 
     A security system that reaches all facets of the cloud-based medical system may not be effective unless there is a centralized component that is configured to be made aware of all communication and data gathering centers, and all devices connected therein. If the security systems were merely localized to each data gathering center or at each point of entry, information from one point of entry may not be properly disseminated to other security points. Thus, if a breach occurs at one point, or if improper devices are used at one point, that information may not be properly disseminated to the other centers or devices. Therefore, a centralized security system, or at least a system configured to communicate with all medical hubs that control access points, would be preferable to be made aware of all of the different issues that may occur and to communicate those issues to other ports as needed. 
     In some aspects, the cloud-based medical system includes a security and authentication system that is configured to monitor all communication and data gathering centers, such as a medical hub or tower located in an operating room, as well as any smart medical instruments communicatively coupled to those centers. The cloud-based security and authentication system, as part of the cloud-based medical system, may be configured to detect unauthorized or irregular access to any hub system or other protected data sets contained within the cloud. Because of the centralized nature of the cloud-based security system - in the sense that the cloud system is configured to communicate with every hub in the system - if there is any identified irregularity found at one hub, the security system is operable to improve security at all other hubs by communicating this information to the other hubs. For example, if surgical instruments with unauthorized serial numbers are used at a hub in one hospital, the cloud-based security system may learn of this at the local hub located in that hospital, and then communicate that information to all other hubs in the same hospital, as well as all hospitals in the surrounding region. 
     In some aspects, the cloud-based medical system may be configured to monitor surgical devices and approve or deny access for each surgical device for use with a surgical hub. Each surgical device may be registered with a hub, by performing an authentication protocol exchange with the hub. The cloud-based medical system may possess knowledge of all surgical devices and a status indicating whether the surgical device is acceptable, such as whether the device has been pirated, lacks a proper serial number, was faulty, possesses a virus, as so on. The cloud-based medical system may then be configured to prevent interaction with the surgical device, even if the surgical device is connected to the hub. 
     In this way, the cloud-based security system can provide the most comprehensive security for any particular hub or medical facility due to its ability to see problems located elsewhere. 
       FIG.  197    provides an illustration of example functionality by a cloud medical analytics system  10000  for providing improved security and authentication to multiple medical facilities that are interconnected, according to some aspects. Starting at block A reference  10002 , suspicious activity may be registered from one facility or region as a starting point. The suspicious activity may come in various forms. For example, a surgical device may be recorded at a hub as having a duplicate serial number, or a number that is not known to be within an acceptable range, or that the serial number may already be registered at a different location. In some aspects, surgical devices may possess additional authentication mechanisms, such as a type of electronic or digital handshake exchange between the surgical device and the surgical hub when they are connected. Each device may be programmed with a digital signature and/or knowledge of how to perform an authentication process. The firmware of the surgical device may need to be properly programmed to know how to perform during this exchange. The authentication handshake may periodically change, and may be specified by the cloud on a periodic basis. Any of these may fail during interconnection of the device with a medical hub, triggering an alert with the medical hub and the cloud system  10000 . 
     In some aspects, the cloud system  10000  may review the information supplied by the medical device that triggered the suspicious activity, and if the information is unequivocally fraudulent or faulty, an alert and a rejection of the device can occur, such that the medical device will be prevented from operating with the medical hub and/or other medical hubs in the same facility. While the cloud system  10000  may be configured to prevent singularities, the cloud system  10000  may also be capable of utilizing its vast array of knowledge to develop additional security measures that a single hub as an entry port would be unable to perform on its own. An example is described further below. 
     At block B reference  10004 , the activity at the local medical hub may be transmitted to the cloud for authentication by at least comparing the surgical device to all known devices within the cloud network. In this scenario, the surgical device may register as being suspicious or having some suspicious activity or property. The cloud may be configured to then undergo a feedback loop of exchange with the local hub or facility from which the suspicious device originated. The cloud may determine to request additional data from that facility. In addition, the medical facility, via one or more surgical hubs, may request authentication or interrogation data about one or more surgical devices from the cloud. In this example, a medical hub in a facility in Texas requests a communication exchange with the cloud system  10000  for more data to determine if the suspicious activity at one of its local hubs is truly problematic. 
     At block C reference  10006 , the cloud authentication and security system may then be configured to perform additional data analysis to determine the veracity of any threat and larger context of the nature of this suspicious activity. In this example, the cloud-based security system has performed analysis and brings to light at least two pieces of evidence of a security threat, which is expressed visually in the chart of block C. First, upon comparing the number of data requests and medical interrogations across multiple medical facilities, it is determined that the current requesting facility in Texas has an inordinate number of data requests or medical interrogations compared to all other facilities. The cloud may be configured to flag this as one security issue that needs to be addressed. Second, in comparison to the number of data requests, the number of suspicious data points or findings is also inordinately high at the Texas facility. One or both of these realizations may prompt the cloud security system to enact different security changes at the Texas facility in particular. 
     Thus, at block D reference  10008 , in response to the identified anomalous behavior of the facilities in Texas as a whole, the cloud security system may request additional data related to Texas to better understand the nature of the practices and potential threats. For example, additional data regarding purchasing practices, vendors, the type of surgical instruments being used, the type of surgical procedures performed in comparison to other facilities, and so forth, may be obtained from one or more surgical hubs at the Texas facility, or may be accessed in data already stored in the cloud system  10000 . The cloud security system may be configured to look for additional anomalies and patterns that may help determine how to change security procedures specific to the Texas facility, or the facilities in the Texas region generally. 
     At block E reference  10010 , once the additional information has been gathered and analyzed, the cloud security system may initiate a changed security protocol for the Texas facility in particular that triggered this analysis from block A, as well as any new security procedures for any surgical devices that indicate a unique or above average threat. For example, it may be determined that a particular type of surgical devices, such as devices originating from a particular manufacturing facility or having a particular set of unique identification numbers, may be faulty, pirated, or have some other kind of security risk. The cloud system  10000  may have analyzed the suspicious data points originating from the Texas region, determined if there were any commonalities or patterns, and issued a change in security protocol based on these identified patterns. These devices may then be locked out from use at all surgical hubs, even if they are not connected to any surgical hub at the present time. Other example changes regarding security include modifying the types of data gathered to learn more about the types of threats or how widespread the threats are. For example, the suspicious activity in Texas may exhibit a certain pattern or authentication signature of attempting to login in with the system, and so this pattern may be placed on an alert to other facilities in Texas and/or to other facilities to pay special attention to. In some cases, the pattern of suspicious activity may be correlated with another indicator, such as a brand or manufacturer, or a series of serial numbers. The cloud system may send out alerts to those facilities known to associate with these correlated indicators, such as all facilities that utilize medical devices with the same manufacturer. 
     In addition, an augmented authentication procedure may be enacted at the localized Texas region. The cloud-security system may opt to perform additional authentication protocols for all devices originating out of the Texas facility, for example. These additional protocols may not be present or required at other facilities, since there is considered a lower level of security risk based on the lack of suspicious activity. 
     In some aspects, as alluded to previously, the cloud-based security system may also be configured to protect against unwanted intrusions, either to any hub or to the cloud system itself. This means that the suspect medical device may be unable to access any data from any medical hub, and may also be prevented from operating if it is connected to a medical hub. In a medical system utilizing the cloud system and multiple medical hubs, the common protocol may require that only medical devices connected to a medical hub are authorized to operate on a patient, and therefore the medical hub will have the capability of preventing a device from activating. The limitation of any faulty or fraudulent surgical device may be designed to protect a patient during a surgical procedure, and it can also be used to protect any surgical hub and the cloud itself. The same lockout procedure may be designed to stop both scenarios from occurring. 
     In some aspects, the surgical hub may be configured to transmit data to the cloud security system that better characterizes the nature of the security flaws or intrusions. For example, the cloud security system may be configured to store in memory the number of intrusion attempts, the source of the intrusion attempt (e.g., from which surgical hub or even what port or connection via the surgical hub), and what method for attempted intrusion there is, if any (e.g., virus attack, authentication spoofing, etc.). 
     In some aspects, the cloud security system may also determine what types of behaviors by a surgical device or other functions by a surgical hub are irregular, compared to a global average or just by each institution. The cloud security system may better identify what practices seem irregular in this way. The data logs of any surgical hub, or across an entire facility, may be recorded and securely stored in the cloud system. The cloud security system may then analyze the attempted access requests and actions to determine trends, similarities and differences across regions or institutions. The cloud security system may then report any irregularities to the institution and flag any identified irregularities for internal investigation into updates to protect against future breaches. Of note, a local hub or local facility with multiple hubs may not realize if any of their authentication behaviors are irregular, unless they are compared to a broader average or comparison of other facilities. The cloud system may be configured to identify these patterns, because it has access to authentication data and procedures from these multiple facilities. 
     In some aspects, the cloud security system may be configured to analyze any current hub control program versions and when it was updated. The cloud security system may verify all updates are correct, and determine where their origins are. This may be an additional check to ensure that the software and firmware systems of the surgical devices are proper and have not been tampered with. 
     In some aspects, the cloud security system may also determine larger threats by analyzing multiple facilities at once. The system may determine, after aggregating data from multiple locations, any trends or patterns of suspicious activity across a wider region. The security system may then change security parameters across multiple facilities immediately or in near real time. This may be useful to quickly react to simultaneous attacks, and may make it even easier to solve simultaneous attacks by gathering data from the multiple attacks at once to better increase the chances and speed of finding a pattern to the attacks. Having the cloud system helps confirm whether attacks or suspicious activity occurs in isolation or is part of a grander scheme. 
     Data Handling and Prioritization 
     Aspects of the present disclosure are presented for a cloud computing system (computer-implemented interactive surgical system as described above) for providing data handling, sorting, and prioritization, which may be applied to critical data generated during various medical operations. The cloud computing system constitutes a cloud-based analytics system, communicatively coupled to a plurality of surgical hubs  7006  and smart medical instruments such as surgical instruments  7012 . Typically, a healthcare facility, such as a hospital or medical clinic, does not necessarily immediately recognize the criticality of data as it is generated. For example, if a medical instrument used during a perioperative period experiences a failure, the response of medical care facility personnel such as nurses and doctors may be directed towards diagnosis of any medical complications, emergency medical assistance, and patient safety generally. In this situation, the criticality of the data might not be analyzed in a time sensitive manner, or at all. Accordingly, the healthcare facility does not necessarily timely respond to or even recognize critical data as such data is generated. Additionally, a particular healthcare facility can lack knowledge of the management of critical data from other similarly situated facilities, either in its region, according to a similar size, and/or according to similar practices or patients, and the like. The cloud-based analytics system may be specifically designed to address this issue of critical data and particularly the timing of data handling that is performed based on the criticality of data within the context of healthcare facility operations. The cloud-based analytics system may quickly and efficiently identify critical data based on specific criteria. In some situations, aggregate data is determined to be critical after the individual noncritical data comprising the aggregated data are aggregated. As used herein, handling critical data (which could be aggregated) may refer to data sorting, prioritizing, and other data handling based on specific criteria or thresholds. 
     To help facilitate timely and improved data sorting, handling, and prioritization, it would be desirable if a common source connected to multiple healthcare facilities could sort, handle, and prioritize critical data from these medical facilities in a holistic manner. In this way, insights could be generated by the common source based on using this aggregated data from the multiple healthcare facilities. In various aspects, the cloud-based analytics system comprises the cloud  7004  that is communicatively coupled to knowledge centers in a medical facility, such as one or more surgical hubs  7006 , and is configured to sort, handle, and prioritize medical data from multiple healthcare facilities. In particular, the cloud-based system can identify critical data and respond to such critical data based on the extent of the associated criticality. For example, the cloud-based system could prioritize a response as requiring urgent action based on the critical data indicating a serious perioperative surgical instrument  7012  failure, such as one that requires intensive care unit (ICU) postoperative treatment. The data handling, sorting, and prioritization described herein may be performed by the processors  7008  of the central servers  7013  of the cloud  7004  by, for example, executing one or more data analytics modules  7034 . 
     Critical data can be determined to be critical based on factors such as severity, unexpectedness, suspiciousness, or security. Other criticality criteria can also be specifically selected such as by a healthcare facility. Criticality can also be indicated by flagging a surgical instrument  7012 , which in turn can be based on predetermined screening criteria, which could be the same or different as the factors described above. For example, a surgical instrument  7012  can be flagged based on its usage being correlated with severe post surgical operation complications. Flagging could also be used to trigger the prioritized data handling of the cloud-based analytics system. In connection with a determination of criticality or flagging a surgical instrument  7012 , the cloud  7004  can transmit a push message or request to one or more surgical hubs  7006  for additional data associated with the use of the surgical instrument  7012 . The additional data could be used for aggregating data associated with the surgical instrument  7012 . For example, after receiving the additional data, the cloud  7004  may determine there is a flaw in the surgical instrument  7012  (e.g., malfunctioning generator in an energy surgical instrument) that is common to other corresponding surgical instruments  7012  in a particular healthcare facility. Accordingly, the cloud  7004  could determine that all such flawed surgical instruments  7012  should be recalled. These flawed surgical instruments  7012  might share a common identification number or quality or a common aspect of a unique identifier, such as a serial number family identifier. 
     In general, the cloud-based analytics system may be capable of aggregating, sorting, handling, and prioritizing data in a timely and systematic manner that a single healthcare facility would not be able to accomplish on its own. The cloud-based analytics system further can enable timely response to the aggregated, sorted, and prioritized data by obviating the need for multiple facilities to coordinate analysis of the particular medical data generated during medical operations at each particular facility. In this way, the cloud-based system can aggregate data to determine critical data or flagging for enabling appropriate responses across the entire network of surgical hubs  7006  and instruments  7012 . Specifically, appropriate responses include sorting, handling, and prioritization by the cloud  7004  according to a priority status of the critical data, which can enable timely and consistent responses to aggregated critical data (or critical aggregated data) across the entire network. Criticality of the data may be defined universally and consistently across all surgical hub  7006  and instruments  7012 . Furthermore, the cloud-based analytics system may be able to verify the authenticity of data from the plurality of medical facilities before such data is assigned a priority status or stored in the aggregated medical data databases. As with the categorization of critical data, data verification can also be implemented in a universal and consistent manner across the system which a single facility may not be able to achieve individually. 
       FIG.  198    is a flow diagram of the computer-implemented interactive surgical system programmed to use screening criteria to determine critical data and to push requests to a surgical hub to obtain additional data, according to one aspect of the present disclosure. In one aspect, once a surgical hub  7006  receives device data  11002  from a surgical instrument  7012  data may be flagged and/or determined to be critical based on predetermined screening criteria. As shown in  FIG.  198   , the hub  7006  applies  11004  the screening criteria to flag devices and to identify critical data. The screening criteria include severity, unexpectedness, suspiciousness, and security. Severity can refer to the severity of any adverse medical consequences resulting from an operation performed using the surgical instrument  7012 . Severity could be assessed using a severity threshold for surgical instrument  7012  failures. For example, the severity threshold could be a temporal or loss rate threshold of bleeding such as over 1.0 milliliters per minute (mL/min). Other suitable severity thresholds could be used. Unexpectedness can refer to a medical parameter of a deviation that exceeds a threshold such as an amount of standard deviation from the mean medical parameter value such as a determined tissue compression parameter significantly exceeding the expected mean value at a time during an operation. 
     Suspiciousness can refer to data that appears to have been improperly manipulated or tampered with. For example, the total therapeutic energy applied to tissue value indicated by the data may be impossible given a total amount energy applied via the generator of the surgical instrument  7012 . In this situation, the impossibility of the data suggests improper manipulation or tampering. Similarly, security can refer to improperly secured data, such as data including a force to close parameter that was inadvertently deleted. The screening criteria also may be specified by a particular surgical hub  7006  or by the cloud  7004 . The screening criteria can also incorporate specific thresholds, which can be used for prioritization, for example. In one example, multiple severity thresholds can be implemented such that the extent of perioperative surgical instrument  7012  failures can be sorted into multiple categories according to the multiple severity thresholds. In particular, the multiple severity thresholds could be based on the number of misaligned staples from a stapling surgical instrument  7012  to reflect an extent of the severity of misalignment. By using the cloud-based analytic system, the cloud may systemically identify critical data and flag surgical instruments  7012  for providing a timely and appropriate response which an individual healthcare facility could not achieve on its own. This timely response by the cloud 7004 can be especially advantageous for severe post surgical operation complications. 
     Determining critical data and flagging the surgical instrument  7012  by the hub  7006  may include determining a location to store data. Data may be routed or stored based on whether the data is critical and whether the corresponding surgical instrument  7012  is flagged. For example, binary criteria can be used to sort data into two storage locations, namely, a memory of a surgical hub  7006  or the memory  7010  of the cloud  7004 . Surgical instruments  7012  generate this medical data and transmit such data, which is denoted as device data  11002  in  FIG.  198   , to their corresponding surgical hub devices  7006 .  FIG.  198    illustrates an example of this binary sorting process. Specifically, in one aspect, the data routing can be determined based on severity screening criteria as shown at the severity decision steps  11006 ,  11008 . At step  11006 , the hub  7006  determines  11006  whether the surgical instrument  7012  that provided the device data  11002  has experienced a failure or malfunction during operation at the perioperative stage and whether this failure is considered severe. The severity thresholds discussed above or other suitable means could be used to determine whether the failure is severe. For example, severe failure may be determined based on whether undesirable patient bleeding occurred during use or firing of the surgical instrument. If the determination at step  11006  is yes, the corresponding data (i.e., critical data) of the surgical instrument  7012  is transmitted  11012  by the hub  7006  to the cloud  7004 . Conversely, if the determination at step  11006  is no, the flow diagram may proceed to step  11008 . 
     If the determination at step  11006  is no, then the flow diagram proceeds to step  11008  in  FIG.  198   , where the surgical hub  7006  determines whether the patient transitioned to nonstandard post-operation care (i.e. the ICU) after the operation was performed with the specific surgical instrument  7012 . However, even if the determination at step  11006  is no, the inquiry at step  11008  may still be performed. If the determination at step  11008  is yes, then the critical device data  11002  is transmitted to the cloud  7004 . For example, the determination at step  11008  is yes if a patient transitioned into the ICU from the operating room subsequent to a routine bariatric surgical procedure. Upon transfer of a patient into the ICU, the surgical hub  7006  may receive a timely signal from the surgical instrument  7012  used to perform the bariatric procedure indicating that the patient has experienced complications necessitating entry into the ICU. Since this signal indicates the step  11008  determination is yes, corresponding device data  11002  is sent  11012  to the cloud  7004 . Additionally, the specific surgical instrument  7012  may be flagged by the cloud  7004  for a prompt specific response by the cloud  7004 , such as designating the surgical instrument  7012  with a prioritization of requiring urgent action. If the determination at step  11008  is no, a signal can be transmitted from the surgical instrument  7012  to the surgical hub  7006  indicating that the procedure was successful. In this scenario, the device data  11002  can be stored  11010  locally in a memory device of the surgical hub  7006 . 
     Additionally or alternatively, the specific surgical instrument  7012  may also be flagged by the hub  7006  or the cloud  7004  to trigger data handling by the cloud  7004 , which can comprise an internal response of the cloud  7004 . When the surgical instrument  7012  is flagged or the device data  11002  is determined to be critical, the triggered response may be the cloud  7004  transmitting a signal comprising a request for additional data regarding the surgical instrument  7012 . Additional data may pertain to the critical device data  11002 . The cloud  7004  can also request additional data even if the specific surgical instrument  7012  is not flagged, such as if the device data  11002  is determined to be critical without the surgical instrument  7012  being flagged. Flagging could also indicate an alarm or alert associated with the surgical instrument  7012 . In general, the hub  7006  is configured to execute determination logic for determining whether the device data  11002  should be sent to the cloud  7004 . The determination logic can be considered screening criteria for determining criticality or flagging surgical instruments  7012 . Besides the severity thresholds used at steps decision steps  11006 ,  11008 , the data routing can be based on frequency thresholds (e.g., the use of a surgical instrument  7012  exceeds a usage quantity threshold such as a number of times an energy generator is used), data size thresholds, or other suitable thresholds such as the other screening criteria discussed above. Flagging may also result in storing a unique identifier of the specific surgical instrument in a database of the cloud-based system. 
     A triggered request  11014  for additional data by the cloud  7004  to the hub  7006  may be made based on a set of inquiries as shown in  FIG.  198   . This triggered request  11014  may be a push request sent by the central servers  7013  of the cloud  7004 . In particular, the processors  7008  can execute the data collection and aggregation data analytic module  7022  to implement this trigger condition functionality. This push request may comprise an update request sent by the cloud  7004  to the hub  7006  to indefinitely collect new data associated with the device data  11002 . That is, the hub  7006  may collect additional data until the cloud  7004  transmits another message rescinding the update request. The push request could also be a conditional update request. Specifically, the push request could comprise initiating a prompt for the hub  7006  to send additional information only if certain conditions or events occur. For example, one condition might be if the sealing temperature used by the surgical instrument  7012  to treat tissue exceeds a predetermined threshold. The push request could also have a time bounding component. In other words, the push request could cause the surgical hub  7006  to obtain additional data for a specific predetermined time period, such as three months. The time period could be based on an estimated remaining useful life of the surgical instrument  7012 , for example. As discussed above, the request  11014  for additional data may occur after the specific surgical instrument  7012  is flagged, which may be due to an affirmative determination at steps  11006 ,  11008  described above. 
     As shown in  FIG.  198   , the triggered request  11014  for additional data may include four inquiries that can be considered trigger conditions for additional information. At the first inquiry, the hub  7006  determines  11016  whether the device data  11002  represents an outlier with no known cause. For example, application of therapeutic energy to tissue during a surgical procedure by the surgical instrument  7012  may cause patient bleeding even though surgical parameters appear to be within a normal range (e.g., temperature and pressure values are within expected range). In this situation, the critical device data  11002  indicates an irregularity without a known reason. The outlier determination  11016  can be made based on comparison of the device data  11002  to an expected value or based on a suitable statistical process control methodology. For example, an actual value of the device data  11002  may be determined to be an outlier based on a comparison of the actual value to a mean expected (i.e., average) value. Calculating that the comparison is beyond a certain threshold can also indicate an outlier. For example, a statistical process control chart could be used to monitor and indicate that the difference between the actual and expected value is a number of standard deviations beyond a threshold (e.g., 3 standard deviations). If the device data  11002  is determined to be an outlier without a known reason, the request  11014  is triggered by the cloud  7004  to the hub  7006 . In response, the hub  7006  timely transmits  11024  additional information to the cloud  7004 , which may provide different, supporting, or additional information to diagnose the reason for the outlier. Other insights into the outlier may also be derived in this way. For example, the cloud  7004  may receive additional surgical procedure parameter information such as the typical clamping force used by other surgical instruments  7012  at the same point in the surgical procedure when the patient bleeding occurred. The expected value may be determined based on aggregated data stored in the aggregated medical data database  7012 , such as by averaging the outcomes or performance of groups of similarly situated surgical instruments  7012 . If at step  11016 , the data is not determined to be an outlier, the flow diagram proceeds to step  11018 . 
     The second inquiry is another example of a trigger condition. At step  11018 , the hub  7006  determines  11018  whether device data  11002  involves data that can be classified as suspicious, which can be implemented by the authorization and security module  7024 . For example, suspicious data may include situations in which an unauthorized manipulation is detected. These include situations where the data appears significantly different than expected so as to suggest unauthorized tampering, data or serial numbers appear to be modified, security of surgical instruments  7012  or corresponding hub  7006  appears to be comprised. Significantly different data can refer to, for example, an unexpected overall surgical outcome such as a successful surgical procedure occurring despite a surgical instrument  7012  time of usage being significantly lower than expected or a particular unexpected surgical parameter such as a power level applied to the tissue significantly exceeding what would be expected for the tissue (e.g., calculated based on a tissue impedance property). Significant data discrepancies could indicate data or serial number modification. In one example, a stapling surgical instrument  7012  may generate a separate unique staple pattern in a surgical operation which may be used to track or verify whether the serial number of that stapling surgical instrument  7012  is subsequently modified. Furthermore, data or serial number modification such as tampering may be detected via other associated information of a surgical instrument  7012  that can be independently verified with the aggregated medical data databases  7011  or some other suitable data modification detection technique. 
     Moreover, compromised security, such as unauthorized or irregular access to any surgical hub  7006  or other protected data sets stored within the cloud  7004  can be detected by a cloud-based security and authentication system incorporating the authorization and security module  7024 . The security and authentication system can be a suitable cloud based intrusion detection system (IDS) for detecting compromised security or integrity. The cloud IDS system can analyze the traffic (i.e. network packets) of the cloud computing network  7001  or collect information (e.g., system logs or audit trails) at various surgical hub  7006  for detecting security breaches. Compromised security detection techniques include comparison of collected information against a predefined set of rules corresponding to a known attack which is stored in the cloud  7004  and anomaly based detection. The cloud  7004  can monitor data from a series of surgical operations to determine whether outliers or data variations significantly reduce without an apparent reason, such as a reduction without a corresponding change in parameters of used surgical instruments  7012  or a change in surgical technique. Additionally, suspiciousness can be measured by a predetermined suspiciousness or unexpectedness threshold, unauthorized modification of device data  11002 , unsecure communication of data, or placement of the surgical instrument  7012  on a watch list (as described in further detail below). The suspiciousness or unexpectedness threshold can refer to a deviation (e.g., measured in standard deviations) that exceeds surgical instrument  7012  design specifications. Unauthorized data communication or modification can be determined by the authorization and security module  7024  when the data encryption of the cloud  7004  is violated or bypassed. In sum, if the hub  7006  determines  11018  the data is suspicious for any of the reasons described above, the request  11014  for additional data may be triggered. In response, the hub  7006  timely transmits  11024  additional information to the cloud  7004 , which may provide different, supporting, or additional information to better characterize the suspiciousness. If at step  11018 , the answer to the second inquiry is no, the flow diagram proceeds to step  11020 . 
     The third and fourth inquiries depict additional trigger conditions. At step  11020 , the hub  7006  may determine that device data  11002  indicates a unique identifier of the surgical instrument  7012  that matches an identifier maintained on a watchlist (e.g., “black list” of prohibited devices). As described above, the “black list” is a watch list that can be maintained as a set of database records comprising identifiers corresponding to prohibited surgical hubs  7006 , surgical instruments  7012 , and other medical devices. The black list can be implemented by the authorization and security module  7024 . Moreover, surgical instruments  7012  on the black list may be prevented from fully functioning or restricted from access with surgical hubs  7006 . For example, an energy surgical instrument  7012  may be prevented from functioning (i.e. an operational lockout) via the cloud  7004  or surgical hub  7006  transmitting a signal to the hub  7006  or surgical instrument  7012  to prevent the generator from applying power to the energy surgical instrument  7012 . This operational lockout can generally be implemented in response to an irregularity indicated by the critical device data  11002 . Surgical instruments can be included on the black list for a variety of reasons such as the authorization and security module  7012  determining the presence of counterfeit surgical instruments  7012  using internal authentication codes, unauthorized reselling of surgical instruments  7012  or related products from one region to another, deviation in performance of surgical instruments  7012  that is nonetheless within design specifications, and reuse of surgical instruments  7012  or related products that are designed for single patient use. For example, internal authentication codes may be unique identifiers maintained by the cloud  7004  in the memory devices  7010 . Other unauthorized usage could also result in placement on the black list. 
     The use of counterfeit authentication codes may be a security breach that is detectable by the cloud IDS system. Reselling of surgical instruments  7012  into other regions could be detected via region specific indicators of resold surgical instrument  7012  or surgical hubs  7006 , for example. The region specific indicator could be encrypted using a suitable encryption technique. In this way, the cloud  7004  may detect when the region specific indicators of a resold surgical instrument  7012  do not match the corresponding region of intended use. Reuse of a single use surgical instrument  7012  can be monitored by detecting tampering with a lockout mechanism (e.g., a stapler cartridge lockout mechanism of a stapling surgical instrument), programming a microprocessor of the single use surgical instrument  7012  to transmit a warning signal to the corresponding surgical hub  7006  when more than one use occurs, or another suitable detection technique. Performance deviation could be monitored using statistical process control methods as described above. The design specifications of particular surgical instruments  7012  may be considered the control limits of a statistical process control methodology. In one example, when detected by the cloud  7004 , a significant trend toward one of the lower or upper control limits constitutes a sufficient deviation that results in the cloud  7004  adding the corresponding surgical instrument to the black list. As discussed above, a deviation that exceeds design specifications may result determining  11018  the device data  11002  is suspicious. Surgical instruments  7012  may be added to or removed from the black list by the cloud  7004  based on analysis of the requested additional data. In sum, if the hub  7006  determines  11020  the surgical instrument  7012  corresponding to the device data  11002  is on the watchlist, the request  11014  for additional data may be triggered. In response, the hub  7006  timely transmits  11024  additional information to the cloud  7004 , which may provide different, supporting, or additional information. If at step  11020 , the answer to the second inquiry is no, the flow diagram proceeds to step  11022 . 
     The trigger condition at step  11022  comprises the hub  70006  determining whether the device data  11002  indicates the surgical instrument  7012  has malfunctioned. In one aspect, a surgical instrument  7012  malfunction results in an automated product inquiry through the corresponding surgical hub  7006 . The hub  7006  sending  11024  additional data to the cloud  7004  may comprise all pertinent data of the surgical instrument  7012  being immediately transmitted to the cloud through the surgical hub  7006 , which may result in central server  7013  processors  7008  of the cloud  7004  executing an automated product inquiry algorithm. However, such an algorithm may not be immediately executed or at all if the malfunction is not significant. The cloud  7004  may be configured to record this set of pertinent data for all surgical instruments  7012  for contingent use when such automated product inquiries are instituted. The automated product inquiry algorithm comprises the cloud  7004  searching for previous incidents that are related to the malfunction. The cloud  7004  may populate a group of records in the aggregated medical data databases  7011  with any incidents or activity related to the malfunction. Subsequently, a corrective and preventive action (CAPA) portion of the algorithm may be instituted for reducing or eliminating such malfunctions or non-conformities. CAPA and the automated product inquiry algorithm are one example of a possible internal response  11102  of the cloud  7004  of the cloud-based analytics system. 
     CAPA involves investigating, recording and analyzing the cause of a malfunction or non-conformity. To implement CAPA, the cloud  7004  may analyze the populated related records in the aggregated medical data databases  7011 , which may include aggregated data fields such as surgical instrument  7012  manufacture dates, times of use, initial parameters, final state/parameters, and surgical instrument  7012  numbers of uses. Thus, both individual and aggregated data maybe used. In other words, the cloud  7004  may analyze both individual data corresponding to the malfunctioning surgical instrument  7012  as well as aggregated data, collected from all related surgical instruments  7012  to the malfunctioning surgical instrument  7012 , for example. Initial and final parameters may be, for example, an initial and final frequency of an applied RF signal of the surgical instrument. CAPA can also involve analysis of the previous time period from when the malfunction occurred or was detected. Such a time period can be, for example, one to two minutes. Based on this CAPA analysis, the cloud  7004  may diagnose the root cause of the malfunction and recommend or execute any suitable corrective action (e.g., readjusting miscalibrated parameters). The automated product inquiry algorithm can also involve a longer follow up of patient outcomes for patients treated with the specific surgical instrument  7012 . 
     For example, the cloud  7004  may determine a priority status of watch list for the surgical instrument  7012  so that the surgical instrument  7012  may be monitored for a period of time after the malfunction is detected and addressed. Moreover, the malfunction may cause the cloud  7004  to expand a list of medical items to be tracked (e.g., the integrity of tissue seals made during surgery). This list of items to be tracked may be performed in conjunction with the patient outcome monitoring by the patient outcome analysis module  7028 . The cloud  7004  may also respond to an irregularity indicated by the malfunction by monitoring patient outcomes corresponding to the irregularity. For example, the cloud  7004  can monitor whether the irregularity corresponds to unsuccessful surgical operations for a predetermined amount of time such as 30 days. Any corrective action also can be assessed by the cloud  7004 . Other data fields can also be monitored in addition to the fields discussed above. In this way, the cloud may timely diagnose and respond to surgical instrument  7012  malfunctions using individual and aggregate data in a manner that an individual healthcare facility could not achieve. 
     In one aspect, if the answer to any of steps  11016 ,  11018 ,  11020 ,  11022  (i.e. trigger conditions) is affirmative (i.e. the trigger condition is activated), then additional data associated or pertinent to the device data  11002  is sent to the cloud  7004 , as can be seen in  FIG.  198   . This additional data may be handled by the data sorting and prioritization module  7032  while the patient outcome analysis module  7028  may analyze the data, for example. In contrast, if the answer to all of steps  11016 ,  11018 ,  11020 ,  11022  is negative, then the respective data is stored  11026  within the corresponding surgical hub  7006 . Thus, when the answer at step  11022  is no, the device data  11002  may be stored locally within the hub  7006  and no additional data is requested of the hub  7006 . Alternatively, the device data may be sent to the cloud  7006  for storage within the memory devices  7010 , for example, without any triggered requests  11014  by the cloud  7004  for additional data. Steps  11016 ,  11018 ,  11020 ,  11022  could also be used for identifying critical data or flagging the surgical instrument (if the specific surgical device has not already been flagged based on steps  11006 ,  11008 ) as part of the screening criteria applied at step  11004 . Other trigger conditions aside from steps  11016 ,  11018 ,  11020 ,  11022  are also possible for triggering the request  11014  for additional data. The request can be sent to all surgical hubs  7006  or a subset thereof. The subset can be geographically specific such that, for example, if surgical hub  7006  used in healthcare facilities located in Illinois and Iowa have malfunctioned in a similar manner, only surgical hub  7006  corresponding to healthcare facilities in the Midwestern United States are requested  11014  for additional information. The requested additional data can be different or supporting data concerning the particular use of surgical instruments  7012  so that the cloud  7004  may gain additional insight into the source of the irregularity, as represented by steps  11016 ,  11018 ,  11020 ,  11022 . For example, if malfunctioning surgical instruments  7012  are causing undesirable patient bleeding, the cloud  7004  may request timing information regarding this bleeding for help in potentially diagnosing why the malfunction is causing the bleeding. 
     The criticality of data can be identified based on the screening criteria as described above, or by any other suitable data analysis technique. In one aspect, as shown in  FIG.  199   , when the critical data is determined, an internal analytic response  11102  of the cloud  7004  may commence. The internal analytic response  11102  can advantageously be made in a timely manner such as in real time or near real time. As discussed above, the criticality of data can be identified based on the severity of an event, the unexpected nature of the data, the suspiciousness of the data, or some other screening criteria (e.g., an internal business flag). The determination of critical data can involve a request generated by a surgical hub  7006  based on the surgical hub  7006  detecting an irregularity or failure of a corresponding surgical instrument  7012  or of a component of the surgical hub  7006  itself. The request by the surgical hub  7006  may comprise a request for a particular prioritization or special treatment of critical data by the cloud  7004 . In various aspects, the cloud internal analytic response  11102  could be to escalate an alarm or response based on the frequency of the event associated with the critical device data  11002 , route the device data  11002  to different locations within the cloud computing system, or exclude the device data  11002  from the aggregated medical data databases  7011 . In addition, the cloud  7004  could also automatically alter a parameter of a malfunctioning surgical instrument  7012  so that modifications for addressing the malfunction can be implemented in real time or near real time. In this manner, even malfunctions that are not readily detected by a clinician in a healthcare facility, for example, may still be advantageously addressed in a timely manner by the cloud  7004 . 
       FIG.  199    is a flow diagram of an aspect of responding to critical data by the computer-implemented interactive surgical system, according to one aspect of the present disclosure. In particular, the internal analytic response  11102  by the cloud  7004  can include handling critical data which includes determining a priority status to determine a time component or prioritization of the response. The response  11102  itself may be based on an operational characteristic indicated by the critical data, such as the characteristics described above in connection with the screening criteria or the trigger conditions of  FIG.  198   . The internal response  11102  may be implemented by the data sorting and prioritization module  7032  as well as the data collection and aggregation module  7022 . As shown in  FIG.  199   , in the prioritization branch of the flow diagram (labeled as Q1 in  FIG.  199   ) the cloud may incorporate the binary decision of whether to exclude the critical data from the aggregated medical data databases  7011  with a priority escalation decision framework. At step  11104  of  FIG.  199   , the cloud  7004  determines whether the critical data should be excluded from the aggregated medical data databases  7011 . The exclusion determination may be considered a threshold determination. 
     It can be desirable to exclude critical data from the aggregated medical data databases  7011  for verification purposes. For example, critical data that is flagged or designated for special routing may be placed on a hold list maintained by the cloud  7004 . The hold list is maintained at a separate storage location in the memory  7010  relative to the aggregated medical data databases  7011  within the cloud  7004 , such as the caches  7018 . The excluded critical data could also be stored in a more permanent storage location in the memory  7010 . Accordingly, if the answer to step  11104  is yes, the cloud  7004  stores  11118  the critical data in the hold list. The cloud  7004  may then validate or verify that the critical device data  11002  is accurate. For example, the cloud  7004  may analyze whether the device data  11002  is logical in light of a corresponding patient outcome or analyze additional associated data of the device data  11002 . Upon proper verification, the device data  11002  may also be stored within the aggregated medical data databases  7011 . But if the device data  11002  is not verified, the cloud  7004  may not include the unverified device data  11002  in the priority escalation decision framework. That is, before verification, the device data  11002  may not be assigned a priority status according to the priority status classification  11106  for the internal cloud response  11102 . 
     However, if the device data  11002  is verified, the flow diagram may proceed to the priority status classification  11106 . Accordingly, if the answer to the exclusion determination at step  11104  is no, the device data  11002  is prioritized according to the priority escalation decision framework, which can define a predetermined escalation method for handling critical data. As shown in  FIG.  199   , a predetermined escalation prioritization system  11106  (i.e., priority escalation decision framework) can comprise four categories, including watch list, automated response, notification, and urgent action required. This predetermined escalation prioritization system  11106  can be considered a form of triage based on classifying critical data according a priority status and escalating between statuses based on particular thresholds. For example, priority can be escalated based on a frequency of event threshold such as the number of misaligned staples fired by a stapling surgical instrument  7012  over a predetermined number of surgical operations. Multiple staggered frequency or other thresholds could also be used. The lowest priority level of the priority status classification  11106  is the watch list level designated at level A. As discussed above, the watch list may be a black list maintained in the memory  7010  as a set of database records of identifiers corresponding to prohibited surgical hubs  7006 . Surgical hubs  7006  can be prohibited to different extents depending on the nature of the critical device data  11002  or additional data. For example, surgical hubs  7006  may be partially locked out such that only the device components experiencing problems are prevent from functioning. Alternatively, surgical hub  7006  on the watch list may not be restricted from functioning in any way. Instead, the surgical hubs  7006  may be monitored by the cloud  7004  for any additional irregularities that occur. Accordingly, the watch list is designated at level A, the least urgent priority status. As shown in the priority status classification  11106 , the automated response at level B is the next most urgent priority status. An automated response could be, for example, an automated initial analysis of the device data  11002  by the patient outcome analysis module  7028  of the cloud  7004  via a set of predefined diagnostic tests. 
     The third most urgent priority status is notification, which is designated at level C of the priority status classification  11106 . In this situation, the cloud  7004  transmits a wireless signal to a healthcare facility employee, clinician, healthcare facility department, or other responsible party depending on the nature of the device data  11002 . The notification signal can be received at a receiver device located at a suitable location within the healthcare facility, for example. Receiving the notification signal can be indicated by a vibration or sound to notify the responsible party at the healthcare facility. The holder of the receiver device (e.g., a healthcare facility clinician) may then conduct further analysis of the critical device data  11002  or additional data or other analysis for resolving an indicated irregularity. If a solution to the irregularity is known, the solution may be timely implemented. The most urgent priority status as depicted in the priority status classification  11106  is urgent action required, which is designed at level D. Urgent action required indicates that a responsible party, device or instrument should immediately analyze and diagnose the problem implicated by the critical data. Upon proper diagnosis, an appropriate response should immediately be performed. In this way, the cloud  7004  may implement a comprehensive approach to critical data prioritization and triaging that no individual medical facility could achieve on its own. Critical data may be handled in a timely manner according to suitable priority levels which can address solving time sensitive problems that arise in the healthcare field. Moreover, the cloud  7004  can prioritize aggregated critical data from all healthcare facilities categorized within a particular region. Accordingly, the time sensitive prioritized approach to handling critical data can be applied system wide, such as to a group of healthcare facilities. Furthermore, the cloud  7004  can generate an alert for a responsible party to respond to critical data (and associated issues implicated by such critical data) in a timely way such as in real time or in near real time according to a corresponding priority status. This alert can be received by a suitable receiver of the responsible party. The priority status of the device data  11002  could also be determined based on the severity of the surgical issue implicated by the device data  11002 . As discussed above, the cloud  7004  may receive additional data from surgical hubs  7006  or surgical instruments  7012  (via the hubs  7006 ) which causes the cloud  7004  to elevate the priority status of the device data  11002 . 
     In one aspect, based on a priority status, the device data  11002  may be subject to the flagging screening at a specific time depending on priority. For example, the device data  11002  may be indicated as critical data but not yet flagged. Additionally, the device data  11002  may first receive an automated response level of priority according to the priority status classification  11106 . In this situation, the severity determination at step  11108  may be relatively quickly in accordance with the level B of priority. Specifically, step  11108  may be reached without first placing the surgical instrument  7012  on a watch list. The severity threshold used at step  11108  can be the same or different from the severity threshold used in  11006 . Aside from the severity determination at step  11108 , other determinations pertinent to the irregularity indicated by the critical device data  11002  or additional data may be made. These determinations may be used to diagnose the occurrence of a critical event. Accordingly, if the answer at step  11108  is yes, the frequency of the event may be assessed at step  11110 . Conversely, if the answer at step  11108  is no, the device data  11002  or additional data can be stored  11118  in the hold list. Additionally or alternatively, the device data  11002  or additional data can be routed to different storage locations within the cloud  7004  according to the routing branch of the flow diagram (labeled as Q2 in  FIG.   199   ). The cloud  7004  may wait for a request from the hub  7006  for alternative routing  11120  of the device data  11002  or additional data. At step  11110 , the cloud  7004  determines the frequency that the critical event is occurring. Based on this frequency, the priority status assigned according to the priority status classification  11106  can be escalated (see step  11116 ). For example, the critical event may be the generator of the surgical instrument  7012  is applying an insufficient sealing temperature to therapeutically treat tissue. In other words, the inquiry of step  11110  inquires whether the medical event implicated by the critical data is occurring at an increasing frequency after the problem was initially identified. 
     An increase in the number of times this insufficient sealing temperature occurs can be monitored to escalate priority status at step  11116 , based on frequency thresholds (see step  11112 ), for example. If at step  11110 , the event is not increasing in frequency, the data can be stored  11118  in the hold list. If the answer at step  11110  is yes (i.e., the event is increasing in frequency), the flow diagram proceeds to step  11112 . At step  11112 , another data verification inquiry is made. In particular, specific thresholds such as the frequency thresholds described above may be applied to determine whether the combination of device data  11002  or additional data is sufficiently correct to ensure that the critical data should be added to the aggregated medical data databases  7011 . Furthermore, the data verification inquiry at step  11112  may comprise a decision regarding whether the sample size of the critical data is sufficiently large (i.e., reached critical mass). Additionally or alternatively, the sample size is analyzed for whether there is sufficient information to determine an appropriate internal response  11102  of the cloud  7004 . The data verification inquiry can also comprise verifying the accuracy of the data by comparison to predetermined standards or verification tests. If the answer to the inquiry at step  11112  is negative, then the critical data is stored within the separate storage location (e.g., hold list) in the cloud  7004 . If the answer to the inquiry at step  11110  is affirmative, the device data  11002  or additional data is added to the aggregated medical data databases  7011 . At step  11116 , the priority status of the device data  11002  or additional data is increased according to the priority status classification  11106 . However, besides the event frequency determination, the addition to the aggregated medical data databases  7011  may itself be an action that results in an elevation of the priority status of the critical data at step 7. In any case, the priority status of the device data  11002  or additional data may be escalated or deescalated as appropriate based on additional analysis or data, for example. An internal response  11102  of the cloud  7004  may be made according to the current priority status (i.e., one of levels A-D) of the critical data. 
     In addition to prioritizing critical data, the internal response  11102  of the cloud  7004  can also involve advantageously routing, grouping, or sorting critical data the aggregated critical data in a timely manner. In particular, the data may be routed to different storage locations within the cloud  7004 , such as in the memory devices  7010 . This routing is illustrated by routing branch of the flow diagram labeled as Q2 in  FIG.  199    at step  11120 . As such, the memory devices  7010  of the central servers  7013  of the cloud  7004  can be organized into various locations that correspond to a characteristic of the critical data or a response corresponding to the critical data. For example, the total memory capability of the memory devices  7010  may be divided into portions that only store data according to individual data routing categories, such as those used at steps  11122 ,  11124 ,  11126 . As shown at step  11120  of  FIG.  199   , the critical data may be routed to different various cloud storage locations. Step  11120  can occur in conjunction with or separately from the prioritization branch of the flow diagram. Step  11120  may be triggered by a request generated by a hub  7006 . The hub  7006  may transmit such a request because of detecting a failure or irregularity associated with a surgical instrument  7012 , for example. The associated critical data may then receive alternative routing  11120  by the cloud  7004  to different cloud storage locations. At step  11122 , the alternative routing  11120  can comprise geographical location based routing. That is, the different cloud storage locations may correspond to location based categorization of the cloud memory devices  7010 . Various subsets of the cloud memory devices  7010  can correspond to various geographical regions. For example, surgical instruments produced from a manufacturing plant in Texas could be grouped together in storage within the cloud memory devices  7010 . In another example, surgical instruments produced from a specific manufacturing company can be categorized together in the cloud memory devices  7010 . Therefore, location based categorization can comprise the cloud  7004  routing critical data based on associations with different manufacturing sites or operating companies. 
     At step  11124 , the alternative routing  11120  can comprise routing for device data  11002  or additional data that requires a rapid internal response  11102  of the cloud  7004 . This alternative routing  11120  at step  11124  could be integrated with the priority status classification  11106 . For example, escalated or urgent priority critical data, such as those at priority level C and D, may be routed by the cloud  7004  to rapid response portions of the memory devices  7010  to enable a rapid response. For example, such critical data may be routed to rapid response caches  7018  which signifies that a rapid response is necessary. At step  11126 , device data  11002  or additional data that implicates a failure of a type that requires special processing are routed to a special processing portion of the memory devices  7010 . For example, a surgical instrument  7012  may be determined to have experienced a failure or malfunction during operation based on a control program deficiency common to a whole group of surgical instruments  7012 . In this situation, special processing may be required to transmit a collective control program update to the group of surgical instruments  7012 . Accordingly, the cloud may route the critical data to the special processing portion of the memory devices  7010  to trigger this special processing. Subsequently, the special processing could also include the patient outcome analysis data analytics module  7028  analyzing and monitoring the effect of the control program update on patient outcomes. The patient outcome analysis module  7028  may also execute an automated product inquiry algorithm as discussed above if necessary. 
       FIG.  200    is a flow diagram of an aspect of data sorting and prioritization by the computer-implemented interactive surgical system, according to one aspect of the present disclosure. This sorting and prioritization may be implemented by the data sorting and prioritization module  7032 , the data collection and aggregation module  7022 , and patient outcome analysis module  7028 . As discussed above, critical device data  11002  or additional data can implicate or correspond to various medical events, such as events 1 through 3 as depicted in  FIG.  200   . An event may be for example, a shift from a phase of tissue treatment to another phase such as a shift from a phase corresponding to cutting with the specific surgical instrument to a phase corresponding to coagulation. In  FIG.  200   , critical data associated with a first medical event  11202  is detected by the surgical hub  7006  and transmitted to the cloud  7004 . Upon receiving the critical data, the cloud  7004  analyzes the critical data at step  11208  to determine that it is comparable to an expected value of the critical data, as described above for example at step  11016 . When the critical data is determined as comparable (i.e., the value of the critical data is expected), the critical data may be aggregated within a large data set in the aggregated medical data databases  7011 , for example. That is, at step  11216 , the critical data is stored within the aggregated databases of the cloud. As shown in  FIG.  200   , the critical data is also subject to a binary classification at steps  11218 ,  11220 . For example, the critical data can be distinguished by good properties and bad properties. The data sorting and prioritization modules can classify the critical data as associated with a bleeding or a non-bleeding event, for example. In this way, the patient outcome analysis module  7028  may classify critical data as corresponding to a positive patient outcome at step  11218  or a negative patient outcome at step  11210 . 
       FIG.  200    also shows the critical data associated with a second medical event  11204  is detected by the surgical hub  7006  and transmitted to the cloud  7004 . The critical data associated with the second medical event  11204  is determined by the cloud to be suspicious or unusual data at step  11210 , which is a trigger condition as described above with reference to step  11118 . Accordingly, the cloud  7004  is triggered to request  11114  additional data from the surgical hub  7006  at step  11212  by transmitting a push message to the surgical hub  7006 . As discussed above, the additional data may enable the patient outcome analysis module  7028  of the cloud  7004  to gain additional insight into the source of the irregularity implicated by the critical data. If the patient outcome analysis module  7028  sufficiently diagnoses the cause of the second medical event  11214 , the critical data or associated additional data is aggregated into the aggregated medical data databases  7011  at step  11216  (see also step  11114 ). Subsequently, the critical data or additional data is classified according to the good/bad binary classification at steps  11218 ,  11220 . If the cloud  7004  cannot sufficiently diagnose the cause of the second medical event  11204 , the process may proceed to step  11224 , in which the critical data is evaluated by a suitable person or department of the corresponding medical facility. Step  11224  can include the threshold data exclusion determination at step  11104 . That is, because a good reason cannot be readily determined for the suspicious or unusual data, the data may be stored in a hold list in accordance with step  11118 . Additionally, the device data  11002  or additional data may be designated at priority status level C, which triggers the evaluation at step  11224  (i.e., healthcare facility employee, clinician, healthcare facility department, or other responsible party evaluates the data). 
     As illustrated in  FIG.  200   , the critical data associated with a third medical event  11206  is detected by the surgical hub  7006  and transmitted to the cloud  7004 . The critical data associated with the third medical event  11206  is determined by the cloud  7004  to indicate that the corresponding surgical instrument  7012  is experiencing a failure or malfunction at step  11220 . As discussed above, severity thresholds can be used to determine whether the failure is severe. The failure or malfunction may refer back to the trigger condition at step  11022  in  FIG.  198    such that the surgical instrument malfunction results in an automated product inquiry through the surgical hub  7006 . As discussed above, the automated product inquiry algorithm may comprise the patient outcome analysis module  7028  searching for data of related incidents stored within the cloud  7004  (e.g., the memory devices  7010 ). The data of related incidents can include video, manufacturer, temporal, and other suitable types of data. Depending on the results of the automated product inquiry, the third medical event  11206  critical data can be prioritized according to priority status classification  11106 . Thus, for example, the inquiry may result in a suspicious or unusual result without a sufficient reason, so the critical data is designated at priority level C. In this connection, a suitable person or department of the corresponding medical facility evaluates the critical data and the results of the automated product inquiry at step  11224 . The results of the evaluation could be, for example, that the results constitute an error to be disregarded at step  11226  or that the results require additional special processing via the patient outcome analysis module  7028  at step  11228  (see also step  11126 ). Such special processing at step  11228  can be the CAPA portion of the automated product inquiry algorithm, as described above. Thus, the cloud-based analytics system may generate timely alerts for triggering a response by the suitable person or department in real time or near real time. 
     In general, the cloud-based analytics system described herein may determine critical data and perform timely data handling, sorting, and prioritizing based on priority status and specific thresholds as described above. Accordingly, the cloud-based analytics system advantageously handles critical data in a timely, systematic, and holistic manner over multiple health care facilities. The critical data handling comprises internal responses by the cloud  7004  based on assigned priority levels. Moreover, based on requests by surgical hubs  7006 , special routing of data within the memory device  7010  of the cloud  7004  may be achieved. The rerouting, prioritizing, confirming, or requesting supporting as described above may be used to improve analysis of the data by the cloud  7004 . 
     Cloud Interface For Client Care Institutions 
     All client care institutions require some level of control in a treatment environment. For example, an institution may wish to control inventory that is present within an operating room. Inventory items within an operating room may include not only medical devices to be used during surgery (e.g., scalpels, clamps, surgical tools, etc.) but also medical supplies to be used during surgery in conjunction with such medical devices (e.g., gauze, sutures, staples, etc.). Heretofore, inventory control for many institutions comprises a simple manual count of inventory items on a periodic basis (e.g., daily, weekly, monthly, etc.). Similarly, other institutions utilize a barcode scanner to count and/or document inventory items on a periodic basis. 
     Aspects of the present disclosure are presented for a cloud interface accessible by participating client care institutions via a cloud-based analytics system. In order to monitor and/or control inventory items to be utilized or being utilized by an institution, each institution adopts its own practice of documenting inventory item usage. For example, an institution may manually count and/or scan inventory items on a periodic basis. Additional example details are disclosed in U.S. Pat. Application Publication No. 2016/0249917, titled SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFE PARAMETER, which published on Sep. 1, 2016, U.S. Pat. Application Publication No. 2014/0110453, titled SURGICAL INSTRUMENT WITH RAPID POST EVENT DETECTION, which issued on Feb. 23, 2016 as U.S. Pat. No. 9,265,585, U.S. Pat. Application Publication No. 2016/0310134, titled HANDHELD ELECTROMECHANICAL SURGICAL SYSTEM, which published on Oct. 27, 2017, and U.S. Pat. Application Publication No. 2015/0317899, titled SYSTEM AND METHOD FOR USING RFID TAGS TO DETERMINE STERILIZATION OF DEVICES, which published on Nov. 5, 2015, the entire disclosures of which are hereby incorporated by reference herein. Information regarding counted and/or scanned inventory items may then be stored in a local computer system to track inventory item usage. Such a manual process is not only labor intensive and inefficient, but also prone to human error. As a result, an institution may be unable to perform a surgical procedure(s) and/or the surgical procedure(s) may be unnecessarily delayed because one or more inventory items, required for the surgical procedure(s), are not available for use for various reasons (e.g., out of stock, in stock but expired, in stock but no longer considered sterile, in stock but defective, etc.). Knowing this, some institutions are forced to carry and/or hold an overstock of inventory items. This, of course, may result in increase expense (e.g., more inventories) and ultimately unnecessary waste (e.g., expired inventory items). 
     To help institutions control inventory items, it would be desirable for institutions to have access, via a cloud interface, to a cloud-based analytics system configured to automate inventory control by automatically receiving data associated with inventory items of the institutions, deriving information based on the received data, and conveying, via the cloud interface, real-time knowledge back to the institutions regarding inventory items. Referring to  FIG.  201   , according to one aspect of the present disclosure, a client care institution system  8000  may transmit (e.g., periodically, in real-time, in batches, etc.) inventory data to a cloud-based analytics system  8002  and the cloud-based analytics system  8002  may derive/extract information from that inventory data. In such an aspect, a cloud-interface  8004  may be accessed/queried by the client care institution system  8000  and the cloud-based analytics system  8002  may transmit its derived/extracted information to the cloud-interface  8004 . Further, in such an aspect, the cloud-interface  8004  may convey/package/structure the derived/extracted information to the client care institution system  8000  to reveal knowledge about the client care institution’s inventory. In one aspect, the client care institution system may comprise a surgical system  102  (e.g.,  FIG.  1   ), the cloud-based analytics system may comprise the cloud-based system  105  (e.g.,  FIG.  1   ) and the cloud-interface may comprise at least one of a visualization system  108 / 208  (e.g.,  FIGS.  1 - 2   ) or a display  135 / 177  associated with the surgical hub  106  (e.g.,  FIGS.  1 - 3 ,  7   , etc.). 
     Referring to  FIG.  1   , in some aspects of the present disclosure, a cloud-based system  105  is communicatively coupled to one or more than one surgical hub of an institution (e.g., one or more than one surgical hub  106  of a surgical system  102 ). Here, each surgical hub is in communication (e.g., wirelessly) with one or more than one inventory item (e.g., intelligent instrument  112 ). The cloud-based system  105  may be configured to aggregate data associated with each inventory item of each institution, analyze that data with respect to system-defined constraints, and generate or facilitate a cloud interface for each institution to monitor and control inventory items. In one example, the cloud-based system  105  may be configured to compute a current availability of each inventory item (e.g., an indication of real-time usage and/or scheduled usage for each inventory item in a surgical system  102 ), a current usage associated with each inventory item (e.g., based on data received from one or more than one surgical hub  106  that has read usage data from a chip/memory associated with each inventory item), irregularities, if any, associated with each inventory item (e.g., defects, etc.), current possible medical device combinations that utilize each inventory item (e.g., various shafts, staple cartridges, end effectors, etc. combinable to form numerous medical device combinations), and available alternatives to each inventory item (e.g., available shaft B and/or shaft C may be substituted for unavailable shaft A for a desired/input surgical procedure(s)). Referring to  FIGS.   202 - 203   , in such an exemplification, after input of a desired surgical procedure(s) (e.g., “cholecystectomy”) by an institution in its cloud interface  8104 , the cloud-based system  105  may provide up-to-date, real-time and/or near real-time knowledge regarding the availability and/or usability of inventory items (e.g., associated with and/or needed to perform the input surgical procedure(s)) based on the system-defined constraints. Referring to  FIG.  203   , in one example, the institution’s cloud interface  8104  may display an inventory item  8106  (e.g., Handles A, B, and C) in association with its current  8108  and/or remaining usage  8110 . If the remaining usage is not adequate (e.g., based on anticipated usage necessary for the desired surgical procedure, etc.), the cloud interface may further display a warning or alert regarding the inadequacy (e.g.,  8112 , highlighting, blacked out, etc.). Such a warning or alert may indicate that the surgical procedure(s) input at the cloud interface cannot be performed based on current inventory items. In one aspect, a same or similar warning or alert may be communicated to the inventory item itself for display on a user interface of the inventory item itself (e.g., a user interface of Handle C). In another aspect, the cloud interface may further display available alternatives to the inventory item (e.g., Handle B). Here, anticipated usage and/or available alternatives may be determined at the surgical hub  106  (e.g., based on local data) and/or the cloud-based analytics system  105  (e.g., based on local data of the surgical hub  106  and/or global data from multiple surgical hubs  106  of multiple institutions). In one example, the surgical hub  106  may infer anticipated usage and/or available alternatives from local data associated with the same or similar surgical procedure (e.g., average number of uses to perform the same or similar surgical procedure, alternative inventory items used to perform the same or similar surgical procedure, etc.). In another example, the cloud-based analytics system  105  may similarly infer anticipated usage and/or available alternatives from local data of the surgical hub  106  and/or global data from multiple surgical hubs  106  of multiple institutions (e.g., average number of uses to perform the same or similar surgical procedure, alternative inventory items used to perform the same or similar surgical procedure, etc.). 
     In other aspects of the present disclosure, a cloud-based system  105  is communicatively coupled to one or more than one surgical hub  106  of an institution, each surgical hub  106  in communication (e.g., wirelessly) with one or more than one inventory item (e.g., intelligent instrument  112 ). The cloud-based system  105  may be configured to create a list of inventory items not authorized to perform surgical procedures due to one or more system-defined constraints. In one exemplification, after input of a desired surgical procedure(s) by an institution into its cloud interface (e.g.,  FIG.  202   ), the cloud-based system  105  may determine that one or more inventory items of the institution (e.g., detected by and associated with and/or needed to perform the input surgical procedure(s)) are not authorized to perform the input surgical procedure(s) based on system-defined constraints. In such an exemplification, it may be determined that an identifier (e.g., serial number, unique ID, etc.) associated with an inventory item is not authorized to perform the input surgical procedure(s) (e.g., inventory item exceeds usable life, inventory item is counterfeit, inventory item is defective, etc.). In one example, the institution’s cloud interface may display an inventory item in association with its unauthorized status  8114 . In such an aspect, the cloud interface may further display a warning or alert regarding the unauthorized status (e.g., highlighting, blacked out, etc.). Such a warning or alert may indicate that the surgical procedure(s) input at the cloud interface cannot be performed based on current inventory items. In one aspect, a same or similar warning or alert may be communicated to the inventory item itself for display on a user interface of the inventory item itself (e.g., a user interface of Handle D). Similar to above, the cloud interface  8104  may display available alternatives to the unauthorized inventory item (e.g., Handle B). 
     In yet other aspects of the present disclosure, a cloud-based system  105  is communicatively coupled to one or more than one surgical hub  106  of an institution, each surgical hub  106  in communication (e.g., wirelessly) with one or more than one inventory item (e.g., intelligent instrument  112 ). The cloud-based system  105  may be configured to create a list of inventory items no longer authorized to perform surgical procedures due to one or more system-defined constraints. In one exemplification, after input of a desired surgical procedure(s) by an institution in its cloud interface (e.g.,  FIG.  202   ), the cloud-based system may determine that one or more inventory items are no longer authorized to perform the input surgical procedure(s) based on system-defined constraints. In such an exemplification, it may be determined that an identifier (e.g., serial number, unique ID, etc.) associated with an inventory item is unusable (e.g., expired, no longer sterile, defective, etc.). In one example, the institution’s cloud interface may display an inventory item in association with its unusable status  8116 . In such an aspect, the cloud interface may further display a warning or alert regarding the unusable status (e.g., highlighting, blacked out, etc.). Such a warning or alert may indicate that the surgical procedure(s) input at the cloud interface cannot be performed based on current inventory items. In one aspect, a same or similar warning or alert may be communicated to the inventory item itself for display on a user interface of the inventory item itself (e.g., a user interface of Handle E). Similar to above, the cloud interface may display available alternatives to the unusable inventory item (e.g., Handle B). 
     In this way, the cloud-based system  105  of the present disclosure may provide up-to-date, real-time, and/or near real-time knowledge regarding the availability of inventory items pertinent to the surgical procedure(s) input to the cloud interface of the participating institutions. Such a system goes well-beyond conventional processes of manually counting and/or scanning inventory items. 
       FIG.  204    illustrates an example multi-component surgical tool (e.g., a wireless surgical device/instrument  235 ) comprising a plurality of modular components  8204 ,  8206 ,  8208 ,  8210 , wherein each modular component is associated with an identifier  8214 ,  8216 ,  8218 ,  8220  respectively (e.g., a serial number). In particular, the surgical tool  235  of  FIG.  204    includes a handle  8204 , a modular adapter  8206 , and end effector  8208  (e.g., a disposable loading unit and/or a reloadable disposable loading unit in various aspects), and a staple cartridge  8210 . In this example, the handle  8204  is associated with serial number “SN135b”, the modular adapter  8206  is associated with serial number “SN33b”, the end effector  8208  is associated with serial number “SN1a” and the staple cartridge  8210  is associated with serial number SN121b. In such an aspect, each modular component (e.g.,  8204 ,  8206 ,  8208 ,  8210 , etc.) is configured to request a communication link to a surgical hub  106  of an institution. In other aspects, the surgical hub  106  may be configured to request a communication link with each modular component. Nonetheless, the surgical hub  106  is positioned within a communicative distance from each modular component (e.g., in an operating room). In one aspect of the present disclosure, a requested communication link is established via BLUETOOTH pairing. In other aspects of the present disclosure, other forms of wireless communication (e.g., WiFi, RFID, etc.) or wired communication are contemplated. Referring again to  FIG.  204   , each modular component (e.g., handle  8204 , modular adapter  8206 , end effector  8208 , staple cartridge  8210 , etc.) may comprise a processor and a memory unit (not shown) that stores its respective serial number. Here, according to one aspect, once a communication link is established between the surgical hub  106  and each modular component, the identifier (e.g., serial number) associated with each modular component is transmitted by each modular component to the surgical hub  106  (e.g., via the same form or different forms of wired/wireless communication). In one alternative aspect, in light of  FIG.  204   , a modular component (e.g., modular adapter  8206 , end effector  8208 , and/or staple cartridge  8210 , etc.) may transmit its respective identifier (e.g., serial number) to another modular component (e.g., handle  8204 ) that transmits/relays all identifier(s) to the surgical hub  106 . Here, similar to above, the same form or different forms of wired/wireless communication may be used. For example, each of the modular adapter  8206 , the end effector  8208  and the staple cartridge  8210  may transmit its respective identifier (e.g.,  8216 ,  8218 ,  8220 ) to the handle  8204  via RFID and the handle  8204  may relay such identifiers (e.g.,  8216 ,  8218 ,  8220 ) along with its own identifier  8214 , via BLUETOOTH, to the surgical hub  106 . In one aspect, once the surgical hub  106  has received all identifiers for all modular components, the surgical hub  106  may transmit the identifiers to the cloud-based analytics system (e.g., comprising cloud-based system  105 ). 
     In various aspects of the present disclosure, the memory unit of each modular component may be configured to store more than its identifier. In one aspect of the present disclosure, each modular component (e.g.,  8204 ,  8206 ,  8208 ,  8210 , etc.) may further comprise a counter (not shown) configured to track a usage parameter of the modular component and its memory unit may be configured to store that usage parameter. In another aspect, the memory unit of each respective modular component may be further configured to store a usable life metric. Such a usable life metric may be stored during manufacture of the modular component. For example, in view of  FIG.  204   , the memory unit of the handle  8204  may store both the usage parameter (e.g.,  235 ) and the usable life metric (e.g.,  400 ). In such an aspect, the handle  8204  has been used 235 times out of its usable life of 400 uses. Similarly, in view of  FIG.  204   , the modular adapter has been used 103 times out of its usable life of 100 uses, and the end effector has been used 5 times out of its usable life of 12 uses. Here, similar to above, once a communication link is established with the surgical hub  106 , the identifier, usage parameter and/or usable life metric stored in the memory unit of each modular component may be transmitted directly from each modular component to the surgical hub  106  or indirectly via another modular component. In addition, similar to above, the same form or different forms of wired/wireless communication may be used. In one aspect, once the surgical hub  106  has received all identifiers for all modular components, the surgical hub  106  may transmit the identifiers to the cloud-based analytics system (e.g., comprising cloud-based system  105 ). 
     In an alternative aspect of the present disclosure, the memory unit of each modular component may not store its usage parameter and/or the usable life metric. In such an aspect, the usage parameter and/or the usable life metric may be stored in a database or other memory (see  FIG.  10   , e.g.,  248 / 249 ) at the surgical hub  106 / 206 . In such an aspect, the surgical hub  106  may comprise a counter configured to track a usage parameter of each modular component in inventory. Furthermore, the surgical hub  106  may be configured to download usable life metrics (e.g., from a manufacturer server) based on the identifier (e.g., serial number) received from each modular component. In various aspects, storage at the surgical hub  106  may be preferred to minimize memory unit requirements in each modular component and/or to avoid any concerns regarding the tampering with and/or the alteration of usage parameters and/or usable life metrics stored at the modular component level (e.g., altering a memory unit of a modular component to reset a usage parameter and/or increase a usable life metric, etc.). 
     In one example, in aspects where the memory unit of each modular component stores its usage parameter and/or usable life metric, the surgical hub  106  may also store/track the usage parameter and/or usable life metric associated with each modular component in its inventory. In such an example, if a usage parameter and/or a usable life metric transmitted from a modular component differs from a usage parameter and/or a usable life metric stored/tracked at the surgical hub  106 , the surgical hub  106  may flag the discrepancy and modify the status of that modular component (e.g., to unavailable, to unauthorized, to unusable, etc.). 
     In another alternative aspect, the memory unit of each modular component may not store its usage parameter and/or the usable life metric. In such an aspect, the usage parameter and/or the usable life metric may be stored in a database (e.g., aggregated medical data database  7012  in  FIG.  180   ) at a cloud-based analytics system. In such an aspect, the cloud-based analytics system may comprise a counter configured to track a usage parameter of each modular component in inventory at each surgical hub. Furthermore, the cloud-based analytics system may be configured to download usable life metrics (e.g., from a manufacturer server) based on the identifier (e.g., a serial number) received from each modular component (e.g., via a surgical hub). Alternatively, the cloud-based analytics system may download a file comprising all identifiers for all modular components (e.g., from a plurality of manufacturers) wherein each identifier is associated with a usable life metric. Here, the cloud-based analytics system may be configured to look-up a received identifier to determine each respective usable life metric. In various aspects, storage at the cloud-based analytics system may be preferred to minimize memory requirements in each modular component and/or to avoid any concerns regarding the tampering with and/or the alteration of usage parameters and/or usable life metrics at the modular component level and/or at the surgical hub level (e.g., altering memory unit of a modular component to reset a usage parameter and/or increase a usable life metric, modifying the database/memory of the surgical hub to reset a usage parameter and/or increase a usable life metric). Such as aspect gives the cloud-based analytics system of the present disclosure more control over modular component use in the interactive surgical system. 
     Looking again to  FIG.  204   , the illustrated multi-component surgical tool  235  comprises four modular components (e.g., handle  8204 , modular adapter  8206 , end effector  8208 , and staple cartridge  8210 ). Such modular devices may comprise reusable and/or reprocessed components. In various aspects, each modular component must satisfy system-defined constraints for the combined multi-component surgical tool  235  to be available/usable/ authorized for use by the cloud-based analytics system. Notably, system-defined constraints may include restrictions other than and/or in addition to the usable life metric discussed above. Such system-defined constraints may be established at the manufacturer level, at the surgical hub level, and/or at the cloud-based analytics system level. One aspect of the present disclosure comprises a user interface at the surgical hub and/or cloud-based analytics system to create system-defined constraints. 
     In one aspect, the surgical hub  106  may be configured to enforce system-defined constraints (e.g., lockout at the hub level). In such an aspect, this may be preferred so that the surgical hub  106  is a local gateway to accessing the cloud-based analytics system. In another aspect, the cloud-based analytics system (e.g., comprising cloud-based system  105 ) may be configured to enforce system-defined constraints (e.g., lockout at the cloud-based analytics system level). In such an aspect, this may be preferred to maintain control over all surgical hubs communicatively coupled to the cloud-based analytics system (e.g., at one institution or at multiple institutions). System-defined constraints, similar to the usable life metric, may be associated with the identifier of each modular component. For example, a system-defined constraint associated with a modular component may include an expiration date, a requirement that an identifier (e.g., serial number) is a system-recognizable identifier (e.g., not counterfeit), and/or flexible system-defined constraints (e.g., constraints deemed non-critical until a threshold is met and the constraint is deemed critical). In one aspect of the present disclosure, if one system-defined constraint is not met, a modular component (e.g.,  8204 ,  8206 ,  8208 ,  8210 , etc.) may be deemed unavailable/unusable/unauthorized despite being available/usable/authorized based on other system-defined constraint(s) (e.g., having remaining usable life). In various aspects, one or more predetermined system-defined constraints are non-critical system-defined constraints. Such non-critical system-defined constraints may be waived (see  FIG.  204   , e.g.,  8274 , manual override) to render the modular component available/usable/authorized and/or may produce in a warning indicator/message (see  FIG.  204   , e.g.,  8244 ). Critical system-defined constraints cannot be waived. 
     In view of  FIG.  204   , an example non-critical system-defined constraint is applied (e.g., by the surgical hub  106  and/or the cloud-based analytics system) to the handle  8204 . Here, although the handle  8204  has  165  remaining uses (usable life metric less determined usage parameter, e.g.,  400 - 235 ) an expiration date associated with its identifier  8214  (e.g., SN135b) indicates that the handle’s control program is out-of-date. In such an aspect, an interface  8200  may be displayed to show a current status of the handle  8204  (see  FIG.  204   , e.g., “Count  235 / 400 ” and/or “Out-of-Date”). More specifically, the interface  8200  may comprise a grid including fields defined by columns and rows. In one example, the modular components of a proposed multi-component surgical tool  235  may be presented (e.g., in an exploded, unassembled view) across the columns of the grid in a first row  8201  and a current/updated status associated with each modular component may be presented across corresponding columns of the grid in a second row  8202 . As such, in accordance with the example, status field  8224  of the interface  8200  corresponds to the handle  8204  and indicates its current status as “COUNT:  235 / 400 ” and “OUT-OF-DATE”. According to other aspects, the status field  8224  of the interface  8200  may further show the usage remaining, remaining capabilities, and/or compatibility with other connected modular components, etc. 
     According to one aspect, the interface  8200  may comprise a cloud-based interface (see  FIG.  203   , e.g.,  8104 ) accessible on a cloud-access terminal of the surgical hub (via at least one of a visualization system  108 / 208  (e.g.,  FIGS.  1 - 2   ) or a display  135 / 177  associated with the surgical hub  106  (e.g.,  FIGS.  1 - 3 ,  7   , etc.)). According to another aspect, the interface  8200  may comprise only a portion(s) of the grid (e.g., status field  8224 , modular component field  8234 , etc.) accessible on the physical handle  8204  itself via a user interface positioned on the handle  8204 . Further, in the context of a non-critical system-defined constraint, the interface  8200  may visually indicate a warning associated with a modular component (e.g., warning indicator  8244 , e.g., box associated with identifier  8214  highlighted and/or encircled and/or comprises a link  8254  (e.g., “A”) in association with modular component field  8234  of the interface  8200 ). In one aspect, the link  8254  (e.g., “A”) may key to a corresponding “Description of Problem” section of the interface  8200  (e.g., “A” “Handle Serial Number Indicates OUT OF DATE Control Program”). In another aspect, the link  8254  (e.g., “A”) may be a hyperlink to present the corresponding description (e.g., “A” “Handle Serial Number Indicates OUT OF DATE Control Program”) in the interface  8200 . According to such aspects, a portion of the descriptive text (e.g., “OUT OF DATE”), keyed/hyperlinked via link  8254 , may be a hyperlink/button  8264 . Upon/After selection of the hyperlink/button  8264  a bypass interface  8274  may be presented in the interface  8200 . According to another aspect, a portion of descriptive text (e.g., OUT-OF-DATE) in status field  8224  may be a hyperlink/button  8284  to, upon/after selection, directly present the bypass interface  8274  in the interface  8200 . Such an aspect may be beneficial/more efficient if the interface  8200  is being presented via a (e.g., smaller) user interface of a modular component (e.g., handle  8204 ). Further, according to such aspects, the interface  8200  may be configured to receive user input to waive (e.g., manually bypass) a predetermined, non-critical system-defined constraint (e.g., the expiration date constraint). In the context of a non-critical system-defined constraint, the bypass interface  8274  may instruct “USER INPUT NEEDED” and present a first user-interface element (e.g., “Y” button) selectable to bypass the non-critical system-defined constraint (e.g., to permit use of the handle  8204 ) and a second user-interface element (e.g., “N” button) selectable to not bypass the non-critical system-defined constraint (e.g., to inhibit use of the handle  8204 ). Here, a selection in the bypass interface  8274  may be transmitted to update the surgical hub  206  and/or the cloud-based system  205 . 
     Next, in view of  FIG.  204   , an example flexible system-defined constraint is applied (e.g., by the surgical hub  106  and/or the cloud-based analytics system) to the modular adapter  8206 . Here, the modular adapter  8206  associated with identifier  8216  (e.g., SN33b) has a usage parameter of  103  (e.g., already 3 times over its suggested usable life metric of 100 uses). In this example, the exceeding use is deemed non-critical until a 10% overage threshold is met (e.g., 110% of the suggested 100 uses, or 110 uses) and the exceeding use is deemed critical. In such an aspect an interface  8200  may be displayed to show a current status of the modular adapter  8206  (see  FIG.  204   , e.g., “COUNT: 103/100” “EXCEEDS”). More specifically, in accordance with the example described above, status field  8226  corresponds to the modular adapter  8206  and indicates its current status as “COUNT: 103/100” and “EXCEEDS”. According to other aspects the status field  8226  of the interface  8200  may further show overage remaining, remaining capabilities, and/or compatibility with other connected modular components. 
     Again, according to one aspect the interface  8200  may comprise a cloud-based interface (see  FIG.  203   , e.g.,  8104 ) accessible on a cloud-access terminal of the surgical hub (via at least one of a visualization system  108 / 208  (e.g.,  FIGS.  1 - 2   ) or a display  135 / 177  associated with the surgical hub  106  (e.g.,  FIGS.  1 - 3 ,  7   , etc.)). According to another aspect, the interface 8200 may comprise only a portion(s) of the grid (e.g., the status field  8226 , modular component field  8236 , etc.) accessible directly on the physical modular adapter  8206  itself via a user interface positioned on the modular adapter  8206  and/or indirectly on the physical handle  8204  itself via a user interface positioned on the handle  8204 . Further, in the context of a flexible system-defined constraint, the interface  8200  may visually indicate a warning associated with a modular component (e.g., warning indicator  8246 , e.g., description of current status encircled and/or comprises a link  8256  (e.g., “B”) in association with status field  8226  of the interface  8200 ). In one aspect, the link  8256  (e.g., “B”) may key to a corresponding “Description of Problem” section of the interface  8200  (e.g., “B” “Modular Adapter EXCEEDS Suggested Life Limit”). In another aspect, the link  8256  (e.g., “B”) may be a hyperlink to present the corresponding description (e.g., “B” “Modular Adapter EXCEEDS Suggested Life Limit”) in the interface  8200 . According to such aspects, a portion of the descriptive text (e.g., “EXCEEDS”), keyed/hyperlinked via link  8256 , may be a hyperlink/button  8266 . Upon/After selection of the hyperlink/button  8266  a warning interface  8276  may be presented in the interface  8200 . According to another aspect, a portion of descriptive text (e.g., EXCEEDS) in status field  8226  may be a hyperlink/button  8286  to, upon/after selection, directly present the warning interface  8276  in the interface  8200 . Such an aspect may be beneficial/more efficient if the interface  8200  is being presented via a (e.g., smaller) user interface of a modular component (e.g., modular adapter  8206  and/or handle  8204 ). Further, according to such aspects, the interface  8200  may be configured to present a warning that the modular adapter  8206  is approaching its overage threshold. In one aspect, the warning interface  8276  may instruct “NO INPUT NEEDED” and present a warning indicating that the overage threshold is being approached (e.g., “Approaching 10% Limit Warning”). In other aspects, the warning may indicate how many uses remain until the overage threshold is met (e.g., “7 Uses Until 10% Overage Limit Is Met”). 
     Next, in view of  FIG.  204   , an example system-defined constraint is applied (e.g., by the surgical hub  106  and/or the cloud-based analytics system) to the end effector  8208 . Here, the end effector  8208  associated with identifier  8218  (e.g., SN1a) has a usage parameter of 5 (e.g., 7 uses under its suggested usable life metric of 12 uses remain). As such, in accordance with this example, the system-defined constraint is deemed satisfied and the end effector  8208  is rendered available/usable/authorized. In such an aspect, an interface  8200  may be displayed to show a current status of the end effector  8208  (see  FIG.  204   , e.g., “COUNT: 5/12”). More specifically, in accordance with the example described above, status field  8228  corresponds to the modular adapter  8208  and indicates its current status as “COUNT: 5/12”. According to other aspects the status field  8228  of the interface  8200  may further show usage remaining, remaining capabilities, and/or compatibility with other connected modular components. 
     Yet again, according to one aspect, the interface  8200  may comprise a cloud-based interface (see  FIG.  203   , e.g.,  8104 ) accessible on a cloud-access terminal of the surgical hub (via at least one of a visualization system  108 / 208  (e.g.,  FIGS.  1 - 2   ) or a display  135 / 177  associated with the surgical hub  106  (e.g.,  FIGS.  1 - 3 ,  7   , etc.)). According to another aspect, the interface  8200  may comprise only a portion(s) of the grid (e.g., the status field  8228 , modular component field  8238 , etc.) accessible directly on the physical end effector  8208  itself via a user interface positioned on the end effector  8208  and/or indirectly on the physical handle  8204  itself via a user interface positioned on the handle  8204 . Here, since the system-defined constraint is satisfied, no warning interface and/or bypass interface is displayed. 
     Lastly, still in view of  FIG.  204   , an example critical system-defined constraint is applied (e.g., by the surgical hub  106  and/or the cloud-based analytics system) to the staple cartridge  8210 . Here, identifier  8220  (e.g., SN121b), associated with the staple cartridge  8210 , is not a system-recognizable identifier. According to one aspect, this may occur when the surgical hub  206  and/or the cloud-based analytics system (e.g., comprising cloud-based system  205 ) is unable to match an identifier (e.g., serial number) received from a modular component with identifiers (e.g., serial numbers) downloaded from the manufacturer(s) of the modular component(s). As such, continuing the example, the system-defined constraint is critical, the system-defined constraint is deemed not satisfied, and the staple cartridge  8210  is rendered unavailable/unusable/unauthorized. Further, as a result, since the critical system-defined constraint cannot be waived, any combined multi-component surgical tool comprising the staple cartridge  8210  may be similarly rendered unavailable/unusable/unauthorized. In such as aspect, an interface  8200  may be displayed to show a current status of the staple cartridge  8210  (see  FIG.  204   , e.g., “LOADED” “COUNTERFEIT”). More specifically, in accordance with the example described above, status field  8230  corresponds to the staple cartridge  8210  and indicates its current status as “LOADED” and “COUNTERFEIT”. 
     Yet again, according to one aspect, the interface  8200  may comprise a cloud-based interface (see  FIG.  203   , e.g.,  8104 ) accessible on a cloud-access terminal of the surgical hub (via at least one of a visualization system  108 / 208  (e.g.,  FIGS.  1 - 2   ) or a display  135 / 177  associated with the surgical hub  106  (e.g.,  FIGS.  1 - 3 ,  7   , etc.)). According to another aspect, the interface  8200  may comprise only a portion(s) of the grid (e.g., the status field  8230 , modular component field  8240 , etc.) accessible directly on the physical staple cartridge  8210  itself via a user interface positioned on the staple cartridge  8210  and/or indirectly on the physical handle  8204  itself via a user interface positioned on the handle  8204 . Further, in the context of a critical system-defined constraint, the interface  8200  may visually indicate a warning associated with a modular component (e.g., warning indicator  8250 , e.g., box associated with identifier  8220  highlighted and/or encircled and/or comprises a link  8260  (e.g., “C”) in association with modular component field  8240  of the interface  8200 ). In one aspect, the link  8260  (e.g., “C”) may key to a corresponding “Description of Problem” section of the interface  8200  (e.g., “C” “Serial Number of Cartridge Indicates COUNTERFEIT Cartridge”). In another aspect, the link  8260  (e.g., “C”) may be a hyperlink to present the corresponding description (e.g., “C” “Serial Number of Cartridge Indicates COUNTERFEIT Cartridge”) in the interface  8200 . According to such aspects, a portion of the descriptive text (e.g., “COUNTERFEIT”), keyed/hyperlinked via link 8260, may be a hyperlink/button  8270 . Upon/After selection of the hyperlink/button  8270  an action interface  8280  may be presented in the interface  8200 . According to another aspect, a portion of descriptive text (e.g., COUNTERFEIT) in status field  8230  may be a hyperlink/button  8290  to, upon/after selection, directly present the action interface  8280  in the interface  8200 . Such an aspect may be beneficial/more efficient if the interface  8200  is being presented via a (e.g., smaller) user interface of a modular component (e.g., staple cartridge  8210  and/or handle  8204 ). Further, according to such aspects, the interface  8200  may be configured to instruct a user to perform an action (e.g., to remove the staple cartridge  8210  associated with the identifier  8220  (e.g., SN121b) and reload with a staple cartridge associated with a system-recognizable identifier. In one aspect, the action interface  8280  may instruct “ACTION REQUIRED” and present a directive “Remove &amp; Reload”. Here, since the system-defined constraint is critical, no warning interface and/or bypass interface is displayed. In one further aspect, a list of available and/or alternative modular components (e.g., staple cartridges) may be displayed. 
     In a similar manner, a list (e.g., black-listed devices) of surgical tools (e.g., wireless surgical devices/instruments  235 ) and/or modular components (e.g., handles, modular adapters, end effectors, staple cartridges, etc.) may be declared unavailable/unusable/unauthorized to communicate with and/or access the surgical hub  206  and/or cloud-based analytics system (e.g., comprising cloud-based system  205 ). In one aspect of the present disclosure, such black-listed devices may comprise inventory items that are known and/or established to be counterfeit, defective, damaged, beyond their usable life, expired, unsterile, etc. In such an aspect, black-listed devices may be used as critical system-defined constraints (e.g., if the device is on the “black-list,” it cannot communicate with and/or access the surgical hub and/or cloud-based analytics system). In line with above, critical system-defined constraints cannot be waived/bypassed. Creating and/or maintaining such a “black-list” of devices at the surgical hub level and/or the cloud-based analytics level, may improve safety and reliability in the operating room. In one aspect, a database (e.g., aggregated medical data database  7012  in  FIG.  180   ) at the cloud-based analytics system may be updated each time a counterfeit device is detected via a surgical hub  206  (e.g., similar to the staple cartridge in  FIG.  204   ). Since a plurality of surgical hubs associated with a plurality institutions may communicate with the cloud-based analytics system, such a database, and associated “black-list”, builds rather quickly. Such a database at the cloud-based analytics system would prevent a black-listed device from being used at a different surgical hub (e.g., a surgical hub other than the surgical hub at which the counterfeit was initially detected) communicatively coupled to the cloud-based analytics system. 
     In another aspect of the present disclosure, black-listed devices may include surgical tools (e.g., wireless surgical devices/instruments  235 ) and/or modular components (e.g., handles, modular adapters, end effectors, staple cartridges, etc.) developed by third-parties wishing to take advantage of benefits provided by the surgical hub and/or cloud-based analytics system (e.g., various inventory control aspects discussed herein). In such an aspect of the present disclosure, black-listed devices may be used as non-critical system-defined constraints and/or flexible system-defined constraints (e.g., if the device is on the “black-list,” it cannot communicate with and/or access the surgical hub and/or cloud-based analytics system). However, contrary to the previously disclosed aspect, such non-critical system-defined constraints and/or flexible system-defined constraints may be waived/bypassed. In one aspect of the present disclosure, such a black-listed device (e.g., a third-party device) may be granted access to the surgical hub and/or cloud-based analytics system for a fee. In one example a competitor product may be initially declared counterfeit. However, once an agreed upon fee is paid, that competitor product may be granted access to the surgical hub and/or cloud-based analytics system. In another aspect, such a black-listed device may be granted partial access to the surgical hub and/or cloud-based analytics system but may be subject to established secondary system-defined constraints. In another aspect, such a black-listed device may be granted access to the surgical hub and/or cloud-based analytics system but may not be able to fully function (e.g., limited functionality) when paired with the surgical hub. Similar to above, a database (e.g., aggregated medical data database  7012  in  FIG.  180   ) at the cloud-based analytics system may be updated each time a previously black-listed device is granted access, partial access with secondary system-defined constraints and/or access with limited functionality. Since a plurality of surgical hubs associated with a plurality institutions may communicate with the cloud-based analytics system, such a database, and its associated access levels, can be implemented across all communicatively coupled surgical hubs. In all such aspects, the surgical hub and/or cloud-based analytics system maintains complete control over devices seeking access. 
     In yet another aspect of the present disclosure a database of the surgical hub (see  FIG.  10   , e.g.,  248 / 249 ) and/or a database (e.g., aggregated medical data database  7012  in  FIG.  180   ) of the cloud-based analytics system may record each modular component and/or surgical tool identifier (e.g., serial number) in a “used identifier list” when first used in the system. As such, each time a new modular component and/or a new surgical tool is plugged in and/or requests communication with the surgical hub and/or cloud-based analytics system, an identifier of the new modular component and/or surgical tool is cross-checked with the “used identifier list.” In such an aspect, if the identifier of the new modular component and/or the new surgical tool matches an identifier already in the “used identifier list,” that identifier may be automatically placed on a “black-list” (e.g., critical system-defined constraint). Here, identifiers (e.g., serial numbers) should be unique. If an already used identifier is presented at first use multiple times, this may evidence fraud and/or counterfeit activity. 
     As discussed herein, various aspects of the present disclosure are directed to the application of system-defined constraints. For example, as discussed with reference to  FIG.  204    above, each modular component of a surgical tool may be associated with an identifier and each identifier may be associated with one or more than one parameter (e.g., usage parameter, expiration date, flexible parameter, etc.). In another aspect of the present disclosure, a surgical tool may be associated with an identifier wherein that identifier is associated with one or more than one parameter. In such an aspect, either the surgical tool does not comprise modular components or the surgical tool comprises modular components associated with the same identifier (e.g., serial number, activation code). Here, system-defined constraints, as discussed herein, may be applied to such a surgical tool in a similar manner. 
     Further, as discussed herein, various aspects of the present disclosure pertain to the identification of reusable/reprocessed devices (e.g., modular components, surgical tools, etc.) and the display of each reusable device’s availability/readiness for a next/proposed surgical procedure and its operational status on a screen other than the screen of the reusable device (e.g., a screen of a cloud-access terminal of the surgical hub). In one aspect of the present disclosure the status of each reusable device (e.g., status of each modular component, status of a surgical tool, and/or overall status of combined modular components and/or subassemblies) is queried and/or determined when the reusable device connects to the system or as the reusable device connects to the system (e.g., to the surgical hub and/or the cloud-based analytics system). In another aspect of the present disclosure, once/after the reusable device is used, the surgical hub and/or cloud-based analytics system time-stamps the use and updates the usage of each modular component and/or surgical tool in its respective database. 
     In further various aspects of the present disclosure, a modular component and/or a surgical tool may be flagged by the surgical hub and/or cloud based analytics system based on predetermined criteria. For example, if a modular component is incompatible with other modular components, its identifier (e.g., serial number) is known to be fake, and/or it is subject to a recall, a database of the surgical hub and/or the cloud-based analytics system may be updated to not allow use of the modular component and/or surgical tool in the system (e.g., creation of critical system-defined constraints). Such created system-defined constraints may be applied as discussed herein. 
     In yet further aspects of the present disclosure, a modular component and/or a surgical tool may be flagged by the surgical hub and/or cloud based analytics system based on a previous use. For example, the surgical hub and/or the cloud based analytics system may track performance of the modular component and/or the surgical tool. Here, performance results may be analyzed by the cloud-based analytics system to inform future uses of the modular component and/or surgical tool. For example, if the end effector did not clamp properly or jammed in a previous use, the end effector may be flagged in a database of the surgical hub and/or the cloud-based analytics system (e.g., black-listed) so that the end effector cannot be used again in the system. 
     Various aspects of the present disclosure are also directed to a cloud-based analytics system that generates a cloud interface for a client care institution. More specifically, aspects of the present disclosure pertain to a cloud-based system including a client care institution surgical hub coupleable with a plurality of inventory items (e.g., handles, modular adapters, end effectors, staple cartridges, etc.) and a cloud-based analytics system. The surgical hub may include a processor programmed to communicate with the plurality of inventory items and the cloud-based analytics system. The cloud-based analytics system may include a processor programmed to i) receive, via the surgical hub, data associated with the plurality of inventory items, wherein the received data comprises a unique identifier for each inventory item, ii) determine whether each inventory item is available for use based on its respective unique identifier and system-defined constraints, wherein the system-defined constraints comprise at least one use restriction, iii) generate a cloud interface for the institution, wherein the institution’s cloud interface comprises a plurality of user-interface elements, wherein at least one user-interface element enables the institution to select one or more than one surgical procedure to be performed, and wherein after selection of a surgical procedure, via the at least one user-interface element, the availability of each inventory item associated with the selected surgical procedure is dynamically generated on the institution’s cloud interface, and iv) display an alert for each inventory item determined as not available based on the system-defined constraints, wherein the alert is displayable on at least one of the institution’s cloud interface or the inventory item. Here, in line with the disclosure herein, alternative inventory items for unavailable items may also be displayed. Such a cloud interface enables an institution to evaluate whether a desired/proposed surgical procedure can proceed based on current inventories. Here, data at the surgical hub level (e.g., historical local usage) and/or the cloud-based analytics system level (e.g., historical local and/or global usage) may be used to determine combinations of modular components and/or surgical tools usable for the surgical procedure selected via the user-interface element. Furthermore, alternative and/or preferred modular components and/or surgical tools may be recommended for the surgical procedure selected via the user-interface element. Such a recommendation (e.g., best practices) may be based on a statistical analysis of data at the surgical hub level and/or the cloud-based analytics system level. Such a recommendation may or may not be based on current inventory of the institution. 
     In yet another aspect of the present disclosure, a modular component and/or surgical tool may be a single-use device rather than a reusable and/or reprocessed device. In such an aspect, packaging associated with the single-use device may include a one-time use activation code. In such an aspect, the one-time use activation code may be entered into an activation input field on a cloud interface via the cloud-access terminal of the surgical hub and transmitted to the cloud-based analytics system. Here, upon receipt, the cloud-based analytics system may cross-check the one-time use activation code with a database of one-time use activation codes (e.g., downloaded from a manufacturer) to authorize use with the system. If the one-time use activation code matches an unused activation code, the modular component and/or surgical tool is authorized. However, if the one-time use activation code does not match an activation code in the database or the one-time use activation code matches an already used activation code, that one-time use activation code may be placed on a black-list such that the single-use modular component and/or surgical tool is not authorized (e.g., critical system-defined constraint). 
     Robotic Systems 
     Aspects of the present disclosure also include detailed description of various robotic surgical devices and systems that are configured to interface with a Hub system, which may ultimately be interconnected to the cloud-based medical analytics system. The combination of multiple Hub systems, each communicatively coupled to a robotic surgical system, with the Hub systems communicatively coupled to the cloud-based medical analytics system, forms a comprehensive digital medical system that is capable of servicing a great number of patients while providing improved care and insights through the aggregation and analysis of data provided by each of the multiple Hub systems and respectively coupled robotic surgical systems. Described below are examples of structures and functions of various robotic surgical devices and systems configured to integrate with this comprehensive digital medical system. 
     Robotic surgical systems can be used in minimally invasive medical procedures. During such medical procedures, a patient can be placed on a platform adjacent to a robotic surgical system, and a surgeon can be positioned at a console that is remote from the platform and/or from the robot. For example, the surgeon can be positioned outside the sterile field that surrounds the surgical site. The surgeon provides input to a user interface via an input device at the console to manipulate a surgical tool coupled to an arm of the robotic system. The input device can be a mechanical input devices such as control handles or joysticks, for example, or contactless input devices such as optical gesture sensors, for example. 
     The robotic surgical system can include a robot tower supporting one or more robotic arms. At least one surgical tool (e.g. an end effector and/or endoscope) can be mounted to the robotic arm. The surgical tool(s) can be configured to articulate relative to the respective robotic arm via an articulating wrist assembly and/or to translate relative to the robotic arm via a linear slide mechanism, for example. During the surgical procedure, the surgical tool can be inserted into a small incision in a patient via a cannula or trocar, for example, or into a natural orifice of the patient to position the distal end of the surgical tool at the surgical site within the body of the patient. Additionally or alternatively, the robotic surgical system can be employed in an open surgical procedure in certain instances. 
     A schematic of a robotic surgical system  15000  is depicted in  FIG.  205   . The robotic surgical system  15000  includes a central control unit  15002 , a surgeon’s console  15012 , a robot  15022  including one or more robotic arms  15024 , and a primary display  15040  operably coupled to the control unit  15002 . The surgeon’s console  15012  includes a display  15014  and at least one manual input device  15016  (e.g., switches, buttons, touch screens, joysticks, gimbals, etc.) that allow the surgeon to telemanipulate the robotic arms  15024  of the robot  15022 . The reader will appreciate that additional and alternative input devices can be employed. 
     The central control unit  15002  includes a processor  15004  operably coupled to a memory  15006 . The processor  15004  includes a plurality of inputs and outputs for interfacing with the components of the robotic surgical system  15000 . The processor  15004  can be configured to receive input signals and/or generate output signals to control one or more of the various components (e.g., one or more motors, sensors, and/or displays) of the robotic surgical system  15000 . The output signals can include, and/or can be based upon, algorithmic instructions which may be pre-programmed and/or input by the surgeon or another clinician. The processor  15004  can be configured to accept a plurality of inputs from a user, such as the surgeon at the console  15012 , and/or may interface with a remote system. The memory  15006  can be directly and/or indirectly coupled to the processor  15004  to store instructions and/or databases. 
     The robot  15022  includes one or more robotic arms  15024 . Each robotic arm  15024  includes one or more motors  15026  and each motor  15026  is coupled to one or more motor drivers  15028 . For example, the motors  15026 , which can be assigned to different drivers and/or mechanisms, can be housed in a carriage assembly or housing. In certain instances, a transmission intermediate a motor  15026  and one or more drivers  15028  can permit coupling and decoupling of the motor  15026  to one or more drivers  15028 . The drivers  15028  can be configured to implement one or more surgical functions. For example, one or more drivers  15028  can be tasked with moving a robotic arm  15024  by rotating the robotic arm  15024  and/or a linkage and/or joint thereof. Additionally, one or more drivers  15028  can be coupled to a surgical tool  15030  and can implement articulating, rotating, clamping, sealing, stapling, energizing, firing, cutting, and/or opening, for example. In certain instances, the surgical tools  15030  can be interchangeable and/or replaceable. Examples of robotic surgical systems and surgical tools are further described herein. 
     The reader will readily appreciate that the computer-implemented interactive surgical system  100  ( FIG.  1   ) and the computer-implemented interactive surgical system  200  ( FIG.  9   ) can incorporate the robotic surgical system  15000 . Additionally or alternatively, the robotic surgical system  15000  can include various features and/or components of the computer-implemented interactive surgical systems  100  and  200 . 
     In one exemplification, the robotic surgical system  15000  can encompass the robotic system  110  ( FIG.  2   ), which includes the surgeon’s console  118 , the surgical robot  120 , and the robotic hub  122 . Additionally or alternatively, the robotic surgical system  15000  can communicate with another hub, such as the surgical hub  106 , for example. In one instance, the robotic surgical system  15000  can be incorporated into a surgical system, such as the computer-implemented interactive surgical system  100  ( FIG.  1   ) or the computer-implemented interactive surgical system  200  ( FIG.  9   ), for example. In such instances, the robotic surgical system  15000  may interact with the cloud  104  or the cloud  204 , respectively, and the surgical hub  106  or the surgical hub  206 , respectively. In certain instances, a robotic hub or a surgical hub can include the central control unit  15002  and/or the central control unit  15002  can communicate with a cloud. In other instances, a surgical hub can embody a discrete unit that is separate from the central control unit  15002  and which can communicate with the central control unit  15002 . 
     Another surgical robotic system is the da Vinci® surgical robotic system by Intuitive Surgical, Inc. of Sunnyvale, California. An example of a system is depicted in  FIGS.  206 - 212   .  FIG.  206    depicts a minimally invasive robotic surgical (MIRS) system  12010  typically used for performing a minimally invasive diagnostic or surgical procedure on a patient  12012  who is lying down on an operating table  12014 . The system  12010  includes a surgeon’s console  12016  for use by a surgeon  12018  during the procedure. One or more assistants  12020  may also participate in the procedure. The MIRS system  12010  can further include a patient side cart  12022 , i.e. a surgical robot, and an electronics cart  12024 . The surgical robot  12022  can manipulate at least one removably coupled tool assembly  12026  (hereinafter referred to as a “tool”) through a minimally invasive incision in the body of the patient  12012  while the surgeon  12018  views the surgical site through the console  12016 . An image of the surgical site can be obtained by an imaging device such as a stereoscopic endoscope  12028 , which can be manipulated by the surgical robot  12022  to orient the endoscope  12028 . Various alterative imaging devices are further described herein. 
     The electronics cart  12024  can be used to process the images of the surgical site for subsequent display to the surgeon  12018  through the surgeon’s console  12016 . The number of robotic tools  12026  used at one time will generally depend on the diagnostic or surgical procedure and the space constraints within the operating room among other factors. If it is necessary to change one or more of the robotic tools  12026  being used during a procedure, an assistant  12020  may remove the robotic tool  12026  from the surgical robot  12022 , and replace it with another tool  12026  from a tray  12030  in the operating room. 
     Referring primarily to  FIG.  207   , the surgeon’s console  12016  includes a left eye display  12032  and a right eye display  12034  for presenting the surgeon  12018  with a coordinated stereo view of the surgical site that enables depth perception. The console  12016  further includes one or more input control devices  12036 , which in turn cause the surgical robot  12022  ( FIG.  206   ) to manipulate one or more tools  12026  ( FIG.  206   ). The input control devices  12036  can provide the same degrees of freedom as their associated tools  12026  ( FIG.  206   ) to provide the surgeon with telepresence, or the perception that the input control devices  12036  are integral with the robotic tools  12026  so that the surgeon has a strong sense of directly controlling the robotic tools  12026 . To this end, position, force, and tactile feedback sensors may be employed to transmit position, force, and tactile sensations from the robotic tools  12026  back to the surgeon’s hands through the input control devices  12036 . The surgeon’s console  12016  is usually located in the same room as the patient  12012  so that the surgeon  12018  may directly monitor the procedure, be physically present if necessary, and speak to an assistant  12020  directly rather than over the telephone or other communication medium. However, the surgeon  12018  can be located in a different room, a completely different building, or other remote location from the patient  12012  allowing for remote surgical procedures. A sterile field can be defined around the surgical site. In various instances, the surgeon  12018  can be positioned outside the sterile field. A sterile adapter can define a portion of the boundary of the sterile field. An example of a sterile adapter for a robotic arm is described in U.S. Pat. Application Publication No. 2015/0257842, filed Mar. 17, 2015, titled BACKUP LATCH RELEASE FOR SURGICAL INSTRUMENT, which issued on Dec. 12, 2017 as U.S. Pat. No. 9,839,487, which is herein incorporated by reference in its entirety. 
     Referring primarily now to  FIG.  208   , the electronics cart  12024  can be coupled with the endoscope  12028  and can include a processor to process captured images for subsequent display, such as to a surgeon on the surgeon’s console, or on another suitable display located locally and/or remotely. For example, where the stereoscopic endoscope  12028  is used, the electronics cart  12024  can process the captured images to present the surgeon with coordinated stereo images of the surgical site. Such coordination can include alignment between the opposing images and can include adjusting the stereo working distance of the stereoscopic endoscope. As another example, image processing can include the use of previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations, for example. 
       FIG.  209    diagrammatically illustrates a robotic surgery system  12050 , such as the MIRS system  12010  of  FIG.  206   . As discussed herein, a surgeon’s console  12052 , such as the surgeon’s console  12016  in  FIG.  206   , can be used by a surgeon to control a surgical robot  12054 , such as the surgical robot  12022  in  FIG.  206   , during a minimally invasive procedure. The surgical robot  12054  can use an imaging device, such as a stereoscopic endoscope, to capture images of the procedure site and output the captured images to an electronics cart  12056 , such as the electronics cart  12024  in  FIG.  206   . As discussed herein, the electronics cart  12056  can process the captured images in a variety of ways prior to any subsequent display. For example, the electronics cart  12056  can overlay the captured images with a virtual control interface prior to displaying the combined images to the surgeon via the surgeon’s console  12052 . The surgical robot  12054  can output the captured images for processing outside the electronics cart  12056 . For example, the surgical robot  12054  can output the captured images to a processor  12058 , which can be used to process the captured images. The images can also be processed by a combination of the electronics cart  12056  and the processor  12058 , which can be coupled together to process the captured images jointly, sequentially, and/or combinations thereof. One or more separate displays  12060  can also be coupled with the processor  12058  and/or the electronics cart  12056  for local and/or remote display of images, such as images of the procedure site, or other related images. 
       FIGS.  210  and  211    show the surgical robot  12022  and a robotic tool  12062 , respectively. The robotic tool  12062  is an example of the robotic tools  12026  ( FIG.  206   ). The reader will appreciate that alternative robotic tools can be employed with the surgical robot  12022  and exemplary robotic tools are described herein. The surgical robot  12022  shown provides for the manipulation of three robotic tools  12026  and the imaging device  12028 , such as a stereoscopic endoscope used for the capture of images of the site of the procedure. Manipulation is provided by robotic mechanisms having a number of robotic joints. The imaging device  12028  and the robotic tools  12026  can be positioned and manipulated through incisions in the patient so that a kinematic remote center or virtual pivot is maintained at the incision to minimize the size of the incision. Images of the surgical site can include images of the distal ends of the robotic tools  12026  when they are positioned within the field-of-view (FOV) of the imaging device  12028 . Each tool  12026  is detachable from and carried by a respective surgical manipulator  12031 , which is located at the distal end of one or more of the robotic joints. The surgical manipulator  12031  provides a moveable platform for moving the entirety of a tool  12026  with respect to the surgical robot  12022 , via movement of the robotic joints. The surgical manipulator  12031  also provides power to operate the robotic tool  12026  using one or more mechanical and/or electrical interfaces. 
       FIG.  212    is a schematic of a telesurgically-controlled surgical system  12100 . The surgical system  12100  includes a surgeon console  12102 , which for example can be the surgeon’s console  12052  ( FIG.  209   ). The surgeon console  12102  drives a surgical robot  12104 , which for example can be the surgical robot  12022  ( FIG.  206   ). The surgical robot  12104  includes a surgical manipulator  12106 , which for example can be the surgical manipulator  12031  ( FIG.  210   ). The surgical manipulator  12106  includes a motor unit  12108  and a robotic tool  12110 . The motor unit  12108  is a carriage assembly that holds five motors, which can be assigned to different mechanisms. In some exemplifications only five motors are used, while in other exemplifications more or less than five motors can be used. The motor unit  12108  includes a power motor  12112 , a camshaft motor  12140 , a pitch motor  12116 , a yaw motor  12118 , and low-force grip motor  12120 , although these motors can be used for different purposes depending on the attached instrument. Generally, each motor is an electric motor that mechanically and electrically couples with corresponding inputs of the robotic tool  12110 . In some exemplifications, the motor unit  12108  may be located at a proximal end of the robotic tool  12110  in a shared chassis with the robotic tool, as generally depicted by the proximal housing shown in  FIG.  211   . A motor housing is further described in U.S. Pat. Application Publication No. 2012/0150192, filed Nov. 15, 2011, titled METHOD FOR PASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTE ACTUATOR INTO AN INDEPENDENTLY ROTATING MEMBER, which issued on Aug. 4, 2015 as U.S. Pat. No. 9,095,362, which is herein incorporated by reference in its entirety. 
     The robotic tool  12110  for example, can be the robotic tool  12026  ( FIG.  206   ) described herein. The robotic tool  12110  includes an elongated effector unit  12122  that includes three discrete inputs that each mechanically couple with the pitch motor  12116 , the yaw motor  12118 , and the low-force grip motor  12120 , respectively, by way of the surgical manipulator  12106 . The robotic tool  12110  also includes a transmission  12124 , which mechanically couples with the power motor  12112  and the camshaft motor  12140 . Examples of tools are further described in International Patent Application Publication No. WO 2015/153642, filed Mar. 31, 2015, titled SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION, and in International Patent Application Publication No. WO 2015/153636, filed Mar. 31, 2015, titled CONTROL INPUT ACCURACY FOR TELEOPERATED SURGICAL INSTRUMENT, each of which is herein incorporated by reference in its entirety. 
     A surgical end effector  12126  is located at the distal end of the effector unit  12122 . The surgical end effector  12126  and effector unit  12122  are connected by way of a moveable wrist. An example of such a wrist is shown at U.S. Pat. Application Publication No. 2011/0118708, filed Nov. 12, 2010, titled DOUBLE UNIVERSAL JOINT, and in U.S. Pat. No. 9,216,062, filed Feb. 15, 2012, titled SEALS AND SEALING METHODS FOR A SURGICAL INSTRUMENT HAVING AN ARTICULATED END EFFECTOR ACTUATED BY A DRIVE SHAFT, each of which is herein incorporated by reference in its entirety. In simplistic terms, the surgical end effector can be characterized by a plurality of discrete but interrelated mechanisms, with each mechanism providing a degree of freedom (DOF) for the surgical end effector  12126 . As used herein with respect to surgical system  12100 , a DOF is one or more interrelated mechanisms for affecting a corresponding movement. The DOFs endow the surgical end effector  12126  with different modes of operation that can operate concurrently or discretely. For example, the wrist enables the surgical end effector  12126  to pitch and yaw with respect to the surgical manipulator  12106 , and accordingly includes a pitch DOF  12128  and a yaw DOF  12130 . The surgical end effector  12126  also includes a roll DOF  12132  rotating surgical end effector  12126  about an elongated axis. Different robotic tool can have different DOFs, as further described herein. 
     The surgical end effector  12126  may include a clamping and cutting mechanism, such as a surgical stapler. An example of such an instrument, including a staple cartridge therefor, is further described in U.S. Pat. Application Publication No. 2013/0105552, filed Oct. 26, 2012, titled CARTRIDGE STATUS AND PRESENCE DETECTION, and U.S. Pat. Application Publication No. 2013/0105545, filed Oct. 26, 2012, titled SURGICAL INSTRUMENT WITH INTEGRAL KNIFE BLADE, both of which are incorporated by reference herein in their respective entireties. A clamping mechanism can grip according to two modes, and accordingly include two DOFs. A low-force DOF  12134  (e.g., a cable actuated mechanism) operates to toggle the clamp with low force to gently manipulate tissue. The low-force DOF  12134  is useful for staging the surgical end effector for a cutting or stapling operation. A high-force DOF  12136  (e.g., a lead screw actuated mechanism) operates to further open the clamp or close the clamp onto tissue with relatively high force, for example, to tourniquet tissue in preparation for a cutting or stapling operation. Once clamped, the surgical end effector  12126  employs a tool actuation DOF  12138  to further affect the tissue, for example, to affect tissue by a stapling, cutting, and/or cauterizing device. Clamping systems for a surgical end effector are further described in U.S. Pat. No. 9,393,017, filed May 15, 2012, titled METHODS AND SYSTEMS FOR DETECTING STAPLE CARTRIDGE MISFIRE OR FAILURE, which issued on Jul. 19, 2016, U.S. Pat. No. 8,989,903, filed Jan. 13, 2012, titled METHODS AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION, which issued on Mar. 2, 2015, and U.S. Pat. No. 9,662,177, filed Mar. 2, 2015, titled METHODS AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION, which issued on May 30, 2017, all of which are incorporated by reference herein in their respective entireties. 
     As shown in  FIG.  212   , the pitch motor  12116 , the yaw motor  12118 , and the low-force grip motor  12120  drive the pitch DOF  12128 , the yaw DOF  12130 , and the low-force grip DOF  12134 , respectively. Accordingly, each of the pitch DOF  12128 , the yaw DOF  12130 , and the low force grip DOF  12134  is discretely paired with a motor, and can operate independently and concurrently with respect to other DOFs. However, the high force grip DOF  12136 , the roll DOF  12132 , and the tool actuation DOF  12138  share a single input with the power motor  12112 , via the transmission  12124 . Accordingly, only one of the high-force grip DOF  12136 , the roll DOF  12132 , and the tool actuation DOF  12138  can operate at one time, since coupling with the power motor  12112  occurs discretely. The camshaft motor  12140  is actuated to shift output of the power motor  12112  between the high force grip DOF  12136 , the roll DOF  12132 , and the tool actuation DOF  12138 . Accordingly, the transmission  12124  advantageously allows a greater amount of DOFs than an arrangement where each motor is dedicated to a single DOF. 
     Additional features and operations of a surgical robotic system, such as the robotic surgical system of  FIGS.  206 - 212   , are further described in the following references, which are herein incorporated by reference in their respective entireties: 
     U.S. Pat. Application Publication No. 2011/0118708, filed Nov. 12, 2010, titled DOUBLE UNIVERSAL JOINT;   U.S. Pat. No. 9,095,362, filed Nov. 15, 2011, titled METHOD FOR PASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTE ACTUATOR INTO AN INDEPENDENTLY ROTATING MEMBER, which issued on Aug. 4, 2015;   U.S. Pat. No. 8,989,903, filed Jan. 13, 2012, titled METHODS AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION, which issued on Mar. 24, 2015;   U.S. Pat. No. 9,216,062, filed Feb. 15, 2012, titled SEALS AND SEALING METHODS FOR A SURGICAL INSTRUMENT HAVING AN ARTICULATED END EFFECTOR ACTUATED BY A DRIVE SHAFT, which issued on Dec. 22, 2015;   U.S. Pat. No. 9,393,017, filed May 15, 2012, titled METHODS AND SYSTEMS FOR DETECTING STAPLE CARTRIDGE MISFIRE OR FAILURE, which issued on Jul. 19, 2016;   U.S. Pat. Application Publication No. 2013/0105552, filed Oct. 26, 2012, titled CARTRIDGE STATUS AND PRESENCE DETECTION;   U.S. Pat. Application Publication No. 2013/0105545, filed Oct. 26, 2012, titled SURGICAL INSTRUMENT WITH INTEGRAL KNIFE BLADE;   International Patent Application Publication No. WO 2015/142814, filed Mar. 17, 2015, titled SURGICAL CANNULA MOUNTS AND RELATED SYSTEMS AND METHODS;   U.S. Pat. Application Publication No. 2015/0257842, filed Mar. 17, 2015, titled BACKUP LATCH RELEASE FOR SURGICAL INSTRUMENT, which issued on Dec. 12, 2017 as U.S. Patent No. 9,839,487;   U.S. Pat. Application Publication No. 2015/0257841, filed Mar. 17, 2015, titled LATCH RELEASE FOR SURGICAL INSTRUMENT;   International Patent Application Publication No. WO 2015/153642, filed Mar. 31, 2015, titled SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION;   International Patent Application Publication No. WO 2015/153636, filed Mar. 31, 2015, titled CONTROL INPUT ACCURACY FOR TELEOPERATED SURGICAL INSTRUMENT; and   U.S. Pat. No. 9,662,177, filed Mar. 2, 2015, titled METHODS AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION, which issued on May 30, 2017.   

     The robotic surgical systems and features disclosed herein can be employed with the da Vinci® surgical robotic system referenced herein and/or the system of  FIGS.  206 - 212   . The reader will further appreciate that various systems and/or features disclosed herein can also be employed with alternative surgical systems including the computer-implemented interactive surgical system  100 , the computer-implemented interactive surgical system  200 , the robotic surgical system  110 , the robotic hub  122 , the robotic hub  222 , and/or the robotic surgical system  15000 , for example. 
     In various instances, a robotic surgical system can include a robotic control tower, which can house the control unit of the system. For example, the processor  12058  ( FIG.  209   ) can be housed within a robotic control tower. The robotic control tower can comprise a robot hub such as the robotic hub  122  ( FIG.  2   ) or the robotic hub  222  ( FIG.  9   ), for example. Such a robotic hub can include a modular interface for coupling with one or more generators, such as an ultrasonic generator and/or a radio frequency generator, and/or one or more modules, such as an imaging module, a suction module, an irrigation module, a smoke evacuation module, and/or a communication module. 
     A robotic hub can include a situational awareness module, which can be configured to synthesize data from multiple sources to determine an appropriate response to a surgical event. For example, a situational awareness module can determine the type of surgical procedure, step in the surgical procedure, type of tissue, and/or tissue characteristics, as further described herein. Moreover, such a module can recommend a particular course of action or possible choices based on the synthesized data. In various instances, a sensor system encompassing a plurality of sensors distributed throughout the robotic system can provide data, images, and/or other information to the situational awareness module. Such a situational awareness module can be accessible to the processor  12058 , for example. In various instances, the situational awareness module can obtain data and/or information from a non-robotic surgical hub and/or a cloud, such as the surgical hub  106  ( FIG.  1   ), the surgical hub  206  ( FIG.  10   ), the cloud  104  ( FIG.  1   ), and/or the cloud  204  ( FIG.  9   ), for example. Situational awareness of a surgical system is further disclosed herein and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, and in U.S. Provisional Pat. Application Serial No. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure of each of which is herein incorporated by reference in its entirety. 
     Surgical systems including a robot, a visualization system (such as the visualization system  108  or the visualization system  208 ), and one or more hubs (such as the hub  106 , the robotic hub  122 , the hub  206 , and/or the robotic hub  222 ) can benefit from robust communication systems for data collection and dissemination. For example, various parameters regarding the surgical site, the surgical instrument(s), and/or the surgical procedure can be important information to the robot, the visualization system, and the hub(s). Moreover, the robot can include one or more subassemblies, such as a control console, which may require information regarding the surgical site, the surgical instrument(s), and/or the surgical procedure, for example. It can be helpful to collect and disseminate the information to the appropriate assemblies and/or subassemblies in real-time or near real-time to inform the machine learning and/or decision-making process, for example. In certain instances, data collection and dissemination can inform the situational awareness of a surgical system that includes one or more robotic systems. 
     In one aspect, a robotic surgical system can include additional communication paths. For example, a robotic surgical system can include a primary wired communication path and a secondary wireless communication path. In certain instances, the two communication paths can be independent such that a secondary path is redundant and/or parallel to a primary path. In various instances, a first type and/or amount of data can be transferred along the primary path and a second type and/or amount of data can be transferred along the secondary path. The multiple communication paths can improve connectivity of the robot and/or the robotic surgical tools to one or more displays within the surgical theater, a control console, and/or control unit. The communication paths can connect a surgical robot to a central control unit (e.g. a hub) and/or a visualization system (e.g. a display), for example. In various instances, the additional communication paths can provide additional data to the robot and/or to a generator module and/or a processor in communication with the generator module. 
     Referring primarily to  FIG.  213   , a robotic surgical system  12200  including a console  12216  and a robot  12222  is depicted. The console  12216  can be similar in many respects to the console  12016  ( FIGS.  206  and  207   ), and the robot  12222  can be similar in many respects to the robot  12022  ( FIGS.  206  and  210   ). A robotic tool  12226 , which can be similar in many respects to the robotic tool  12026  ( FIG.  206   ), for example, is positioned at the distal end of one of the arms of the robot  12222 . The robotic tool  12226  is an energy device. For example, energy can be supplied to the robotic tool  12226  by a generator that is coupled to the robotic tool  12226 . 
     The robotic surgical system  12200  also includes a hub  12224 , which can be similar in many respects to the robotic hub  122  ( FIG.  2   ) and/or the robotic hub  222  ( FIG.  9   ). The hub  12224  includes a generator module  12230 , which is similar in many respects to the generator module  140  ( FIG.  3   ), and a wireless communication module  12238 , which is similar in many respects to the communication module  130  ( FIG.  3   ). The generator module  12230  is configured to supply energy to the robotic tool  12226  via a first wired connection  12244 . 
     In one instance, the first wired connection  12244  can be a two-way communication path between the robotic tool  12226  and the surgical hub  12224 . The first wired connection  12244  can convey advanced energy parameters or other electrical data between the robotic tool  12226  and the surgical hub  12224 . For example, the surgical hub  12224  can provide information to the robotic tool  12226  regarding the power level (e.g. current for an RF device and amplitude and/or frequency for an ultrasonic device) supplied thereto. Additionally, the robotic tool  12226  can provide information to the robot  12222  regarding the detected conductivity and/or impendence at the tissue interface, corresponding to a property of the tissue and/or the effectiveness of the energy device. 
     Additionally, a second wired connection  12240  between the console  12216  and the robotic tool  12226  mounted to the robot  12222  provides a communication path for control signals from the robot console  12216  to the robotic tool  12226 . In one instance, the second wired connection  12240  can be a one-way communication path from the robot  12222  to the console  12216  with respect to control parameters or other mechanical data collected by the robot  12222  and/or the robotic tool  12226 . For example, the robot  12222  can provide information to the console  12216  about a surgical actuation of the robotic tool, such as a closing motion and/or a firing motion. More specifically, the robot can communicate force-to-clamp parameters (e.g. clamping pressure by the robotic tool  12226  on tissue) and/or force-to-fire parameters from the robotic tool  12226  to the console  12216 , for example. 
     Referring still to  FIG.  213   , absent the wireless communication paths  12242  and  12246 , the robotic hub  12224  may be unable to communicate with the console  12216  and vice versa. Additionally, the robotic tool  12226  may be unable to communicate with the hub  12224 . In instances in which communication paths between the hub  12224  and the robot  12222  and/or the robotic tool  12226  are lacking, the mechanical control parameters (e.g. clamping force) from the robotic tool  12226  may not be communicated to the robotic hub  12224  and the generator module  12230  thereof. Additionally, electrical advanced energy parameters may not be communicated from the robot  12222  to the robotic hub  12224  and/or to the console  12216 . In such instances, the system  12200  would comprise open-loop controls. 
     Different energy parameters and different clamping pressures may be better suited for certain types of tissue and/or certain applications. For example, an ultrasonic weld is generally a function of transducer amplitude and clamping pressure over time. Similarly, an RF weld is generally a function of current and clamping pressure over time. However, without the wireless communication paths  12242  and  12246  mentioned above, the generator module  12230  can be unaware of the clamping pressure. Similarly, the console  12216  can be unaware of the energy parameters. 
     To optimize the control of the robotic tool  12226 , the robotic tool  12226  can convey one or more mechanical control parameters to the robotic hub  12224 . Additionally, the hub  12224  can convey one or more advanced energy parameters to the console  12216 . The data transfer can provide closed-loop controls for the system  12200 . In one instance, the mechanical control parameters and advanced energy parameters can be balanced for different types of tissue and/or particular applications. For example, the clamping pressure can be decreased and the power to the robotic tool  12226  can be increased, or vice versa. 
     Referring still to  FIG.  213   , the robotic tool  12226  includes a wireless communication module  12228 , as further described herein. The wireless communication module  12228  is in signal communication with the wireless communication module  12238  of the robotic hub  12224  via the wireless communication path  12242 . For example, the wireless communication module  12238  can include a first receiver  12232  configured to receive wireless signals from the robotic tool  12226 . The wireless communication module  12238  also includes a second receiver  12234 , which can receive signals from the console  12216  via the second wireless communication path  12246 . In such instances, the first and second wireless communication paths  12242  and  12246 , respectively, can complete a communication circuit back to the console  12216  from the robotic tool  12226  via the surgical hub  12224 , for example. 
     In other instances, the wireless communication module  12228  can be on the robot  12222 . For example, the wireless communication module  12228  can be positioned on an arm of the robot and/or a tool mounting portion of the robot  12222 . 
     Additionally or alternatively, a wireless communication path can be provided between the robotic tool  12226  and the console  12216 . 
     The wireless paths described herein can provide data transfer without encumbering the mobility of the robotic tool  12226  and/or creating additional opportunities for entanglement or cords and/or wires. In other instances, one or more of the wireless communication paths described herein can be replaced with wired connection(s). 
     In one aspect, the robotic tool  12226  and/or the hub  12224  can share information regarding sensed tissue parameters (e.g. conductivity or inductance corresponding to a property of the tissue) and/or control algorithms for energizing the tissue (e.g. power levels), which can be based on the sensed tissue parameters. The robotic tool  12226  can provide information regarding the status, the activation state, identification information, and/or smart data to the hub  12224 , for example. Data provided to the hub  12224  can be stored, analyzed, and/or further disseminated by the hub  12224  such as to a display screen  12236  thereof. In such instances, the hub  12224  is a conduit or relay post for transmitting the data to additional locations via the wired or wireless connections. 
     In certain instances, the hub  12224  includes a situational awareness module, as further described herein. The situational awareness module can be configured to determine and/or confirm a step in a surgical procedure and/or suggest a particular surgical action based on information received from various sources, including the robot  12222  and the console  12216 . The wireless communication paths  12242  and  12246  linking the hub  12224  to the robot  12222  and the console  12216 , respectively, can be configured to inform the situational awareness module. For example, mechanical control parameters regarding clamping and/or firing can be communicated to the hub  12224  and the situational awareness module thereof via the second wireless communication path  12246 . Additionally or alternatively, energy parameters regarding activation of the energy tool and/or sensed tissue parameters can be communicated to the hub  12224  and the situational awareness module thereof via the first wireless communication path  12242 . 
     In certain instances, the data wirelessly transmitted to the hub  12224  can inform the situational awareness module thereof. For example, based on sensed tissue parameters detected by the robotic tool  12226  and transmitted along the first wireless communication path  12242 , the situational awareness module can determine and/or confirm the type of tissue involved in the surgical procedure and, in certain instances, can suggest a therapeutic response based on the type of tissue encountered. 
     Referring still to  FIG.  213   , the second wired connection  12240  from the robot  12222  to the console  12216  provides a first communication path. Moreover, the wired or wireless connection between the robot  12222  and the hub  12224  in combination with the wireless communication path  12246  between the hub  12224  and the console  12216  forms a second, parallel communication path from the robot  12222  to the console  12212 . Because the second communication path communicates via the hub  12224  and the wireless communication module  12238  thereof, the second communication path is different than the first communication path. However, such a path provides a parallel and alternative path to the second wired connection  12240  between the robot  12222  and the console  12216 . Similarly, parallel and/or redundant paths are also provided via the wireless path  12242  and the wired path  12244  between the robot  12222  and the hub  12224 . The alternative parallel communication path(s) can bolster the integrity of the communications systems and enables robot communication between the various components of the surgical system. 
     Additionally or alternatively, information may be communicated directly to a device or system having wireless capabilities such as a visualization system or display like the visualization system  108  or the visualization system  208 , for example. A surgical system  12300  depicted in  FIG.  238    includes the console  12216  for a surgeon S, the robot  12222  including the robotic tool  12226  mounted thereto, and the surgical hub  12224 . The surgical system  12300  also includes a monitor  12350 , which is positioned within the surgical theater. Additional clinicians can be within the surgical theater including a nurse N, a medical assistant MA, and an anesthesiologist A. Certain clinicians can be positioned within the sterile field. For example, the nurse N, who is stationed at a table  12352  supporting a plurality of medical instruments and robotic tools, can be sterile. The medical assistant MA holding the handheld surgical instrument and the anesthesiologist A may be positioned outside the sterile field. The monitor  12350  is viewable by clinicians within the sterile field and outside the sterile field. An additional display  12354  can be positioned within the sterile field. The additional display  12354  can be a mobile computer with wireless, cellular and/or Bluetooth capabilities, for example. In one instance, the additional display  12354  can be a tablet, such as an iPad® tablet, that is positionable on the patient P or patient table  12358 . In such instances, the display  12354  is positioned within the sterile field. 
     The wireless communication module  12228  ( FIG.  213   ) on the robotic tool  12226  can be in signal communication with the monitor  12350  and/or the display  12354 . In such instances, data and/or information obtained at the surgical site and/or by the robotic tool  12226  can be directly communicated to a screen within the surgical theater and immediately viewable to various clinicians with the surgical theater, including clinicians within the sterile field or outside the sterile field. In such instances, data can be provided in real time, or near real time, to inform the clinicians’ decisions during the surgical procedure. Additionally, certain information can be communicated to the hub  12224  for further storage, analysis and/or dissemination, as further described herein. 
     Owing to wireless communication paths, the monitor  12350  and/or the display  12354  can also display information from the hub, including energy parameters, in certain instances. For example, the hub  12224  can obtain data indicative of an activation state or activation level of the generator module  12230  ( FIG.  213   ) and/or can receive data indicative of sensed tissue parameters from the robotic tool  12226 , as further described herein. In such instances, the activation information and/or tissue information can be displayed on the monitor  12350  and/or the display  12354  such that the information is readily available to operators both within the sterile filed and outside the sterile field. 
     In one aspect, the hub  12224  can ultimately communicate with a cloud, such as the cloud  104  or the cloud  204 , for example, to further inform the machine-learning and decision-making processes related to the advanced energy parameters and/or mechanical control parameters of the robotic tool  12226 . For example, a cloud can determine an appropriate surgical action and/or therapeutic response for a particular tissue parameter, surgical procedure, and/or patient demographic based on aggregated data stored therein. To protect patient confidentiality, the hub  12224  can communicate redacted and/or a confidential version of the data, for example. 
     As described herein with respect to  FIG.  213   , the robotic tool  12226  includes the wireless communication module  12228 . The wireless communication module  12228  is also shown in  FIG.  214   . Specifically, a proximal portion of the robotic tool  12226  including the wireless communication module  12228  is depicted in  FIG.  214   , as well as a tool mounting portion, or attachment portion,  12250  of the robot  12222  for releasably attaching the proximal housing of the robotic tool  12226 . A detailed view of a mechanical and electrical interface between the robotic tool  12226  and the tool mounting portion  12250  is depicted in  FIG.  215   . 
     The robotic tool  12226  includes a first drive interface  12252  that drivingly couples with a second drive interface  12254  on the tool mounting portion  12250 . The tool mounting portion  12250  includes a carriage or motor housing that houses a plurality of motors, which can be similar in many respects to the motors  12112 ,  12116 ,  12118 ,  12120 , and  12140  ( FIG.  212   ), for example. The motors are driving coupled to rotary outputs  12256  at the second drive interface  12254  that engage rotary inputs  12258  on the robotic tool  12226 . For example, the rotary inputs  12258  are positioned and structured to mechanically mate with the rotary outputs  12256  on the tool mounting portion  12250 . 
     A plug  12260  for supplying power to the motors is shown in  FIG.  214   . The plug  12260  is also coupled to the wireless communication module  12228 . In such instances, the wireless communication module  12228  can be powered via a current supplied by the plug  12260 . The plug  12260  can ultimately be wired to the generator module  12230  in the hub  12224  to complete the wired connection  12244  between the robotic tool  12226  and the hub  12224  (see  FIG.  213   ). 
     Referring primarily now to  FIG.  214   , the tool mounting portion  12250  also includes electrical contacts  12262 , and the robotic tool  12226  includes electrical contacts  12264  positioned and structured to mate with the electrical contacts  12262  on the tool mounting portion  12250 . Electrical signals can be communicated between the robotic tool  12226  and the robot  12222  ( FIG.  213   ) via the mating electrical contacts  12262 ,  12264 . In certain instances, mechanical control parameters from the robotic tool  12262  can be communicated to the robot  12222  via the electrical contacts  12262 ,  12264 , as further described herein. Additionally or alternatively, advanced energy parameters can be communicated to the robot  12222  and/or to the robotic tool  12226  via the mating electrical contacts  12262 ,  12264 , or vice versa, as further described herein. 
     As depicted in  FIG.  215   , when the robotic tool  12226  is mounted to the tool mounting portion  12250 , a flex circuit  12270  is positioned intermediate the mating electrical contacts  12264  of the robotic tool  12226  and the electrical contacts  12262  of the tool mounting portion  12250  to facilitate data transmission. The flex circuit  12270  is positioned to intercept communication signals between the robotic tool  12262  and the tool mounting portion  12250 . In such instances, the flex circuit  12270  is configured to capture signals passing between those contacts  12262 ,  12264 . In certain instances, the flex circuit  12270  can provide intelligence features to the robotic tool  12226 . 
     In various instances, the flex circuit  12270  can include a feedback pigtail connector. The pigtail connector can intercept the connection between the robotic tool  12226  and the tool mounting portion  12250 . 
     In various instances, the flex circuit  12270  of  FIG.  214    can also include a wireless transmitter that is configured to communicate with the hub  12224  ( FIG.  213   ) via the wireless communication path  12242 . In other instances, the flex circuit  12270  can be coupled to a wireless communication module like the module  12228  in  FIGS.  213  and  214   , which can include a wireless transmitter and/or a wireless receiver. 
     The flex circuit  12270  occupies a small footprint between the tool mounting portion  12250  and the robotic tool  12226 . In one aspect, existing robotic systems can be retrofit with such flex circuits. In other words, existing robotic tools and tool mounting portion can utilize the robust communication systems described herein without modifying the current robotic tools and/or tool mounting portions. 
     In various instances, the flex circuit  12270 , or another intermediate pigtail connector, can be configured to acquire one or more signals between an external controller (e.g., an energy generator of a generator module  140  in a hub  106  ( FIG.  3   )) and the robotic tool  12226 . Moreover, such a circuit or connector can be used to deliver signals to the robotic tool  12226  via the intercepting connections. 
     In one aspect, the robotic hub includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to relay a wireless signal between a robot and a control console, as described herein. In certain instances, the memory stores instructions executable by the processor to adjust a control parameter of the generator (e.g. power level) based on signals intercepted by a flex circuit and/or transmitted along a wireless communication path. Additionally or alternatively, the memory stores instructions executable by the processor to adjust a control parameter of the energy tool (e.g. clamping pressure) based on signals indicative of a tissue property intercepted by the flex circuit and/or transmitted along the wireless communication path. 
     In various aspects, the present disclosure provides a control circuit to relay a wireless signal between a robot and a control console, adjust a control parameter of the generator, and/or adjust a control parameter of an energy tool, as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to relay a wireless signal between a robot and a control console, adjust a control parameter of the generator, and/or adjust a control parameter of an energy tool, as described herein. 
     In one aspect, one or more features and/or effects of a robotically-controlled surgical tool and end effector thereof can be controlled by a control algorithm. For example, the intensity of an end effector effect can be controlled by a control algorithm stored in the memory of the robot and executable by a processor. In one instance, an end effector effect can be smoke evacuation, insufflation, and/or cooling. In another instance, an end effector effect can be articulation and/or retraction. As an example, a robot can implement a load control holding algorithm for articulation of a robotic tool that results in a predefined lateral load on tissue and is limited by a displacement limit, as further described herein. 
     In certain instances, it can be desirable to incorporate a pump into a robotically-controlled surgical tool, such as an energy tool including an RF electrode and/or an ultrasonic blade, for example. A pump can provide insufflation gases or air to a surgical site. In certain instances, a pump can provide coolant to a surgical site and/or can extract smoke and/or steam from the surgical site. 
     Robotically-controlled surgical tools include a drive system for releasably engaging with a robot and transferring drive motions from the robot to the robotic tool. For example, a robotically-controlled surgical tool can include an interface including rotary driver(s) configured to receive rotary inputs from motor(s) in a motor housing or tool mounting portion. Exemplary drive systems and interfaces therefor are further described herein. 
     The rotary drivers in the robotic tools are configured to actuate various surgical functions such as rotation of a shaft, closure of end effector jaws, and articulation of the end effector, for example. Examples of interface configurations are further described herein and in International Patent Application Publication No. WO 2015/153642, filed Mar. 31, 2015, titled SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION, in International Patent Application Publication No. WO 2015/153636, filed Mar. 31, 2015, titled CONTROL INPUT ACCURACY FOR TELEOPERATED SURGICAL INSTRUMENT, and in U.S. Pat. No. 9,095,362, filed Nov. 15, 2011, titled METHOD FOR PASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTE ACTUATOR INTO AN INDEPENDENTLY ROTATING MEMBER, each of which is herein incorporated by reference in its entirety. 
     In certain instances, the number of motors, the number of rotary drivers, and/or the arrangements of motors and/or rotary drivers can be limited or constrained by the footprint of the drive system and/or coupling between the robotic tool and the tool mounting portion. In one aspect, it can be desirable for new and/or improved robotically-controlled surgical tools to be compatible with existing robotic platforms. For example, without enlarging the motor housing or tool mounting portion, it can be desirable to change the functionality and/or add functionality to robotic tools for use with an existing motor housing and tool mounting portion. In such instances, it can be challenging to incorporate certain features, like a pump for example, into a robotic tool compatible with an existing surgical robot. Moreover, it can be desirable to include controls and/or control algorithms for such a pump within the existing architecture of the surgical robot. 
     In one aspect, a pump for a robotic tool can be powered by a rotary drive of the robotic tool interface. The rotary drive and, thus, the pump can be driven at a variable rate, which can depend on the needs of the robotic tool and/or the surgical procedure. For example, the speed of the rotary drive coupled to the pump can be related to the volume of smoke being evacuated from the surgical site and/or the application of energy to tissue by the robotic tool. In one instance, the robotic tool can be an intelligent tool that includes a processor configured to determine the appropriate rate for the pump based on sensors on the robotic tool and/or other inputs thereto. In other instances, a processor in the control unit of the robot can be configured to determine the appropriate rate for the pump based on sensors on the robot and/or modules thereof, such as a smoke evacuation module in a robotic hub, for example. 
     Energy devices utilize energy to affect tissue. In an energy device, the energy is supplied by a generator. Energy devices include devices with tissue-contacting electrodes, such as an electrosurgical device having one or more radio frequency (RF) electrodes, and devices with vibrating surfaces, such as an ultrasonic device having an ultrasonic blade. For an electrosurgical device, a generator is configured to generate oscillating electric currents to energize the electrodes. For an ultrasonic device, a generator is configured to generate ultrasonic vibrations to energize the ultrasonic blade. 
     As provided herein, energy devices deliver mechanical or electrical energy to a target tissue in order to treat the tissue (e.g. to cut the tissue and/or cauterize blood vessels within and/or near the target tissue). The cutting and/or cauterization of tissue can result in fluids and/or particulates being released into the air. Such fluids and/or particulates emitted during a surgical procedure can constitute smoke, for example, which can include carbon and/or other particles suspended in air. 
     In various instances, an energy tool for use with a robotic system can include a suction port coupled to a pump that is powered by a motor on the tool driver. For example, an energy tool for the da Vinci® surgical robotic system can include a suction port coupled to a pump that is powered by a motor on the tool driver. The pump can be configured to extract smoke from a surgical site via the suction port. In such instances, the energy tool can include a smoke evacuation system. In one aspect, the robotic tool can include a pump. Alternatively, the robotic tool can be coupled to a pump. 
     The reader will appreciate that such an evacuation system can be referred to as a “smoke evacuation system” though such an evacuation system can be configured to evacuate more than just smoke from a surgical site. Throughout the present disclosure, the “smoke” evacuated by an evacuation system is not limited to just smoke. Rather, the evacuation systems disclosed herein can be used to evacuate a variety of fluids, including liquids, gases, vapors, smoke, steam, or combinations thereon. The fluids can be biologic in origin and/or can be introduced to the surgical site from an external source during a procedure. The fluids can include water, saline, lymph, blood, exudate, and/or pyogenic discharge, for example. Moreover, the fluids can include particulates or other matter (e.g. cellular matter or debris) that is evacuated by the evacuation system. For example, such particulates can be suspended in the fluid. 
     Referring primarily to  FIGS.  216 - 218   , a robotic tool  12426  for use with a robotic surgical system is depicted. The robotic tool  12426  can be employed with the robotic surgical system  12010  ( FIG.  206   ), for example. The robotic tool  12426  is a bipolar radio-frequency (RF) robotic tool. For example, the tool can be similar in many respects to the tool disclosed in U.S. Pat. No. 8,771,270, filed on Jul. 16, 2008, titled BIPOLAR CAUTERY INSTRUMENT, which is herein incorporated by reference in its entirety. 
     In other instances, the robotic tool  12426  can be a monopolar RF tool, an ultrasonic tool, or a combination ultrasonic-RF tool. For example, the robotic tool  12426  can be similar in many similar to the tool disclosed in U.S. Pat. No. 9,314,308, filed Mar. 13, 2013, titled ROBOTIC ULTRASONIC SURGICAL DEVICE WITH ARTICULATING END EFFECTOR, which is herein incorporated by reference in its entirety. 
     The robotic tool  12426  includes a proximal housing  12437 , a shaft  12438  extending from the proximal housing  12437 , and an end effector  12428  extending from a distal end of the shaft  12438 . Referring primarily to  FIG.  217   , the end effector  12428  includes opposing jaws  12430   a ,  12430   b . Each jaw  12430   a ,  12430   b  includes a tissue-contacting surface including an electrode. For example, the jaw  12430   a  can include a supply electrode, and the jaw  12430   b  can include a return electrode, or vice versa. The end effector  12428  is shown in a clamped configuration and generating an RF weld in  FIG.  217   . In such instances, smoke S from the RF weld may accumulate around the end effector  12428 . For example, the smoke S can accumulate in the abdomen of a patient in certain instances. 
     The robotic tool  12426  also includes an evacuation system  12436 . For example, to improve visibility and efficiency of the robotic tool  12426 , the smoke S at the surgical site can be evacuated along an evacuation channel, or suction conduit,  12440  extending proximally from the end effector  12428 . The evacuation channel  12440  can extend through the shaft  12438  of the robotic tool  12426  to the proximal housing  12437 . The evacuation conduit  12440  terminates at a suction port  12442  adjacent to the end effector  12428 . During operating of the evacuation system  12436 , smoke S at the surgical site is drawn into the suction port  12442  and through the evacuation conduit  12440 . 
     In various instances, the robotic tool  12426  can include insufflation, cooling, and/or irrigation capabilities, as well. For example, the evacuation system  12436  can be configured to selectively pump a fluid, such as saline or CO 2  for example, toward the end effector  12428  and into the surgical site. 
     In various instances, the evacuation channel  12440  can be coupled to a pump for drawing the smoke S along the evacuation channel  12440  within the shaft  12438  of the robotic tool  12426 . Referring primarily to  FIG.  218   , the evacuation system  12436  includes a pump  12446 . The pump  12446  is housed in the proximal housing  12437  of the robotic tool  12426 . The pump  12446  is a lobe pump, which has been incorporated into a drive interface  12448  of the robotic tool  12426 . The drive interface  12448  includes rotary drivers  12450 , which are driven by rotary outputs from motors in the tool mounting portion of the robot, as described herein (see rotary outputs  12256  ( FIG.  214   ) and rotary outputs  12824   a - 12824   e  ( FIG.  222   ), for example). 
     Lobe pumps can be low volume and quiet or noiseless and, thus, desirable in certain instances. For example, a lobe pump can ensure the noise generated by the evacuation system  12436  is not distracting to the clinicians and/or allows communication between clinicians in the surgical theater. The reader will readily appreciate that different pumps can be utilized by the evacuation system  12436  in other instances. 
     A channel  12452  terminating in a fitting  12454  extends from the pump  12446  in  FIGS.  216  and  218   . The fitting  12454  is a luer fitting, however, the reader will readily appreciate that alternative fittings are envisioned. The luer fitting can be selectively coupled to a reservoir that is configured to receive the smoke S from the surgical site, for example. Additionally or alternatively, the luer fitting can supply discharge from the pump  12446  to a filter. 
     Referring still to  FIG.  218   , internal components of the drive interface  12448  are depicted, however, certain components are excluded for clarity. The evacuation channel  12440  extends through the shaft  12438  to the lobe pump  12446  in the proximal housing  12437 . The pump  12446  is driven by a rotary driver  12450  of the interface  12448 . In various instances, the interface  12448  can include four rotary drivers  12450 . In one example, a first rotary driver  12450  is configured to power an articulation motion, a second rotary driver  12450  is configured to power a jaw closure motion, a third rotary driver  12450  is configured to power a shaft rotation, and a fourth rotary driver  12450  is configured to power the pump  12446 . The reader will appreciate that alternative interface arrangements can include more than or less than four rotary drivers  12450 . Additionally, the drive motions generated by the rotary drivers  12450  can vary depending on the desired functionality of the robotic tool  12426 . Moreover, in certain instances, the drive interface  12448  can include a transmission or shifter such that the rotary drivers  12450  can shift between multiple surgical functions, as further described herein (see transmission  12124  in  FIG.  212    and transmission assembly  12840  in  FIGS.  223 - 228   , for example). In one instance, the rotary driver  12450  coupled to the pump  12446  can also actuate a clamping motion of the end effector  12428 , for example. 
     In one aspect, activation of the pump  12446  of the robotic tool  12426  can be coordinated with the application of energy by the robotic tool  12426 . In various instances, a control algorithm for the rotary driver  12450  for the pump  12446  can be related to the rate at which smoke S is extracted from the surgical site. In such instances, the robot (e.g. the robot  12022  in  FIGS.  206  and  210   ) can have direct control over the volume of evacuation and/or extraction from the surgical site. 
     In one instance, the on/off control for the pump  12446  is controlled based on inputs from a camera, such as the camera of the imaging device  124  ( FIG.  2   ) like an endoscope, for example. The imaging device  124  can be configured to detect the presence of smoke S in a visual field at the surgical site. In another aspect, the on/off control for the pump  12446  is controlled based on inputs from a smoke sensor  12453  ( FIG.  217   ) in-line with the fluid being pumped out of the patient. For example, the pump  12446  can remain on as long as a threshold amount of smoke S is detected by the smoke sensor  12453  and can be turned off or paused when the detected volume of smoke S falls below the threshold amount. In still another aspect, the pump  12446  is turned on when energy is activated and, in certain instances, can remain on for a period of time after the energy has been stopped. The duration of time for which the pump  12446  can remain on after the energy has stopped may be fixed or may be proportional to the length of time the energy was activated, for example. 
     Referring primarily to  FIG.  220   , a flow chart depicting logic steps for operating a pump, such as the pump  12446 , is depicted. A processor for the robot (e.g. robot  12022 ) and/or a processor of a hub (e.g. hub  106 , hub  206 , robotic hub  122 , and robotic hub  222 ) that is in signal communication with the robot can determine or estimate the rate of smoke evacuation from the surgical site. The rate of smoke evacuation can be determined at step  12510  by one or more factors or inputs including the activation of energy by the robotic tool (a first input  12502 ), a smoke sensor in-line with the smoke evacuation channel (a second input  12504 ), and/or an imaging device configured to view the surgical site (a third input  12506 ). The first input  12502  can correspond to the duration of energy application and/or the power level, for example. Based on the one or more factors, the pump can be adjusted at step  12512 . For example, the rate at which the rotary driver drives the pump can be adjusted. In other instances, the rotary driver can stop or pause the operation of the pump while the detected rate of smoke evacuation is below a threshold volume. The flow chart of  FIG.  220    can continue throughout the operation of a robotic tool. In certain instances, the steps  12510  and  12512  can be repeated at predefined intervals during a surgical procedure and/or when requested by a clinician and/or recommend by a hub. 
     Referring now to  FIG.  219   , a robotic tool  12526  for use with a robotic surgical system is depicted. The robotic tool  12526  can be employed with the robotic surgical system  12010  ( FIG.  206   ), for example. The robotic tool  12526  is an ultrasonic robotic tool having cooling and insufflation capabilities. For example, the robotic tool  12526  can be similar in many respects to the robotic tool disclosed in U.S. Pat. No. 9,314,308, filed Mar. 13, 2013, titled ROBOTIC ULTRASONIC SURGICAL DEVICE WITH ARTICULATING END EFFECTOR, which is herein incorporated by reference in its entirety. 
     The robotic tool  12526  includes a proximal housing  12537 , a shaft  12538  extending from the proximal housing  12537 , and an end effector  12528  extending from a distal end of the shaft  12538 . The end effector  12528  includes an ultrasonic blade  12530   a  and an opposing clamp arm  12530   b . The robotic tool  12526  also includes an irrigation system  12536 , which is configured to provide a coolant, such as saline or cool CO 2  for example, to the surgical site. Irrigation can be configured to cool the tissue and/or the ultrasonic blade  12530   a , for example. The irrigation system  12536  includes an irrigation channel  12540 , which extends through the shaft  12538  to the proximal housing  12537 . The irrigation channel  12540  terminates at an irrigation port adjacent to the end effector  12528 . 
     In various instances, the irrigation channel  12540  can be coupled to a blower configured to direct fluid along the irrigation channel  12540  within the shaft  12538  of the robotic tool  12526 . The irrigation system  12536  includes a blower  12546 . The blower  12546  is housed in the proximal housing  12537  of the robotic tool  12526 . The blower  12546  is a regenerative blower, which has been incorporated into a drive interface  12548  of the robotic tool  12526 . The drive interface  12548  includes rotary drivers  12550 , which are driven by rotary outputs from motors in the tool mounting portion of the robot, as described herein (see rotary outputs  12256  ( FIG.  214   ) and rotary outputs  12824   a  - 12824   e  ( FIG.  222   ), for example). 
     A channel  12552  terminating in a fitting  12554  extends from the blower  12546 . The fitting  12554  is a luer fitting, however, the reader will readily appreciate that alternative fittings are envisioned. The luer fitting can be selectively coupled to a reservoir that is configured to provide the irrigation fluid to the blower  12546 . In operation, coolant can enter the insufflation line through the fitting  12554  and the blower  12546  can draw the coolant toward the blower  12546  at the drive interface  12548  and then blow the coolant distally along the shaft  12538  of the robotic tool  12526  toward the end effector  12528 . The coolant can be expelled at or adjacent to the end effector  12528 , which can cool the ultrasonic blade and/or maintain insufflation of the surgical site, such as insufflation of an abdomen, for example. 
     In  FIG.  219   , internal components of the drive interface  12548  are depicted, however, certain components are excluded for clarity. The irrigation channel  12540  extends through the shaft  12538  to the blower  12546  in the proximal housing  12537 . The blower  12546  is driven by a rotary driver  12550  of the drive interface  12548 . Similar to the interface  12448  ( FIG.  218   ), the interface  12548  includes four rotary drivers  12550 . In one example, a first rotary driver  12550  is configured to power an articulation motion, a second rotary driver  12550  is configured to power a jaw closure motion, a third rotary driver  12550  is configured to power a shaft rotation, and a fourth rotary driver  12550  is configured to power the irrigation system  12536 . The reader will appreciate that alternative interface arrangements can include more than or less than four rotary drivers  12550 . Additionally, the drive motions generated by the rotary drivers  12550  can vary depending on the desired functionality of the robotic tool. Moreover, in certain instances, the drive interface  12548  can include a transmission or shifter such that the rotary drivers  12550  can shift between multiple surgical functions, as further described herein (see transmission  12124  in  FIG.  212    and transmission assembly  12840  in  FIGS.  223 - 228   , for example). In one instance, the rotary driver  12550  coupled to the blower  12546  can also actuate a clamping motion of the end effector  12528 , for example. 
     As described herein with respect to the pump  12446  in  FIG.  218   , operation of the blower  12546  in  FIG.  219    can be coordinated with the application of energy by the robotic tool  12526 . For example, the blower  12546  can be turned on when energy is activated and, in certain instances, the blower  12546  can remain on for a period of time after the energy has been stopped. The duration of time for which the blower  12546  can remain on after the energy has stopped may be fixed or may be proportional to the length of time the energy was activated, for example. Additionally or alternatively, the power level of the blower  12546  can be proportional or otherwise related to the activation level of the robotic tool  12526 . For example, a high power level can correspond to a first rate and a lower power level can correspond to a second rate. In one example, the second rate can be less than the first rate. 
     In one aspect, the robotic tool  12526  can also include an insufflation pump that is upstream of the regenerative blower  12546 . The insufflation pump can direct a first volume of fluid into a trocar and a second volume of fluid into the regenerative blower  12546 . The fluid provided to the trocar can be configured to insufflate the surgical site, for example, the abdomen of a patient. The fluid provided by the regenerative blower  12546  can be configured to cool the ultrasonic blade, for example. 
     The robotic surgical tools  12426  and  12526  can be used in connection with a hub, such as the robotic hub  122  or the robotic hub  222 , for example. In one aspect, the robotic hubs can include a situational awareness module, as described herein. The situational awareness module can be configured to determine and/or confirm a step in a surgical procedure and/or suggest a particular surgical action based on information received from various sources, including one or more robotic surgical tool(s) and/or a generator module. In one instance, the actuation of a pump on a robotic surgical tool can inform the situational awareness module that evacuation and/or irrigation have been employed, which can lead to a conclusion regarding a particular surgical procedure or group of surgical procedures. Similarly, data from the situational awareness module can be supplied to a processor. In certain instances, the processor can be communicatively coupled to a memory that stores instructions executable by the processor to adjust a pumping rate of the pump based on data from the situational awareness module which can indicate, for example, the type of surgical procedure and/or the step in the surgical procedure. For example, situational awareness can indicate that insufflation is necessary for at least a portion of a particular surgical procedure. In such instances, a pump, such as the blower  12546  ( FIG.  219   ) can be activated and/or maintained at a level to maintain a sufficient insufflation. 
     In one aspect, the robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to rotate a driver in a robotic tool at a variable rate to provide an adjustable power level to a pump in the robotic tool, as described herein. 
     In various aspects, the present disclosure provides a control circuit to rotate a rotary driver in a robotic tool at a variable rate, as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to rotate a rotary driver in a robotic tool at a variable rate to provide an adjustable power level to a pump in the robotic tool, as described herein. 
     Referring now to  FIGS.  234  and  235   , a surgical procedure utilizing two robotic tools is depicted. In  FIG.  234   , the robotic tools are engaged with tissue at a surgical site. The first tool in this example is a flexible robotic retractor  12902 , which is applying a retracting force to a portion of a patient’s liver L. In  FIG.  235   , the flexible robotic retractor  12902  can be moved along a longitudinal axis of the tool shaft in a direction A and/or can be moved laterally (e.g. pivoted at a joint between two rigid linkages in the robotic retractor) in a direction B. 
     The second tool in this example is an articulating bipolar tool  12904 , which is being clamped on tissue. For example, the articulating bipolar tool  12904  can be configured to mobilize liver attachments A to the liver utilizing bipolar RF currents. The articulating bipolar tool  12904  can be articulated laterally (e.g. pivoted at an articulation joint proximal to the bipolar jaws of the robotic tool  12904 ) in the direction C. The directions A, B, and C are indicated with arrows in  FIG.  235   . 
     In the depicted example, the flexible robotic retractor  12902  seeks to hold back an organ, the liver L, as the bipolar jaws of the articulating bipolar tool  12904  seek to cut and/or seal clamped tissue to mobilize the liver attachments A. In one aspect, movement of the liver L by the flexible robotic retractor  12902  can be configured to maintain a constant retraction force as the bipolar tool  12904  mobilizes the liver attachments A to the liver L. A load control algorithm can be configured to maintain the constant retraction force on the tissue. In certain instances, the load control algorithm can be an articulation control algorithm that provides a set, or predetermined, torque at the articulation joint(s) of the articulating bipolar tool  12904  and/or the flexible robotic retractor  12902 . The set torque at an articulation joint can be approximated based on current supplied to the articulation motor, for example. 
     In certain instances, the flexible robotic retractor  12902  can risk or otherwise threaten over-retraction of the liver L. For example, if displacement of the flexible robotic retractor  12902  approaches a set displacement limit, the flexible robot retractor  12902  can risk tearing a portion of the tissue. To prevent such an over-retraction, as the displacement of the flexible robotic retractor  12902  approaches the displacement limit, the force generated by the flexible robotic retractor  12902  can be reduced by the load control algorithm. For example, the force can be reduced below a constant, or substantially constant, retraction force when a displacement limit has been met. 
     Referring now to a graphical display  12910  in  FIG.  236   , the retraction force F exerted on an organ and the displacement δ of the robotic tool, and by extension the organ, is plotted over time. The reader will appreciate that the robotic tools  12902  and  12904 , as depicted in the surgical procedure of  FIGS.  234  and  235   , can be utilized to generate the graphical display  12910 . Alternative surgical tool(s) and surgical procedures are also contemplated. In one aspect, an operator can set a retraction force threshold Y and a displacement limit X as depicted in  FIG.  236   . In other instances, the retraction force threshold Y and/or the displacement limit X can be determined and/or computed based on information from a surgical hub and/or cloud. In certain instances, a particular retraction force threshold Y and/or displacement limit X can be recommended to a clinician based on data stored in the memory of the robot, the surgical hub, and/or the cloud. The retraction force threshold Y and/or the displacement limit X can depend on patient information, for example. 
     During the surgical procedure, if the retraction force F drops below the constant retraction force threshold Y, or drops by a predefined percentage or amount relative to the constant retraction force threshold Y, as at times t 1 , t 2 , and t 3 , the flexible robotic retractor  12902  can be further displaced, to displace the organ, and increase the retraction force F toward the threshold Y. Similarly, if the displacement δ approaches the displacement limit X, as at time t 4 , the retraction force can be reduced to limit further displacement beyond the displacement limit X. For example, referring again to  FIG.  234   , the liver L is depicted in a second position indicated as L′. The position of the liver L′ can correspond to the displacement limit X of the flexible robotic retractor  12902 . 
     Referring now to  FIG.  237   , a flow chart depicting logic steps for operating a robotic tool, such as the tool  12902  ( FIGS.  234  and  235   ) for example, is depicted. A processor for the robot (e.g. the robot  12022 ) and/or of a processor of a hub (e.g. the hub  106 , the hub  206 , the robotic hub  122 , and the robotic hub  222 ) that is in signal communication with the robot can set a displacement limit at step  12920 . Additionally, the processor can set a force limit at step  12922 . The displacement limit and the force limit can be selected based on input from one or more sources including a clinician input  12930 , a robot input  12932 , a hub input  12934 , and/or a cloud input  12936 , as further described herein. In certain instances, the hub can suggest a particular limit based on data collected by a robot, provided to the hub, and/or stored in the cloud. For example, a situational awareness module can suggest a particular limit based on the surgical procedure or step thereof ascertained by the situational awareness module. Additionally or alternatively, the clinician can provide an input and/or select the limit from the hub’s suggestions. In other instances, the clinician can override the hub’s suggestions. The limits can correspond to a range of values, such as the limit ± one percent, ± five percent, or ± ten percent, for example. 
     The robotic tool can initially operate in a constant force mode. At step  12924  in the constant force mode, the force exerted by the robotic tool can be maintained at the force limit. The processor can monitor the force to ensure the force stays below the force limit Y. If the force exceeds the force limit Y, the displacement value can be increased at step  12926  until the force reaches or sufficiently approaches the force limit Y. A force can sufficiently approach the force limit when the force is within a range of values corresponding to the force limit. The processor can monitor the displacement to ensure the displacement stays below the displacement limit X. 
     If the displacement approaches the displacement limit X (or enters the range of values corresponding to the displacement limit), the robotic tool can switch to a displacement limit mode. In the displacement limit mode, the force value can be decreased at step  12928  to ensure the robotic tool stays within the displacement limit. A new force limit can be set at step  12922  to ensure the displacement stays within the displacement limit. In such instances, the robotic tool can switch back to the constant force mode (with the new, reduced force limit) and steps  12924 ,  12926 , and  12928  can be repeated. 
     In certain instances, the stiffness of the shaft of one or more of the robotic tools can be factored into the load control algorithm in order to achieve the desired amount of lateral force on an organ, like the liver L. For example, the flexible robotic retractor  12902  can define a stiffness that affects the lateral load exerted on a tissue by the end effector thereof. 
     In certain instances, a drive housing for a robotic tool can include a plurality of rotary drivers, which can be operably driven by one or more motors. The motors can be positioned in a motor carriage, which can be located at the distal end of a robotic arm. In other instances, the motors can be incorporated into the robotic tool. In certain instances, a motor can operably drive multiple rotary drivers and a transmission can be configured to switch between the multiple rotary drivers. In such instances, the robotic tool cannot simultaneously actuate two or more rotary drivers that are associated with the single drive motor. For example, as described herein with respect to  FIG.  212   , the motor  12112  can selectively power one of the roll DOF  12132 , the high force grip DOF  12136 , or the tool actuation DOF  12138 . The transmission  12124  can selectively couple the motor  12112  to the appropriate DOF. 
     In certain instances, it can be desirable to increase the torque delivered to an output of the robotic tool. For example, clamping and/or firing of a surgical stapler may benefit from additional torque in certain instances, such as when the tissue to be cut and/or stapled is particularly thick or tough. Especially for longer end effectors and/or longer firing strokes, additional torque can be required to complete the firing stroke. In certain instances, an I-beam firing structure can be utilized, especially for longer end effectors and/or longer firing strokes. The I-beam can limit deflection at the distal tip of the firing stroke for example. However, an I-beam can require increased torque. 
     Additionally, certain robotic tools may require additional flexibility regarding the simultaneous operation of multiple DOFs or surgical end effector functions. To increase the power, torque, and flexibility of a robotic system, additional motors and/or larger motors can be incorporated into the motor carriage. However, the addition of motors and/or utilization of larger motors can increase the size of the motor carriage and the drive housing. 
     In certain instances, a robotic surgical tool can include a compact drive housing. A compact drive housing can improve the access envelope of the robotic arm. Moreover, a compact drive housing can minimize the risk of arm collisions and entanglements. Though the drive housing is compact, it can still provide sufficient power, torque, and flexibility to the robotic tool. 
     In certain instances, shifting between end effector functions can be achieved with one of the drive shafts. Shifting and locking of the rotary drives may only occur when a robotic surgical system is in a rest mode, for example. In one aspect, it can be practical to have three rotary drives operate as many end effector functions as needed based on the cam structure of the shifting drive. In one aspect, by using three rotary drives in cooperation, a robotic surgical tool can shift between four different possible functions instead of three different functions. For example, three rotary drives can affect shaft rotation, independent head rotation, firing, closing, and a secondary closing means. In still other instances, a rotary drive can selectively power a pump, such as in the surgical tools  12426  and  12526  in  FIGS.  218  and  219   , respectively, for example. 
     Additionally or alternatively, multiple rotary drives can cooperatively drive a single output shaft in certain instances. For example, to increase the torque delivered to a surgical tool, multiple motors can be configured to deliver torque to the same output shaft at a given time. For example, in certain instances, two drive motors can drive a single output. A shifter drive can be configured to independently engage and disengage the two drive motors from the single output. In such instances, increased torque can be delivered to the output by a compact drive housing that is associated with multiple rotary drivers and end effector functions. As a result, load capabilities of the surgical tool can be increased. Moreover, the drive housing can accommodate surgical tools that require different surgical functions, including the operation of multiple DOFs or surgical functions. 
     Referring now to  FIGS.  221 - 228   , a drive system  12800  for a robotic surgical tool  12830  is depicted. The drive system  12800  includes a housing  12832  and a motor carriage  12828 . A shaft  12834  of the surgical tool  12830  extends from the housing  12832 . The motor carriage  12828  houses five motors  12826  similar to the motor carriage  12108  ( FIG.  212   ). In other instances, the motor carriage  12828  can house less than five motors or more than five motors. In other instances, the motors  12826  can be housed in the robotic surgical tool  12830 . 
     Each motor  12826  is coupled to a rotary output  12824  and each rotary output  12824  is coupled to a rotary input  12836  in the housing  12832  at a drive interface  12822 . The rotary motions from the motors  12826  and corresponding rotary outputs  12824  are transferred to a respective rotary input  12836 . The rotary inputs  12836  correspond to rotary drivers, or rotary drive shafts, in the housing  12832 . In one example, a first motor  12826   a  can be a left/right articulation (or yaw) motor, a second motor  12826   b  can be an up/down articulation (or pitch) motor, a third motor  12826   c  can be a shifter motor, a fourth motor  12826   d  can be a first cooperative motor, and a fifth motor  12826   e  can be a second cooperative motor. Similarly, a first rotary output  12824   a  can be a left/right articulation (or yaw) output, a second rotary output  12824   b  can be an up/down articulation (or pitch) output, a third rotary output  12824   c  can be a shifter output, a fourth rotary output  12824   d  can be a first cooperative output, and a fifth rotary output  12824   e  can be a second cooperative output. Furthermore, a first rotary input  12836   a  can be a left/right articulation (or yaw) drive shaft, a second rotary input  12836   b  can be an up/down articulation (or pitch) drive shaft, a third rotary input  12836   c  can be a shifter drive shaft, a fourth rotary input  12836   d  can be a first cooperative drive shaft, and a fifth rotary input  12836   e  can be a second cooperative drive shaft. In other instances, the drive shafts  12836   a - 12836   e  can be operably positionable in different orientations to effectuate different gear trains configurations to transmit a desired rotary output. 
     The surgical tool  12830  is depicted in a plurality of different configurations in  FIGS.  230 - 233   . For example, the surgical tool  12830  is in an unactuated configuration in  FIG.  230   . The shaft  12834  has been articulated about the yaw and pitch axes (in the directions of the arrows A and B) in  FIG.  231   . Rotation of the first and second rotary inputs  12836   a  and  12836   b  is configured to articulate the shaft  12834  about the yaw and pitch axes, respectively. In  FIG.  232   , the shaft  12834  has been rotated in the direction of the arrow C about the longitudinal axis of the shaft  12834  and a jaw of the end effector  12835  has been closed with a low-force actuation in the direction of arrow D. Rotation of the fourth rotary output  12836   d  is configured to selectively affect the rotation of the shaft  12834 , and rotation of the fifth rotary output  12836   e  is configured to selectively affect the low-force closure of the end effector  12835 . In  FIG.  233   , the jaw of the end effector  12835  has been clamped with a high-force actuation in the direction of arrow E, and the firing member has been advanced in the direction of arrow F. Rotation of the fourth rotary output  12836   d  and the fifth rotary output  12836   e  is configured to selectively and cooperatively affect the high-force closure of the end effector  12835  and the firing of the firing member therein, respectively. 
     Referring primarily now to  FIGS.  223 - 228   , the housing  12832  includes multiple layers of gear train assemblies. Specifically, the housing  12832  includes a first gear train assembly  12838   a  layered under a second gear train assembly  12838   b , which is layered under a third gear train assembly  12838   c , which is layered under a fourth gear train assembly  12838   d . The first gear train assembly  12838   a  corresponds to a first DOF, such as rotation of the shaft  12834 , for example. The second gear train assembly  12838   b  corresponds to a second DOF, such as closure (i.e. fast closure) of the end effector  12835  with a low closure force, for example. The third gear train assembly  12838   c  corresponds to a third DOF, such as clamping (i.e. slow closure) of the end effector  12835  with a high closure force, for example. The fourth gear train assembly  12838   d  corresponds to a fourth DOF, such as firing of a firing element in the end effector  12835 , for example. The five rotary inputs  12836   a - 12836   e  extend through the four layers of gear train assemblies  12838   a - 12838   d . 
     The first motor  12826   a  is drivingly coupled to the first rotary input  12836   a . In such instances, the first motor  12826   a  is singularly configured to drive the first rotary input  12836   a , which affects the first DOF. For example, referring primarily to  FIG.  224   , articulation wires  12842  can extend from the first rotary input  12836   a  through the shaft  12834  of the robotic tool  12830  toward the end effector  12835 . Rotation of the first rotary input  12836   a  is configured to actuate the articulation wires  12842  to affect left/right articulation of the end effector  12835 . Similarly, the second motor  12826   b  is drivingly coupled to the second rotary input  12836   b . In such instances, the second motor  12826   b  is singularly configured to drive the second rotary input  12836   b , which affects the second DOF. Referring still to  FIG.  224   , articulation wires  12844  can extend from the second rotary input  12836   b  through the shaft  12834  of the robotic tool  12830  toward the end effector  12835 . Rotation of the second rotary input  12836   b  is configured to actuate the articulation wires  12844  to affect up/down articulation of the end effector  12835 . In other instances, at least one of the first rotary input  12836   a  and the second rotary input  12836   b  can correspond to a different DOF or different surgical function. 
     The housing  12832  also includes a transmission assembly  12840 . For example, the third rotary input  12836   c  is a shifter drive shaft of the transmission assembly  12840 . As depicted in  FIGS.  223 - 228   , the third rotary input  12836   c  can be a camshaft, including a plurality of camming lobes. An arrangement of cam lobes  12839  can correspond with each gear train assembly  12838   a - 12838   d  layered in the housing  12832 . Moreover, each gear train assembly  12838   a - 12838   d  includes a respective shuttle  12846   a - 12846   d  operably engaged by the third rotary input  12836   c . For example, the third rotary input  12836   c  can extend through an opening in each shuttle  12846   a - 12846   d  and selectively engage at least one protrusion  12848  on the shuttle  12846   a - 12846   d  to affect shifting of the respective shuttle  12846   a - 12846   d  relative to the third rotary input  12836   c . In other words, rotation of the third rotary input  12836   c  is configured to affect shifting of the shuttles  12846   a - 12846   d . As the shuttles  12846   a - 12846   d  shift within each gear train assembly  12838   a - 12838   d , respectively, the cooperative drive shafts  12836   d  and  12836   e  are selectively drivingly coupled to one or more output shafts of the robotic tool  12830 , as further described herein. 
     In other instances, a drive system for a robotic tool can include a vertically shifting gear selector, which can be configured to shift the shuttles  12846   a - 12846   d  or otherwise engage an output drive from a motor to one or more input drives on the robotic tool  12830 . 
     Referring still to  FIGS.  221 - 228   , the fourth and fifth output drives, or the first and second cooperative drive shafts,  12836   d  and  12836   e , respectively, can operate independently or in a coordinated, synchronized manner. For example, in certain instances, each cooperative drive shaft  12836   d  and  12836   e  can be paired with a single output gear or output shaft. In other instances, both cooperative drives  12836   d  and  12836   e  can be paired with a single output gear or output shaft. 
     Referring primarily to  FIG.  225   , in a first configuration of the transmission arrangement  12840 , the first cooperative drive shaft  12836   d  is drivingly engaged with a first output gear  12852  of the first gear train assembly  12838   a . For example, the first gear train assembly  12838   a  includes one or more first idler gears  12850   a . In  FIG.  225   , the first gear train assembly  12838   a  includes two first idler gears  12850   a . The first idler gears  12850   a  are positioned on the first shuttle  12846   a  in the first gear train assembly  12838   a . In the first configuration ( FIG.  225   ), the first shuttle  12846   a  has been shifted toward the first output gear  12852  by the camshaft  12836   c  such that one of the first idler gears  12850   a  on the first shuttle  12846   a  is moved into meshing engagement with the first output gear  12852  and one of the first idler gears  12850   a  is moved into meshing engagement with the first cooperative drive shaft  12836   d . In other words, the first cooperative drive shaft  12836   d  is drivingly engaged with the first output gear  12852 . 
     Rotation of the first output gear  12852  corresponds to a particular DOF. For example, rotation of the first output gear  12852  is configured to rotate the shaft  12834  of the robotic tool  12830 . In other words, in the first configuration of the transmission arrangement  12840  ( FIG.  225   ), a rotation of the fourth motor  12826   d  and the fourth rotary output  12824   d  is configured to rotate the first cooperative drive shaft  12836   d , which is coupled to the first output gear  12852  via the first idlers gears  12850   a  and rotates (or rolls) the shaft  12834 . 
     The first gear train assembly  12838   a  also includes a first locking arm  12860   a . The first locking arm  12860   a  extends from the first shuttle  12846   a . Movement of the first shuttle  12846   a  is configured to move the first locking arm  12860   a . For example, in the first configuration of  FIG.  225   , the first locking arm  12860   a  is disengaged from the first gear train assembly  12838   a  such that the first output gear  12852  can rotate. Movement of the first shuttle  12846   a  can move the first locking arm  12860   a  into engagement with the first output gear  12852 . For example, when the first idler gears  12850   a  are moved out of engagement with the first output gear  12852 , the first locking arm  12860   a  can engage the first output gear  12852  or another gear in the first gear train assembly  12838   a  to prevent the rotation of the first output gear  12852 . 
     Referring still to  FIG.  225   , in the first configuration of the transmission arrangement  12840 , the second cooperative drive shaft  12836   e  is drivingly engaged with a second output gear  12854  of the second gear train assembly  12838   b . For example, the second gear train assembly  12838   b  includes one or more second idler gears  12850   b  and a planetary gear  12853  that is meshingly engaged with the second output gear  12854 . In  FIG.  225   , the second gear train assembly  12838   b  includes two second idler gears  12850   b . The second idler gears  12850   b  are positioned on the second shuttle  12846   b  in the second gear train assembly  12838   b . In the first configuration, the second shuttle  12846   b  has been shifted toward the second output gear  12854  by the camshaft  12836   c  such that one of the second idler gears  12850   b  on the second shuttle  12846   b  is moved into meshing engagement with the planetary gear  12853 , and one of the second idler gears  12850   b  is moved into meshing engagement with the second cooperative drive shaft  12836   e . In other words, the second cooperative drive shaft  12836   e  is drivingly engaged with the second output gear  12854  via the second idler gears  12850   b  and the planetary gear  12853 . The second output gear  12854  is configured to drive a second output shaft  12864  ( FIGS.  226 - 228   ), which transfers a drive motion to the end effector  12835 . 
     Rotation of the second output gear  12854  corresponds to a particular DOF. For example, a rotation of the second output gear  12854  is configured to close the end effector  12835  of the robotic tool  12830  with a low closure force. In other words, in the first configuration of the transmission arrangement  12840 , a rotation of the fifth motor  12826   e  and the fifth rotary output  12824   e  is configured to rotate the second cooperative drive shaft  12836   e , which is coupled to the second output gear  12854 , via the second idlers gears  12850   b  and the planetary gear  12853 , and closes the end effector  12835  of the robotic tool  12830  with a low closure force. 
     The second gear train assembly  12838   b  also includes a second locking arm  12860   b . The second locking arm  12860   b  extends from the second shuttle  12846   b . Movement of the second shuttle  12846   b  is configured to move the second locking arm  12860   b . For example, in the first configuration of  FIG.  225   , the second locking arm  12860   b  is disengaged from the planetary gear  12853 . Movement of the second shuttle  12846   b  can move the second locking arm  12860   b  into engagement with the second planetary gear  12853 . For example, when the second idler gears  12850   b  are moved out of engagement with the second gear train assembly  12838   b  or planetary gear  12853  thereof, the second locking arm  12860   b  can engage a portion of the second gear train assembly  12838   b , such as planetary gear  12853 , for example, to prevent rotation of the planetary gear  12853  and the second output gear  12854 . 
     In the first configuration, rotary drive motions can be concurrently applied to the first and second cooperative drive shafts  12836   d  and  12836   e , respectively, to concurrently affect multiple degrees of freedom. For example, the transmission arrangement  12840  can permit the simultaneous rotation of the shaft  12834  and closing of the end effector jaws. In other instances, one of the output gears  12852 ,  12854  can be locked by the respective locking arm when the other output gear  12852 ,  12854  is drivingly coupled to the respective cooperative drive shaft  12836   d ,  12836   e . 
     Referring still to  FIG.  225   , in the first configuration of the transmission arrangement  12840 , a third output gear  12856  in the third gear train assembly  12838   c  and a fourth output gear  12858  in the fourth gear train assembly  12838   d  are locked via the locking arms  12860   c  and  12860   d , respectively. As a result, rotation of the third output gear  12856 , which corresponds to clamping or high-force closing of the end effector jaws, is prevented by the first configuration. Additionally, rotation of the fourth output gear  12858 , which corresponds to firing the firing member in the end effector  12835 , is also prevented. In other words, when the transmission arrangement  12840  is configured to deliver rotary motions to affect a low-force closure DOF or shaft rotation DOF, high-force clamping and firing is prevented. In such instances, the high-force clamping function and firing function can be selectively locked out by the transmission arrangement  12840 . 
     Referring now to  FIG.  226   , a second configuration of the transmission arrangement  12840  is depicted. In the second configuration, the first and second cooperative drive shafts  12836   d  and  12836   e  are drivingly engaged with a third output gear  12856  of the third gear train assembly  12838   c . The third output gear  12856  is configured to drive a third output shaft  12866  ( FIGS.  226 - 228   ), which transfers a drive motion to the end effector  12835 . For example, the third gear train assembly  12838   c  includes one or more third idler gears  12850   c  and a planetary gear  12855  that is meshingly engaged with the third output gear  12856 . In  FIG.  226   , the third gear train assembly  12838   c  includes three third idler gears  12850   c . The third idler gears  12850   c  are positioned on the third shuttle  12846   c  in the third gear train assembly  12838   c . In the second configuration, the third shuttle  12846   c  has been shifted toward the third output gear  12856  by the camshaft  12836   c  such that one of the third idler gears  12850   c  is moved into meshing engagement with the planetary gear  12855 , one of the third idler gears  12850   c  is moved into meshing engagement with the first cooperative drive shaft  12836   d , and one of the third idler gears  12850   c  is moved into meshing engagement with the second cooperative drive shaft  12836   e . In other words, both cooperative drive shafts  12836   d  and  12836   e  are drivingly engaged with the third output gear  12856  via the third idler gears  12850   c  and the planetary gear  12855 . 
     Rotation of the third output gear  12856  corresponds to a particular DOF. For example, a rotation of the third output gear  12856  is configured to clamp the end effector  12835  of the robotic tool  12830  with a high closure force. In other words, in the second configuration of the transmission arrangement  12840 , a rotation of the fourth motor  12826   d  and the fifth motor  12826   e  and the corresponding rotation of the fourth rotary output  12824   d  and the fifth rotary output  12824   e  are configured to rotate the cooperative drive shafts  12836   d  and  12836   e , respectively. In such instances, a torque supplied by both cooperative drive shafts  12836   d  and  12836   e  is coupled to the third output gear  12856  via the third idlers gears  12850   c  to clamp the end effector  12835  of the robotic tool  12830  with a high closure force. 
     Referring still to  FIG.  226   , in the second configuration of the transmission arrangement  12840 , the third output gear  12856  is unlocked. More specifically, the third locking arm  12860   c  is disengaged from the third gear train assembly  12838   c  such that the third output gear  12856  can rotate. Additionally, the camshaft  12836   c  has moved the first locking arm  12860   a  into engagement with the first gear train assembly  12838   a , the second locking arm  12860   b  into engagement with the second gear train assembly  12838   b , and the fourth locking arm  12860   d  into engagement with the fourth gear train assembly  12838   d  to prevent rotation of the first output gear  12852 , the second output gear  12854 , and the fourth output gear  12858 , respectively. As a result, rotation of the shaft  12834 , low-force closing of the end effector jaws, and firing of the end effector  12835 , is prevented by the transmission arrangement  12840  in the second configuration. In such instances, the shaft rotation function, the low-force closing function, and the firing function can be selectively locked out by the transmission arrangement  12840 . 
     Referring now to  FIG.  227   , a third configuration of the transmission arrangement  12840  is depicted. In the third configuration, the first and second cooperative drive shafts  12836   d  and  12836   e  are drivingly engaged with a fourth output gear  12858  of the fourth gear train assembly  12838   d . For example, the fourth gear train assembly  12838   d  includes one or more fourth idler gears  12850   d  and a planetary gear  12857  that is meshingly engaged with the fourth output gear  12858 . In  FIG.  227   , the fourth gear train assembly  12838   d  includes three fourth idler gears  12850   d . The fourth idler gears  12850   d  are positioned on the fourth shuttle  12846   d  in the fourth gear train assembly  12838   d . In the third configuration, the fourth shuttle  12846   d  has been shifted toward the fourth output gear  12858  by the camshaft  12836   c  such that one of the fourth idler gears  12850   d  is moved into meshing engagement with the planetary gear  12857 , one of the fourth idler gears  12850   d  is moved into meshing engagement with the first cooperative drive shaft  12836   d , and one of the fourth idler gears  12850   d  is moved into meshing engagement with the second cooperative drive shaft  12836   e . In other words, both cooperative drive shafts  12836   e  and  12836   e  are drivingly engaged with the fourth output gear  12858  via the fourth idler gears  12850   d  and the planetary gear  12857 . The fourth output gear  12858  is configured to drive a third output shaft  12868  ( FIGS.  226 - 228   ), which transfers a drive motion to the end effector  12835 . 
     Rotation of the fourth output gear  12858  corresponds to a particular DOF. For example, a rotation of the fourth output gear  12858  is configured to firing a firing member in the end effector  12835  of the robotic tool  12830 . In other words, in the third configuration of the transmission arrangement  12840 , a rotation of the fourth motor  12826   d  and the fifth motor  12826   e  and the corresponding rotation of the fourth rotary output  12824   d  and the fifth rotary output  12824   e  are configured to rotate the cooperative drive shafts  12836   d  and  12836   e , respectively. In such instances, a torque supplied by both cooperative drive shafts  12836   d  and  12836   e  is coupled to the fourth output gear  12858  via the fourth idlers gears  12850   d  and planetary gear  12857  to fire the end effector  12835  of the robotic tool  12830 . 
     Referring still to  FIG.  227   , in the third configuration of the transmission arrangement  12840 , the fourth output gear  12858  is unlocked. More specifically, the fourth locking arm  12860   d  is disengaged from the fourth gear train assembly  12838   d  such that the fourth output gear  12858  can rotate. Additionally, the camshaft  12836   c  has moved the first locking arm  12860   a  into engagement with the first gear train assembly  12838   a , the second locking arm  12860   b  into engagement with the second gear train assembly  12838   b , and the third locking arm  12860   c  into engagement with the third gear train assembly  12838   c  to prevent rotation of the first output gear  12852 , the second output gear  12854 , and the third output gear  12856 , respectively. As a result, rotation of the shaft  12852 , low-force closing of the end effector jaws, and high-force clamping of the end effector jaws is prevented by the transmission arrangement  12840  in the third configuration. In such instances, the shaft rotation function, the low-force closing function, and the high-force clamping function can be selectively locked out by the transmission arrangement  12840 . 
     In one aspect, the dual drive motors  12826   d  and  12826   e  can coordinate with the shifting motor  12826   c  to provide a compact drive housing  12832  that enables multiple end effector functions. Moreover, a greater torque can be supplied for one or more end effector functions via the cooperative drive shafts  12836   d  and  12836   e . 
     In one aspect, when the cooperative drive shafts  12836   d  and  12836   e  are operated together, the two drives shafts  12836   d  and  12836   e  are synchronized. For example, the drive shafts  12836   d  and  12836   e  can both drive a common output shaft such as the output shafts  12866  and/or  12868 . Torque can be provided to the common output shafts  12866  and/or  12868  via both drive shafts  12836   d  and  12836   e . 
     Referring now to  FIG.  229   , a graphical display  12890  of output torque for different surgical functions of a robotic tool, such as the robotic tool  12830  ( FIGS.  221 - 228   ), for example, is depicted. The output torque for rotating the tool shaft (e.g. shaft  12834 ) via a first cooperative drive shaft and for low-force closing of end effector jaws via a second cooperative drive shaft are less than t1, the maximum output torque from a single shaft. The lower output torques for shaft rotation and low-force jaw closure can be within the range of loads obtainable from a cable on a spindle, for example. In certain instances, other lower load functionalities of the surgical tool can be affected with the output from a single shaft. 
     To affect high-force clamping, the torque approaches t2, the maximum output torque from the cooperative drive shafts (e.g. cooperative drive shafts  12836   d  and  12836   e ). For example, t2 can be twice the value of t1. The values “a” and “b” in  FIG.  229    show relative forces for the robotic tool. The value “a” is the load difference between a low-force closure and high-force clamping, such as closure with a closure tube system and clamping via an I-beam, example. In certain instances, a closure tube system and an I-beam system can cooperate, or overlap temporally as shown in  FIG.  229   , to complete the clamping of the end effector. The value “b” can be equal to or less than the value “a”. For example, the torque required to fire the end effector can be the same, or substantially the same, as the difference in torque between low-force closing and high-force clamping. The values “a” and “b” are more than the maximum output torque from a single shaft, but less than the maximum output torque from cooperative drive shafts. 
     In one instance, the synchronization of multiple drive shafts (e.g. cooperative drive shafts  12836   d  and  12836   e ) can be the slaving of one drive shaft to the following of the other drive shaft. For example, a different maximum torque threshold can be set on the slaved drive shaft such that it can push up to the first drive shaft’s limit but not over it. In one aspect, the speed of the output shaft can be monitored for increases and/or decreases in rotational speed. For example, a sensor can be positioned to detect the rotational speed of the output shaft. Further, the cooperative drive shafts can be coordinated to balance the torque when one of the cooperative drive shafts begins to slow down or brake the output shaft instead of both cooperative drive shafts accelerating it. 
     The motors described herein are housed in a tool mount on a robotic arm. In other instances, one or more of the motors can be housed in the robotic tool. 
     In one aspect, input drivers at an interface of the robotic tool are configured to mechanically and electrically couple with output drivers in a tool mount. As described herein, motors in the tool mount can be configured to deliver rotary drive motions to the drivers in the robotic tool. In other instances, the drivers in the robotic tool can be configured to receive linear drive motions from output drivers in the tool mount. For example, one or more linear drive motions can be transferred across the interface between the tool mount and the robotic tool. 
     When a single motor is drivingly coupled to an output shaft, the transmission assembly is in a low-torque operating state in comparison to a high-torque operating state in which more than one motor is drivingly coupled to the output shaft. The maximum torque deliverable to the output shaft in the high-torque operating state is greater than the maximum torque deliverable to the output shaft in the low-torque operating state. In one instance, the maximum torque in the high-torque operating state can be double the maximum torque in the low-torque operating state. The maximum torques deliverable to the output shaft can be based on the size and torque capabilities of the motors. 
     In one aspect, the robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to selectively operably couple a first rotary driver and a second rotary driver to output shafts of a tool housing, wherein one of the first rotary driver and the second rotary driver is configured to supply torque to an output shaft in a low-torque operating state, and wherein the first rotary driver and the second rotary driver are configured to concurrently supply torque to an output shaft in the high-torque operating state, as described herein. 
     In various aspects, the present disclosure provides a control circuit to selectively operably couple a first rotary driver and/or a second rotary driver to an output shaft as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to selectively operably couple a first rotary driver and/or a second rotary driver to an output shaft, as described herein. 
     Another robotic surgical system is depicted in  FIGS.  239  and  240   . With reference to  FIG.  239   , the robotic surgical system  13000  includes robotic arms  13002 ,  13003 , a control device  13004 , and a console  13005  coupled to the control device  13004 . As illustrated in  FIG.  239   , the surgical system  13000  is configured for use on a patient  13013  lying on a patient table  13012  for performance of a minimally invasive surgical operation. The console  13005  includes a display device  13006  and input devices  13007 ,  13008 . The display device  13006  is set up to display three-dimensional images, and the manual input devices  13007 ,  13008  are configured to allow a clinician to telemanipulate the robotic arms  13002 ,  13003 . Controls for a surgeon’s console, such as the console  13005 , are further described in International Patent Publication No. WO 2017/075121, filed Oct. 27, 2016, titled HAPTIC FEEDBACK FOR A ROBOTIC SURGICAL SYSTEM INTERFACE, which is herein incorporated by reference in its entirety. 
     Each of the robotic arms  13002 ,  13003  is made up of a plurality of members connected through joints and includes a surgical assembly  13010  connected to a distal end of a corresponding robotic arm  13002 ,  13003 . Support of multiple arms is further described in U.S. Pat. Application Publication No. 2017/0071693, filed Nov. 11, 2016, titled SURGICAL ROBOTIC ARM SUPPORT SYSTEMS AND METHODS OF USE, which is herein incorporated by reference in its entirety. Various robotic arm configurations are further described in International Patent Publication No. WO 2017/044406, filed Sep. 6, 2016, titled ROBOTIC SURGICAL CONTROL SCHEME FOR MANIPULATING ROBOTIC END EFFECTORS, which is herein incorporated by reference in its entirety. In an exemplification, the surgical assembly  13010  includes a surgical instrument  13020  supporting an end effector  13023 . Although two robotic arms  13002 ,  13003 , are depicted, the surgical system  13000  may include a single robotic arm or more than two robotic arms  13002 ,  13003 . Additional robotic arms are likewise connected to the control device  13004  and are telemanipulatable via the console  13005 . Accordingly, one or more additional surgical assemblies  13010  and/or surgical instruments  13020  may also be attached to the additional robotic arm(s). 
     The robotic arms  13002 ,  13003  may be driven by electric drives that are connected to the control device  13004 . According to an exemplification, the control device  13004  is configured to activate drives, for example, via a computer program, such that the robotic arms  13002 ,  13003  and the surgical assemblies  13010  and/or surgical instruments  13020  corresponding to the robotic arms  13002 ,  13003 , execute a desired movement received through the manual input devices  13007 ,  13008 . The control device  13004  may also be configured to regulate movement of the robotic arms  13002 ,  13003  and/or of the drives. 
     The control device  13004  may control a plurality of motors (for example, Motor 1 ...n) with each motor configured to drive a pushing or a pulling of one or more cables, such as cables coupled to the end effector  13023  of the surgical instrument  13020 . In use, as these cables are pushed and/or pulled, the one or more cables affect operation and/or movement of the end effector  13023 . The control device  13004  coordinates the activation of the various motors to coordinate a pushing or a pulling motion of one or more cables in order to coordinate an operation and/or movement of one or more end effectors  13023 . For example, articulation of an end effector by a robotic assembly such as the surgical assembly  13010  is further described in U.S. Pat. Application Publication No. 2016/0303743, filed Jun. 6, 2016, titled WRIST AND JAW ASSEMBLIES FOR ROBOTIC SURGICAL SYSTEMS and in International Patent Publication No. WO 2016/144937, filed Mar. 8, 2016, titled MEASURING HEALTH OF A CONNECTOR MEMBER OF A ROBOTIC SURGICAL SYSTEM, each of which is herein incorporated by reference in its entirety. In an exemplification, each motor is configured to actuate a drive rod or a lever arm to affect operation and/or movement of end effectors  13023  in addition to, or instead of, one or more cables. 
     Driver configurations for surgical instruments, such as drive arrangements for a surgical end effector, are further described in International Patent Publication No. WO 2016/183054, filed May 10, 2016, titled COUPLING INSTRUMENT DRIVE UNIT AND ROBOTIC SURGICAL INSTRUMENT, International Patent Publication No. WO 2016/205266, filed Jun. 15, 2016, titled ROBOTIC SURGICAL SYSTEM TORQUE TRANSDUCTION SENSING, International Patent Publication No. WO 2016/205452, filed Jun. 16, 2016, titled CONTROLLING ROBOTIC SURGICAL INSTRUMENTS WITH BIDIRECTIONAL COUPLING, and International Patent Publication No. WO 2017/053507, filed Sep. 22, 2016, titled ELASTIC SURGICAL INTERFACE FOR ROBOTIC SURGICAL SYSTEMS, each of which is herein incorporated by reference in its entirety. The modular attachment of surgical instruments to a driver is further described in International Patent Publication No. WO 2016/209769, filed Jun. 20, 2016, titled ROBOTIC SURGICAL ASSEMBLIES, which is herein incorporated by reference in its entirety. Housing configurations for a surgical instrument driver and interface are further described in International Patent Publication No. WO 2016/144998, filed Mar. 9, 2016, titled ROBOTIC SURGICAL SYSTEMS, INSTRUMENT DRIVE UNITS, AND DRIVE ASSEMBLIES, which is herein incorporated by reference in its entirety. Various endocutter instrument configurations for use with the robotic arms  13002 ,  13003  are further described in International Patent Publication No. WO 2017/053358, filed Sep. 21, 2016, titled SURGICAL ROBOTIC ASSEMBLIES AND INSTRUMENT ADAPTERS THEREOF and International Patent Publication No. WO 2017/053363, filed Sep. 21, 2016, titled ROBOTIC SURGICAL ASSEMBLIES AND INSTRUMENT DRIVE CONNECTORS THEREOF, each of which is herein incorporated by reference in its entirety. Bipolar instrument configurations for use with the robotic arms  13002 ,  13003  are further described in International Patent Publication No. WO 2017/053698, filed Sep. 23, 2016, titled ROBOTIC SURGICAL ASSEMBLIES AND ELECTROMECHANICAL INSTRUMENTS THEREOF, which is herein incorporated by reference in its entirety. Reposable shaft arrangements for use with the robotic arms  13002 ,  13003  are further described in International Patent Publication No. WO 2017/116793, filed Dec. 19, 2016, titled ROBOTIC SURGICAL SYSTEMS AND INSTRUMENT DRIVE ASSEMBLIES, which is herein incorporated by reference in its entirety. 
     The control device  13004  includes any suitable logic control circuit adapted to perform calculations and/or operate according to a set of instructions. The control device  13004  can be configured to communicate with a remote system “RS,” either via a wireless (e.g., Wi-Fi, Bluetooth, LTE, etc.) and/or wired connection. The remote system “RS” can include data, instructions and/or information related to the various components, algorithms, and/or operations of system  13000 . The remote system “RS” can include any suitable electronic service, database, platform, cloud “C” (see  FIG.  239   ), or the like. The control device  13004  may include a central processing unit operably connected to memory. The memory may include transitory type memory (e.g., RAM) and/or non-transitory type memory (e.g., flash media, disk media, etc.). In some exemplifications, the memory is part of, and/or operably coupled to, the remote system “RS.” 
     The control device  13004  can include a plurality of inputs and outputs for interfacing with the components of the system  13000 , such as through a driver circuit. The control device  13004  can be configured to receive input signals and/or generate output signals to control one or more of the various components (e.g., one or more motors) of the system  13000 . The output signals can include, and/or can be based upon, algorithmic instructions which may be preprogrammed and/or input by a user. The control device  13004  can be configured to accept a plurality of user inputs from a user interface (e.g., switches, buttons, touch screen, etc. of operating the console  13005 ) which may be coupled to remote system “RS.” 
     A memory  13014  can be directly and/or indirectly coupled to the control device  13004  to store instructions and/or databases including pre-operative data from living being(s) and/or anatomical atlas(es). The memory  13014  can be part of, and/or or operatively coupled to, remote system “RS.” 
     In accordance with an exemplification, the distal end of each robotic arm  13002 ,  13003  is configured to releasably secure the end effector  13023  (or other surgical tool) therein and may be configured to receive any number of surgical tools or instruments, such as a trocar or retractor, for example. 
     A simplified functional block diagram of a system architecture  13400  of the robotic surgical system  13010  is depicted in  FIG.  240   . The system architecture  13400  includes a core module  13420 , a surgeon master module  13430 , a robotic arm module  13440 , and an instrument module  13450 . The core module  13420  serves as a central controller for the robotic surgical system  13000  and coordinates operations of all of the other modules  13430 ,  13440 ,  13450 . For example, the core module  13420  maps control devices to the arms  13002 ,  13003 , determines current status, performs all kinematics and frame transformations, and relays resulting movement commands. In this regard, the core module  13420  receives and analyzes data from each of the other modules  13430 ,  13440 ,  13450  in order to provide instructions or commands to the other modules  13430 ,  13440 ,  13450  for execution within the robotic surgical system  13000 . Although depicted as separate modules, one or more of the modules  13420 ,  13430 ,  13440 , and  13450  are a single component in other exemplifications. 
     The core module  13420  includes models  13422 , observers  13424 , a collision manager  13426 , controllers  13428 , and a skeleton  13429 . The models  13422  include units that provide abstracted representations (base classes) for controlled components, such as the motors (for example, Motor 1 ...n) and/or the arms  13002 ,  13003 . The observers  13424  create state estimates based on input and output signals received from the other modules  13430 ,  13440 ,  13450 . The collision manager  13426  prevents collisions between components that have been registered within the system  13010 . The skeleton  13429  tracks the system  13010  from a kinematic and dynamics point of view. For example, the kinematics item may be implemented either as forward or inverse kinematics, in an exemplification. The dynamics item may be implemented as algorithms used to model dynamics of the system’s components. 
     The surgeon master module  13430  communicates with surgeon control devices at the console  13005  and relays inputs received from the console  13005  to the core module  13420 . In accordance with an exemplification, the surgeon master module  13430  communicates button status and control device positions to the core module  13420  and includes a node controller  13432  that includes a state/mode manager  13434 , a fail-over controller  13436 , and a N-degree of freedom (“DOF”) actuator  13438 . 
     The robotic arm module  13440  coordinates operation of a robotic arm subsystem, an arm cart subsystem, a set up arm, and an instrument subsystem in order to control movement of a corresponding arm  13002 ,  13003 . Although a single robotic arm module  13440  is included, it will be appreciated that the robotic arm module  13440  corresponds to and controls a single arm. As such, additional robotic arm modules  13440  are included in configurations in which the system  13010  includes multiple arms  13002 ,  13003 . The robotic arm module  13440  includes a node controller  13442 , a state/mode manager  13444 , a fail-over controller  13446 , and a N-degree of freedom (“DOF”) actuator  13348 . 
     The instrument module  13450  controls movement of an instrument and/or tool component attached to the arm  13002 ,  13003 . The instrument module  13450  is configured to correspond to and control a single instrument. Thus, in configurations in which multiple instruments are included, additional instrument modules  13450  are likewise included. In an exemplification, the instrument module  13450  obtains and communicates data related to the position of the end effector or jaw assembly (which may include the pitch and yaw angle of the jaws), the width of or the angle between the jaws, and the position of an access port. The instrument module  13450  has a node controller  13452 , a state/mode manager  13454 , a fail-over controller  13456 , and aN-degree of freedom (“DOF”) actuator  13458 . 
     The position data collected by the instrument module  13450  is used by the core module  13420  to determine when the instrument is within the surgical site, within a cannula, adjacent to an access port, or above an access port in free space. The core module  13420  can determine whether to provide instructions to open or close the jaws of the instrument based on the positioning thereof. For example, when the position of the instrument indicates that the instrument is within a cannula, instructions are provided to maintain a jaw assembly in a closed position. When the position of the instrument indicates that the instrument is outside of an access port, instructions are provided to open the jaw assembly. 
     Additional features and operations of a robotic surgical system, such as the surgical robot system depicted in  FIGS.  239  and  240   , are further described in the following references, each of which is herein incorporated by reference in its entirety:
     U.S. Pat. Application Publication No. 2016/0303743, filed Jun. 6, 2016, titled WRIST AND JAW ASSEMBLIES FOR ROBOTIC SURGICAL SYSTEMS;   U.S. Pat. Application Publication No. 2017/0071693, filed Nov. 11, 2016, titled SURGICAL ROBOTIC ARM SUPPORT SYSTEMS AND METHODS OF USE;   International Patent Publication No. WO 2016/144937, filed Mar. 8, 2016, titled MEASURING HEALTH OF A CONNECTOR MEMBER OF A ROBOTIC SURGICAL SYSTEM;   International Patent Publication No. WO 2016/144998, filed Mar. 9, 2016, titled ROBOTIC SURGICAL SYSTEMS, INSTRUMENT DRIVE UNITS, AND DRIVE ASSEMBLIES;   International Patent Publication No. WO 2016/183054, filed May 10, 2016, titled COUPLING INSTRUMENT DRIVE UNIT AND ROBOTIC SURGICAL INSTRUMENT;   International Patent Publication No. WO 2016/205266, filed Jun. 15, 2016, titled ROBOTIC SURGICAL SYSTEM TORQUE TRANSDUCTION SENSING;   International Patent Publication No. WO 2016/205452, filed Jun. 16, 2016, titled CONTROLLING ROBOTIC SURGICAL INSTRUMENTS WITH BIDIRECTIONAL COUPLING;   International Patent Publication No. WO 2016/209769, filed Jun. 20, 2016, titled ROBOTIC SURGICAL ASSEMBLIES;   International Patent Publication No. WO 2017/044406, filed Sep. 6, 2016, titled ROBOTIC SURGICAL CONTROL SCHEME FOR MANIPULATING ROBOTIC END EFFECTORS;   International Patent Publication No. WO 2017/053358, filed Sep. 21, 2016, titled SURGICAL ROBOTIC ASSEMBLIES AND INSTRUMENT ADAPTERS THEREOF;   International Patent Publication No. WO 2017/053363, filed Sep. 21, 2016, titled ROBOTIC SURGICAL ASSEMBLIES AND INSTRUMENT DRIVE CONNECTORS THEREOF;   International Patent Publication No. WO 2017/053507, filed Sep. 22, 2016, titled ELASTIC SURGICAL INTERFACE FOR ROBOTIC SURGICAL SYSTEMS;   International Patent Publication No. WO 2017/053698, filed Sep. 23, 2016, titled ROBOTIC SURGICAL ASSEMBLIES AND ELECTROMECHANICAL INSTRUMENTS THEREOF;   International Patent Publication No. WO 2017/075121, filed Oct. 27, 2016, titled HAPTIC FEEDBACK CONTROLS FOR A ROBOTIC SURGICAL SYSTEM INTERFACE;   International Patent Publication No. WO 2017/116793, filed Dec. 19, 2016, titled ROBOTIC SURGICAL SYSTEMS AND INSTRUMENT DRIVE ASSEMBLIES.   

     The robotic surgical systems and features disclosed herein can be employed with the robotic surgical system of  FIGS.  239  and  240   . The reader will further appreciate that various systems and/or features disclosed herein can also be employed with alternative surgical systems including the computer-implemented interactive surgical system  100 , the computer-implemented interactive surgical system  200 , the robotic surgical system  110 , the robotic hub  122 , the robotic hub  222 , and/or the robotic surgical system  15000 , for example. 
     In various instances, a robotic surgical system can include a robotic control tower, which can house the control unit of the system. For example, the control unit  13004  of the robotic surgical system  13000  ( FIG.  239   ) can be housed within a robotic control tower. The robotic control tower can include a robotic hub such as the robotic hub  122  ( FIG.  2   ) or the robotic hub  222  ( FIG.  9   ), for example. Such a robotic hub can include a modular interface for coupling with one or more generators, such as an ultrasonic generator and/or a radio frequency generator, and/or one or more modules, such as an imaging module, suction module, an irrigation module, a smoke evacuation module, and/or a communication module. 
     A robotic hub can include a situational awareness module, which can be configured to synthesize data from multiple sources to determine an appropriate response to a surgical event. For example, a situational awareness module can determine the type of surgical procedure, step in the surgical procedure, type of tissue, and/or tissue characteristics, as further described herein. Moreover, such a module can recommend a particular course of action or possible choices to the robotic system based on the synthesized data. In various instances, a sensor system encompassing a plurality of sensors distributed throughout the robotic system can provide data, images, and/or other information to the situational awareness module. Such a situational awareness module can be incorporated into a control unit, such as the control unit  13004 , for example. In various instances, the situational awareness module can obtain data and/or information from a non-robotic surgical hub and/or a cloud, such as the surgical hub  106  ( FIG.  1   ), the surgical hub  206  ( FIG.  10   ), the cloud  104  ( FIG.  1   ), and/or the cloud  204  ( FIG.  9   ), for example. Situational awareness of a surgical system is further disclosed herein and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, and U.S. Provisional Pat. Application Serial No. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure of each of which is herein incorporated by reference in its entirety. 
     In certain instances, the activation of a surgical tool at certain times during a surgical procedure and/or for certain durations may cause tissue trauma and/or may prolong a surgical procedure. For example, a robotic surgical system can utilize an electrosurgical tool having an energy delivery surface that should only be energized when a threshold condition is met. In one example, the energy delivery surface should only be activated when the energy delivery surface is in contact with the appropriate, or targeted, tissue. As another example, a robotic surgical system can utilize a suction element that should only be activated when a threshold condition is met, such as when an appropriate volume of fluid is present. Due to visibility restrictions, evolving situations, and the multitude of moving parts during a robotic surgical procedure, it can be difficult for a clinician to determine and/or monitor certain conditions at the surgical site. For example, it can be difficult to determine if an energy delivery surface of an electrosurgical tool is in contact with tissue. It can also be difficult to determine if a particular suctioning pressure is sufficient for the volume of fluid in the proximity of the suctioning port. 
     Moreover, a plurality of surgical devices can be used in certain robotic surgical procedures. For example, a robotic surgical system can use one or more surgical tools during the surgical procedure. Additionally, one or more handheld instruments can also be used during the surgical procedure. One or more of the surgical devices can include a sensor. For example, multiple sensors can be positioned around the surgical site and/or the operating room. A sensor system including the one or more sensors can be configured to detect one or more conditions at the surgical site. For example, data from the sensor system can determine if a surgical tool mounted to the surgical robot is being used and/or if a feature of the surgical tool should be activated. More specifically, a sensor system can detect if an electrosurgical device is positioned in abutting contact with tissue, for example. As another example, a sensor system can detect if a suctioning element of a surgical tool is applying a sufficient suctioning force to fluid at the surgical site. 
     When in an automatic activation mode, the robotic surgical system can automatically activate one or more features of one or more surgical tools based on data, images, and/or other information received from the sensor system. For example, an energy delivery surface of an electrosurgical tool can be activated upon detecting that the electrosurgical tool is in use (e.g. positioned in abutting contact with tissue). As another example, a suctioning element on a surgical tool can be activated when the suction port is moved into contact with a fluid. In certain instances, the surgical tool can be adjusted based on the sensed conditions. 
     A robotic surgical system incorporating an automatic activation mode can automatically provide a scenario-specific result based on detected condition(s) at the surgical site. The scenario-specific result can be outcome-based, for example, and can streamline the decision-making process of the clinician. In certain instances, such an automatic activation mode can improve the efficiency and/or effectiveness of the clinician. For example, the robotic surgical system can aggregate data to compile a more complete view of the surgical site and/or the surgical procedure in order to determine the best possible course of action. Additionally or alternatively, in instances in which the clinician makes fewer decisions, the clinician can be better focused on other tasks and/or can process other information more effectively. 
     In one instance, a robotic surgical system can automatically adjust a surgical tool based on the proximity of the tool to a visually-detectable need and/or the situational awareness of the system. Referring to  FIGS.  241 A and  241 B , an ultrasonic surgical tool for a robotic system  13050  is depicted in two different positions. In a first position, as depicted in  FIG.  241 A , the blade  13052  of an ultrasonic surgical tool  13050  is positioned out of contact with tissue  13060 . In such a position, a sensor on the ultrasonic surgical tool  13050  can detect a high resistance. When the resistance detected is above a threshold value, the ultrasonic blade  13052  can be de-energized. Referring now to  FIG.  241 B , the ultrasonic blade  13052  is depicted in a second position in which the distal end of the blade  13052  is positioned in abutting contact with tissue  13060 . In such instances, a sensor on the ultrasonic surgical tool  13050  can detect a low resistance. When the detected resistance is below a threshold value, the ultrasonic blade  13052  can be activated such that therapeutic energy is delivered to the tissue  13060 . Alternative sensor configurations are also envisioned and various sensors are further described herein. 
     Referring to  FIGS.  242 A and  242 B , another surgical tool, a monopolar cautery pencil  13055 , is depicted in two different positions. In a first position, as depicted in  FIG.  242 A , the monopolar cautery pencil  13055  is positioned out of contact with tissue. In such a position, a sensor on the monopolar cautery pencil  13055  can detect a high resistance. When the resistance detected is above a threshold value, the monopolar cautery pencil  13055  can be de-energized. Referring now to  FIG.  242 B , the monopolar cautery pencil  13055  is depicted in a second position in which the distal end of the monopolar cautery pencil  13055  is positioned in abutting contact with tissue. In such instances, a sensor on the monopolar cautery pencil  13055  can detect a low resistance. When the detected resistance is below a threshold value, the monopolar cautery pencil  13055  can be activated such that therapeutic energy is delivered to the tissue. Alternative sensor configurations are also envisioned and various sensors are further described herein. 
       FIG.  243    shows a graphical display  13070  of continuity C and current I over time t for the ultrasonic surgical tool  13050  of  FIGS.  241 A and  241 B . Similarly, the monopolar cautery pencil  13055  can generate a graphical display similar in many respects to the graphical display  13070 , in certain instances. In the graphical display  13070 , continuity C is represented by a dotted line, and current I is represented by a solid line. When the resistance is high and above a threshold value, the continuity C can also be high. The threshold value can be between 40 and 400 ohms, for example. At time A′, the continuity C can decrease below the threshold value, which can indicate a degree of tissue contact. As a result, the robotic surgical system can automatically activate advanced energy treatment of the tissue. The ultrasonic transducer current depicted in  FIG.  243    increases from time A′ to B′ when the continuity parameters indicate the degree of tissue contact. In various instances, the current I can be capped at a maximum value indicated at B′, which can correspond to an open jaw transducer limit, such as in instances in which the jaw is not clamped, as shown in  FIGS.  241 A and  241 B . In various instances, the situational awareness module of the robotic surgical system may indicate that the jaw is unclamped. Referring again to the graphical display  13070  in  FIG.  243   , energy is applied until time C′, at which time a loss of tissue contact is indicated by the increase in continuity C above the threshold value. As a result, the ultrasonic transducer current I can decrease to zero as the ultrasonic blade is de-energized. 
     In various instances, a sensor system can be configured to detect at least one condition at the surgical site. For example, a sensor of the sensor system can detect tissue contact by measuring continuity along the energy delivery surface of the ultrasonic blade. Additionally or alternatively, the sensor system can include one or more additional sensors positioned around the surgical site. For example, one or more surgical tools and/or instruments being used in the surgical procedure can be configured to detect a condition at the surgical site. The sensor system can be in signal communication with a processor of the robotic surgical system. For example, the robotic surgical system can include a central control tower including a control unit housing a processor and memory, as further described herein. The processor can issue commands to the surgical tool based on inputs from the sensor system. In various instances, situational awareness can also dictate and/or influence the commands issued by the processor. 
     Turning now to  FIG.  244   , an end effector  196400  includes RF data sensors  196406 ,  196408   a ,  196408   b  located on jaw member  196402 . The end effector  196400  includes jaw member  196402  and an ultrasonic blade  196404 . The jaw member  196402  is shown clamping tissue  196410  located between the jaw member  196402  and the ultrasonic blade  196404 . A first sensor  196406  is located in a center portion of the jaw member  196402 . Second and third sensors  196408   a ,  196408   b , respectively, are located on lateral portions of the jaw member  196402 . The sensors  196406 ,  196408   a ,  196408   b  are mounted or formed integrally with a flexible circuit  196412  (shown more particularly in  FIG.  245   ) configured to be fixedly mounted to the jaw member  196402 . 
     The end effector  196400  is an example end effector for various surgical devices described herein. The sensors  196406 ,  196408   a ,  196408   b  are electrically connected to a control circuit via interface circuits. The sensors  196406 ,  196408   a ,  196408   b  are battery powered and the signals generated by the sensors  196406 ,  196408   a ,  196408   b  are provided to analog and/or digital processing circuits of the control circuit. 
     In one aspect, the first sensor  196406  is a force sensor to measure a normal force F 3  applied to the tissue  196410  by the jaw member  196402 . The second and third sensors  196408   a ,  196408   b  include one or more elements to apply RF energy to the tissue  196410 , measure tissue impedance, down force F 1 , transverse forces F 2 , and temperature, among other parameters. Electrodes  196409   a ,  196409   b  are electrically coupled to an energy source such as an electrical circuit and apply RF energy to the tissue  196410 . In one aspect, the first sensor  196406  and the second and third sensors  196408   a ,  196408   b  are strain gauges to measure force or force per unit area. It will be appreciated that the measurements of the down force F 1 , the lateral forces F 2 , and the normal force F 3  may be readily converted to pressure by determining the surface area upon which the force sensors  196406 ,  196408   a ,  196408   b  are acting upon. Additionally, as described with particularity herein, the flexible circuit  196412  may include temperature sensors embedded in one or more layers of the flexible circuit  196412 . The one or more temperature sensors may be arranged symmetrically or asymmetrically and provide tissue  196410  temperature feedback to control circuits of an ultrasonic drive circuit and an RF drive circuit. 
     One or more sensors such as a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as, for example, an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor, may be adapted and configured to measure tissue compression and/or impedance. 
       FIG.  245    illustrates one aspect of the flexible circuit  196412  shown in  FIG.  244    in which the sensors  196406 ,  196408   a ,  196408   b  may be mounted to or formed integrally therewith. The flexible circuit  196412  is configured to fixedly attach to the jaw member  196402 . As shown particularly in  FIG.  245   , asymmetric temperature sensors  196414   a ,  196414   b  are mounted to the flexible circuit  196412  to enable measuring the temperature of the tissue  196410  ( FIG.  244   ). 
     The reader will appreciate that alternative surgical tools can be utilized in the automatic activation mode described above with respect to  FIG.  241 A- 245   . 
       FIG.  246    is a flow chart  13150  depicting an automatic activation mode  13151  of a surgical tool. In various instances, the robotic surgical system and processor thereof is configured to implement the processes indicated in  FIG.  246   . Initially, a sensor system is configured to detect a condition at step  13152 . The detected condition is communicated to a processor, which compares the detected condition to a threshold parameter at step  13154 . The threshold parameter can be a maximum value, minimum value, or range of values. If the sensed condition is an out-of-bounds condition, the processor can adjust the surgical function at step  13156  and the processor can repeat the comparison process of steps  13152  and  13154 . If the sensed condition is not an out-of-bounds condition, no adjustment is necessary ( 13158 ) and the comparison process of steps  13152  and  13154  can be repeated again. 
     In various instances, the robotic surgical system can permit a manual override mode  13153 . For example, upon activation of the manual override input  13160 , such as by a clinician, the surgical system can exit the automatic activation mode  13151  at step  13162  depicted in  FIG.  246   . In such instances, even when a sensed condition is an out-of-bounds condition, the surgical function would not be automatically adjusted by the processor. However, in such instances, the processor can issue a warning or recommendation to the clinician recommending a particular course of action based on the sensed condition(s). 
     In various instances, an automatic activation mode can be utilized with a robotic surgical system including a suctioning feature. In one instance, a robotic surgical system can communicate with a suction and/or irrigation tool. For example, a suction and/or irrigation device (see module  128  in  FIG.  3   ) can communicate with a robotic surgical system via the surgical hub  106  ( FIG.  1   ) and/or the surgical hub  206  ( FIG.  9   ) and a suction and/or irrigation tool can be mounted to a robotic arm. The suction/irrigation device can include a distal suction port and a sensor. In another instance, a robotic surgical tool, such as an electrosurgical tool, can include a suctioning feature and a suction port on the end effector of the tool. 
     Referring to  FIG.  247   , when a suction port on an end effector  13210  is moved into contact with a fluid, a processor of the robotic surgical system can automatically activate the suction feature. For example, a fluid detection sensor  13230  on the tool  13200  can detect fluid  13220  in the proximity of the tool  13200  and/or contacting the tool  13200 . The fluid detection sensor  13230  can be a continuity sensor, for example. The fluid detection sensor  13230  can be in signal communication with the processor such that the processor is configured to receive input and/or feedback from the fluid detection sensor  13230 . In certain instances, the suctioning feature can be automatically activated when the suction port is moved into proximity with a fluid  13220 . For example, when the suction port moves within a predefined spatial range of a fluid  13220 , the suction feature can be activated by the processor. The fluid  13220  can be saline, for example, which can be provided to the surgical site to enhance conductivity and/or irrigate the tissue. 
     In various instances, the tool can be a smoke evacuation tool and/or can include a smoke evacuation system, for example. A detail view of an end effector  13210  of a bipolar radio-frequency surgical tool  13200  is shown in  FIG.  247   . The end effector  13210  is shown in a clamped configuration. Moreover, smoke and steam  13220  from an RF weld accumulate around the end effector  13210 . In various instances, to improve visibility and efficiency of the tool  13200 , the smoke and steam  13220  at the surgical site can be evacuated along a smoke evacuation channel  13240  extending proximally from the end effector. The evacuation channel  13240  can extend through the shaft  13205  of the surgical tool  13200  to the interface of the surgical tool  13200  and the robot. The evacuation channel  13240  can be coupled to a pump for drawing the smoke and/or steam  13220  along the smoke evacuation channel  13240  within the shaft  13205  of the surgical tool  13200 . In various instances, the surgical tool  13200  can include insufflation, cooling, and/or irrigation capabilities, as well. 
     In one instance, the intensity of the suction pressure can be automatically adjusted based on a measured parameter from one or more surgical devices. In such instances, the suction pressure can vary depending on the sensed parameters. Suction tubing can include a sensor for detecting the volume of fluid being extracted from the surgical site. When increased volumes of fluid are being extracted, the power to the suction feature can be increased such that the suctioning pressure is increased. Similarly, when decreased volumes of fluid are being extracted, the power to the suction feature can be decreased such that the suctioning pressure is decreased. 
     In various instances, the sensing system for a suction tool can include a pressure sensor. The pressure sensor can detect when an occlusion is obstructing, or partially obstructing, the fluid flow. The pressure sensor can also detect when the suction port is moved into abutting contact with tissue. In such instances, the processor can reduce and/or pause the suctioning force to release the tissue and/or clear the obstruction. In various instances, the processor can compare the detected pressure to a threshold maximum pressure. Exceeding the maximum threshold pressure may lead to unintentional tissue trauma from the suctioning tool. Thus, to avoid such trauma, the processor can reduce and/or pause the suctioning force to protect the integrity of tissue in the vicinity thereof. 
     A user can manually override the automatic adjustments implemented in the automatic activation mode(s) described herein. The manual override can be a one-time adjustment to the surgical tool. In other instances, the manual override can be a setting that turns off the automatic activation mode for a specific surgical action, a specific duration, and/or a global override for the entire procedure. 
     In one aspect, the robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The processor is communicatively coupled to a sensor system, and the memory stores instructions executable by the processor to determine a use of a robotic tool based on input from the sensor system and to automatically energize an energy delivery surface of the robotic tool when the use is determined, as described herein. 
     In various aspects, the present disclosure provides a control circuit to automatically energize an energy delivery surface, as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to automatically energize an energy delivery surface of a robotic tool, as described herein. 
     In one aspect, the robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The processor is communicatively coupled to a fluid detection sensor, and the memory stores instructions executable by the processor to receive input from the fluid detection sensor and to automatically activate a suctioning mode when fluid is detected, as described herein. 
     In various aspects, the present disclosure provides a control circuit to automatically activate a suctioning mode, as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to automatically activate a suctioning mode, as described herein. 
     Multiple surgical devices, including a robotic surgical system and various handheld instruments, can be used by a clinician during a particular surgical procedure. When manipulating one or more robotic tools of the robotic surgical system, a clinician is often positioned at a surgeon’s command console or module, which is also referred to as a remote control console. In various instances, the remote control console is positioned outside of a sterile field and, thus, can be remote to the sterile field and, in some instances, remote to the patient and even to the operating room. If the clinician desires to use a handheld instrument, the clinician may be required to step away from the remote control console. At this point, the clinician may be unable to control the robotic tools. For example, the clinician may be unable to adjust the position or utilize the functionality of the robotic tools. Upon stepping away from the remote control console, the clinician may also lose sight of one or more displays on the robotic surgical system. The separation between the control points for the handheld instruments and the robotic surgical system may inhibit the effectiveness with which the clinician can utilize the surgical devices, both robotic tools and surgical instruments, together. 
     In various instances, an interactive secondary display is configured to be in signal communication with the robotic surgical system. The interactive secondary display includes a control module in various instances. Moreover, the interactive secondary display is configured to be wireless and movable around an operating room. In various instances, the interactive secondary display is positioned within a sterile field. In one instance, the interactive secondary display allows the clinician to manipulate and control the one or more robotic tools of the robotic surgical system without having to be physically present at the remote control console. In one instance, the ability for the clinician to operate the robotic surgical system away from the remote control console allows multiple devices to be used in a synchronized manner. As a safety measure, in certain instances, the remote control console includes an override function configured to prohibit control of the robotic tools by the interactive secondary display. 
       FIG.  248    depicts a surgical system  13100  for use during a surgical procedure that utilizes a surgical instrument  13140  and a robotic surgical system  13110 . The surgical instrument  13140  is a powered handheld instrument. The surgical instrument  13140  can be a radio frequency (RF) instrument, an ultrasonic instrument, a surgical stapler, and/or a combination thereof, for example. The surgical instrument  13140  includes a display  13142  and a processor  13144 . In certain instances, the handheld surgical instrument  13140  can be a smart or intelligent surgical instrument having a plurality of sensors and a wireless communication module. 
     The robotic surgical system  13110  includes a robot  13112  including at least one robotic tool  13117  configured to perform a particular surgical function. The robotic surgical system  13110  is similar in many respects to robotic surgical system  13000  discussed herein. The robotic tool  13117  is movable in a space defined by a control envelope of the robotic surgical system  13110 . In various instances, the robotic tool  13117  is controlled by various clinician inputs at a remote control console  13116 . In other words, when a clinician applies an input at the remote control console  13116 , the clinician is away from the patient’s body and outside of a sterile field  13138 . Clinician input to the remote control console  13116  is communicated to a robotic control unit  13114  that includes a robot display  13113  and a processor  13115 . The processor  13115  directs the robotic tool(s)  13117  to perform the desired function(s). 
     In various instances, the surgical system  13100  includes a surgical hub  13120 , which is similar in many respects to the hub  106 , the hub  206 , the robotic hub  122 , or the robotic hub  222 , for example. The surgical hub  13120  is configured to enhance cooperative and/or coordinated usage of the robotic surgical system  13110  and the surgical instrument(s)  13140 . The surgical hub  13120  is in signal communication with the control unit  13114  of the robotic surgical system  13110  and the processor  13144  of the surgical instrument(s)  13140 . In various instances, a signal is transmitted through a wireless connection, although any suitable connection can be used to facilitate the communication. The control unit  13114  of the robotic surgical system  13110  is configured to send information to the surgical hub  13120  regarding the robotic tool(s)  13117 . Such information includes, for example, a position of the robotic tool(s)  13117  within the surgical site, an operating status of the robotic tool(s)  13117 , a detected force by the robotic tool(s), and/or the type of robotic tool(s)  13117  attached to the robotic surgical system  13110 , although any relevant information and/or operating parameters can be communicated. Examples of surgical hubs are further described herein and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. 
     In other instances, the robotic surgical system  13110  can encompass the surgical hub  13120  and/or the control unit  13114  can be incorporated into the surgical hub  13120 . For example, the robotic surgical system  13110  can include a robotic hub including a modular control tower that includes a computer system and a modular communication hub. One or more modules can be installed in the modular control tower of the robotic hub. Examples of robotic hubs are further described herein and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. 
     The processor  13144  of the surgical instrument(s)  13140  is configured to send information to the surgical hub  13120  regarding the surgical instrument  13140 . Such information includes, for example, a position of the surgical instrument(s)  13140  within the surgical site, an operating status of the surgical instrument(s)  13140 , a detected force by the surgical instrument(s)  13140 , and/or identification information regarding the surgical instrument(s)  13140 , although any relevant information and/or operating parameters can be sent to the surgical hub. 
     In various instances, a hub display  13125  is in signal communication with the surgical hub  13120  and may be incorporated into the modular control tower, for example. The hub display  13125  is configured to display information received from the robotic surgical system  13110  and the surgical instrument(s)  13140 . The hub display  13125  can be similar in many respects to the visualization system  108  ( FIG.  1   ), for example. In one aspect, the hub display  13125  can include an array of displays such as video monitors and/or heads-up displays around the operating room, for example. 
     In various instances, the surgical hub  13120  is configured to recognize when the surgical instrument  13140  is activated by a clinician via wireless communication signal(s). Upon activation, the surgical instrument  13140  is configured to send identification information to the surgical hub  13120 . Such identification information may include, for example, a model number of the surgical instrument, an operating status of the surgical instrument, and/or a location of the surgical instrument, although other suitable device parameters can be communicated. In various instances, the surgical hub  13120  is configured to utilize the communicated information to assess the compatibility of the surgical instrument  13140  with the capabilities of the surgical hub  13120 . Examples of capabilities of the surgical hub with compatible surgical instruments are further discussed herein. 
     In various instances, the control unit  13114  of the robotic surgical system  13110  is configured to communicate a video feed to the surgical hub  13120 , and the surgical hub  13120  is configured to communicate the information, or a portion thereof, to the surgical instrument  13140 , which can replicate a portion of the robot display  13113 , or other information from the robotic surgical system  13110 , on a display  13142  of the surgical instrument  13140 . In other instances, the robotic surgical system  13110  (e.g. the control unit  13114  or surgical tool  13117 ) can communicate directly with the surgical instrument  13140 , such as when the robotic surgical system  13110  includes a robotic hub and/or the surgical tool  13117  includes a wireless communication module, for example. The reproduction of a portion of the robot display  13113  on the surgical instrument  13140  allows the clinician to cooperatively use both surgical devices by providing, for example, alignment data to achieve integrated positioning of the surgical instrument  13140  relative to the robotic tool(s)  13117 . In various instances, the clinician is able to remove any unwanted information displayed on the display  13142  of the surgical instrument  13140 . 
     Referring still to  FIG.  248   , in various instances, the surgical system  13100  further includes an interactive secondary display  13130  within the sterile field  13138 . The interactive secondary display  13130  is also a local control module within the sterile field  13138 . The remote control console  13116 , or the primary control, can be positioned outside the sterile field  13138 . For example, the interactive secondary display  13130  can be a handheld mobile electronic device, such as an iPad® tablet, which can be placed on a patient or the patient’s table during a surgical procedure. For example, the interactive secondary display  13130  can be placed on the abdomen or leg of the patient during the surgical procedure. In other instances, the interactive secondary display  13130  can be incorporated into the surgical instrument  13140  within the sterile field  13138 . In various instances, the interactive secondary display  13130  is configured to be in signal communication with the robotic surgical system  13110  and/or the surgical instrument  13140 . In such instances, the interactive secondary display  13130  is configured to display information received from the robotic tool(s)  13117  (for example, robotic tool  1 , robotic tool  2 , ... robotic tool n) and the surgical instruments  13140  (for example, surgical instrument  1 , surgical instrument  2 , ... surgical instrument n). The interactive secondary display  13130  depicts tool information  13133  and instrument information  13135  thereon. In various instances, the user is able to interact with the interactive secondary display  13130  to customize the size and/or location of the information displayed. 
     Referring still to  FIG.  248   , in various instances, the surgical hub  13120  is configured to transmit robot status information of the surgical robot system  13100  to the surgical instrument  13140 , and the surgical instrument  13140  is configured to display the robot status information on the display  13142  of the surgical instrument  13140 . 
     In various instances, the display  13142  of the surgical instrument  13140  is configured to communicate commands through the surgical hub  13120  to the control unit  13114  of the robotic surgical system  13110 . After viewing and interpreting the robot status information displayed on the display  13142  of the surgical instrument  13140  as described herein, a clinician may want to utilize one or more functions of the robotic surgical system  13110 . Using the buttons and/or a touch-sensitive display  13142  on the surgical instrument  13140 , the clinician is able to input a desired utilization of and/or adjustment to the robotic surgical system  13110 . The clinician input is communicated from the surgical instrument  13140  to the surgical hub  13120 . The surgical hub  13120  is then configured to communicate the clinician input to the control unit  13114  of the robotic surgical system  13110  for implementation of the desired function. In other instances, the handheld surgical instrument  13140  can communicate directly with the control unit  13114  of the robotic surgical system  13110 , such as when the robotic surgical system  13110  includes a robotic hub, for example. 
     In various instances, the surgical hub  13120  is in signal communication with both the robotic surgical system  13110  and the surgical instrument  13140 , allowing the surgical system  13100  to adjust multiple surgical devices in a synchronized, coordinated, and/or cooperative manner. The information communicated between the surgical hub  13120  and the various surgical devices includes, for example, surgical instrument identification information and/or the operating status of the various surgical devices. In various instances, the surgical hub  13120  is configured to detect when the surgical instrument  13140  is activated. In one instance, the surgical instrument  13140  is an ultrasonic dissector. Upon activation of the ultrasonic dissector, the surgical hub  13120  is configured to communicate the received activation information to the control unit  13114  of the robotic surgical system  13110 . 
     In various instances, the surgical hub  13120  automatically communicates the information to the control unit  13114  of the robotic surgical system  13110 . The reader will appreciate that the information can be communicated at any suitable time, rate, interval and/or schedule. Based on the information received from the surgical hub  13120 , the control unit  13114  of the robotic surgical system  13110  is configured to decide whether to activate at least one robotic tool  13117  and/or activate a particular operating mode, such as a smoke evacuation mode, for example. For example, upon activation of a surgical tool that is known to generate, or possibly generate, smoke and/or contaminants at the surgical site, such as an ultrasonic dissector, the robotic surgical system  13110  can automatically activate the smoke evacuation mode or can cue the surgeon to activate the smoke evacuation mode. In various instances, the surgical hub  13120  is configured to continuously communicate additional information to the control unit  13114  of the robotic surgical system  13110 , such as various sensed tissue conditions, in order to adjust, continue, and/or suspend further movement of the robotic tool  13117  and/or the entered operating mode. 
     In various instances, the surgical hub  13120  may calculate parameters, such as smoke generation intensity, for example, based on the additional information communicated from the surgical instrument  13140 . Upon communicating the calculated parameter to the control unit  13114  of the robotic surgical system  13110 , the control unit  13114  is configured to move at least one robotic tool and/or adjust the operating mode to account for the calculated parameter. For example, when the robotic surgical system  13110  enters the smoke evacuation mode, the control unit  13114  is configured to adjust a smoke evacuation motor speed to be proportionate to the calculated smoke generation intensity. 
     In certain instances, an ultrasonic tool mounted to the robot  13112  can include a smoke evacuation feature that can be activated by the control unit  13114  to operate in a smoke evacuation mode. In other instances, a separate smoke evacuation device can be utilized. For example, a smoke evacuation tool can be mounted to another robotic arm and utilized during the surgical procedure. In still other instances, a smoke evacuation instrument that is separate from the robotic surgical system  13110  can be utilized. The surgical hub  13120  can coordinate communication between the robotically-controlled ultrasonic tool and the smoke evacuation instrument, for example. 
     In  FIGS.  249 - 252   , various surgical devices and components thereof are described with reference to a colon resection procedure. The reader will appreciate that the surgical devices, systems, and procedures described with respect to those figures are an exemplary application of the system of  FIG.  248   . Referring now to  FIG.  249   , a handle portion  13202  of a handheld surgical instrument  13300  is depicted. In certain aspects, the handheld surgical instrument  13300  corresponds to the surgical instrument  13140  of the surgical system  13100  in  FIG.  248   . In one instance, the handheld surgical instrument  13300  is a powered circular stapler and includes a display  13310  on the handle portion  13302  thereof. 
     Before pairing the handheld surgical instrument  13300  to a robotic surgical system (e.g. the robotic surgical system  13110  in  FIG.  248   ) via the surgical hub  13320  ( FIG.  250   ), as described herein, the display  13310  on the handle  13302  of the handheld surgical instrument  13300  can include information regarding the status of the instrument  13300 , such as the clamping load  13212 , the anvil status  13214 , and/or the instrument or cartridge status  13216 , for example. In various instances, the display  13310  of the handheld surgical instrument  13300  includes an alert  13318  to the user that communicates the status of the firing system. In various instances, the display  13310  is configured to display the information in a manner that communicates the most important information to the user. For example, in various instances, the display  13310  is configured to display warning information in a larger size, in a flashing manner, and/or in a different color. When the handheld surgical instrument  13300  is not paired with a surgical hub, the display  13310  can depict information gathered only from the handheld surgical instrument  13300  itself. 
     Referring now to  FIG.  250   , after pairing the handheld surgical instrument  13300  with the surgical hub  13320 , as described herein with respect to  FIG.  248   , for example, the information detected and displayed by the handheld surgical instrument  13300  can be communicated to the surgical hub  13320  and displayed on a hub display (e.g. the hub display  13125  of  FIG.  248   ). Additionally or alternatively, the information can be displayed on the display of the robotic surgical system. Additionally or alternatively, the information can be displayed on the display  13310  on the handle portion  13302  of the handheld surgical instrument  13300 . In various instances, a clinician can decide what information is displayed at the one or multiple locations. As mentioned above, in various instances, the clinician is able to remove any unwanted information displayed on the display  13310  of the handheld surgical instrument  13300 , the display of the robotic surgical system, and/or the display on the hub display. 
     Referring still to  FIG.  250   , after pairing the handheld surgical instrument  13300  with the robotic surgical system, the display  13310  on the handle portion  13302  of the handheld surgical instrument  13300  can be different than the display  13310  on the handheld surgical instrument  13300  before pairing with the robotic surgical system. For example, procedural information from the surgical hub  13320  and/or robotic surgical system can be displayed on the powered circular stapler. For example, as seen in  FIG.  250   , robot status information including alignment information  13312  from the surgical hub  13320  and one or more retraction tensions  13316 ,  13317  exerted by a robotic tool on particular tissue(s), is displayed on the display  13310  of the handheld surgical instrument  13300  for the convenience of the clinician. In various instances, the display  13310  of the handheld surgical instrument  13300  includes an alert  13318  to the user that communicates a parameter monitored by the surgical hub  13320  during a surgical procedure. In various instances, the display  13310  is configured to display the information in a manner that communicates the most important information to the user. For example, in various instances, the display  13310  is configured to display warning information in a larger size, in a flashing manner, and/or in a different color. 
     Referring still to  FIG.  250   , the display  13310  of the handheld surgical instrument  13300  is configured to display information regarding one or more retraction tensions  13316 ,  13317  exerted by one or more devices during a surgical procedure involving one or more robotic tools. For example, the handheld surgical instrument  13300 , the powered circular stapler, is involved a the colon resection procedure of  FIG.  251   . In this procedure, one device (e.g. a robotic tool) is configured to grasp colonic tissue and another device (e.g. the handheld circular stapler) is configured to grasp rectal tissue. As the devices move apart from one another, the force of retracting the colonic tissue F RC  and the force of retracting the rectal tissue F RR  are monitored. In the illustrated example, an alert notification  13318  is issued to the user as the force of retracting the colonic tissue has exceeded a predetermined threshold. Predetermined thresholds for both retracting forces F RC , F RR  are indicated by horizontal dotted lines on the display  13310 . The user is notified when one or both thresholds are surpassed and/or reached in an effort to minimize damage and/or trauma to the surrounding tissue. 
     In  FIG.  252   , graphical displays  13330 ,  13340  of retracting forces F RC , F RR  are illustrated. In the circumstances illustrated in the graphical displays  13330 ,  13340 , the user is notified when pre-determined thresholds are exceeded, depicted by the shaded region  13332  of the graphical display  13330 , indicating that the retracting force of the colonic tissue F RC  has exceeded a predetermined threshold of 0.5 lbs. 
     In certain instances, it can be difficult to align the end effector of a circular stapler with targeted tissue during a colorectal procedure because of visibility limitations. For example, referring again to  FIG.  251   , during a colon resection, the surgical instrument  13300 , a circular stapler, can be positioned adjacent to a transected rectum  13356 . Moreover, the anvil  13301  of the surgical instrument  13300  can be engaged with a transected colon  13355 . A robotic tool  133175  is configured to engage the anvil  13301  and apply the retracting force F RC . It can be difficult to confirm the relative position of the surgical instrument  13300  with the targeted tissue, for example, with the staple line through the transected colon  13355 . In certain instances, information from the surgical hub  13320  and robotic surgical system can facilitate the alignment. For example, as shown in  FIG.  250   , the center of the surgical instrument  13300  can be shown relative to the center of the targeted tissue  13318  on the display screen  13310  of the surgical instrument  13300 . In certain instances, and as shown in  FIG.  251   , sensors and a wireless transmitter on the surgical instrument  13300  can be configured to convey positioning information to the surgical hub  13320 , for example. 
     A colorectal procedure, visibility limitations thereof, and an alignment tool for a surgical hub are further described herein and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. 
     As mentioned above, the display  13310  on the handheld instrument  13300  can also be configured to alert the clinician in certain scenarios. For example, the display  13310  in  FIG.  250    includes an alert  13318  because the one or more of the forces exceed the predefined force thresholds. Referring again to  FIGS.  251  and  252   , during the colon resection, the robotic arm can exert a first force F RC  on the anvil, and the handheld instrument  13300  can exert a second force F RR  on the rectum  13356 . The tension on the rectum  13356  by the circular stapler can be capped at a first limit (for example 0.5 lb in  FIG.  252   ), and the tension on the colon  13355  from the robotic arm can be capped at a second limit (for example 0.5 lb in  FIG.  252   ). An intervention may be suggested to the clinician when the tension on the rectum  13356  or colon  13355  exceeds a threshold value. 
     The tension on the colon F RC  in  FIGS.  251  and  252    can be ascertained by resistance to the robotic arm, and thus, can be determined by a control unit (e.g. the control unit  13114  of the robotic surgical system  13110 ). Such information can be communicated to the handheld surgical instrument  13300  and displayed on the display  13310  thereof in the sterile field such that the information is readily available to the appropriate clinician in real-time, or near real-time, or any suitable interval, rate, and/or schedule, for example. 
     In various instances, a surgical system, such as a surgical system  13360  of  FIGS.  253  and  254   , includes interactive secondary displays  13362 ,  13364  within the sterile field. The interactive secondary displays  13362 ,  13364  are also mobile control modules in certain instances and can be similar to the interactive secondary displays  13130  in  FIG.  248   , for example. A surgeon’s command console, or remote control module,  13370 , is the primary control module and can be positioned outside the sterile field. In one instance, the interactive secondary display  13362  can be a mobile device, a watch, and/or a small tablet, which can be worn on the wrist and/or forearm of the user, and the interactive secondary display  13364  can be a handheld mobile electronic device, such as an iPad® tablet, which can be placed on a patient  13361  or the patient’s table during a surgical procedure. For example, the interactive secondary displays  13362 ,  13364  can be placed on the abdomen or leg of the patient  13361  during the surgical procedure. In other instances, the interactive secondary displays  13362 ,  13364  can be incorporated into a handheld surgical instrument  13366  within the sterile field. 
     In one instance, the surgical system  13360  is shown during a surgical procedure. For example, the surgical procedure can be the colon resection procedure described herein with respect to  FIGS.  249 - 252   . In such instances, the surgical system  13360  includes a robot  13372  and a robotic tool  13374  extending into the surgical site. The robotic tool can be an ultrasonic device comprising an ultrasonic blade and a clamp arm, for example. The surgical system  13360  also includes the remote command console  13370  that encompasses a robotic hub  13380 . The control unit for the robot  13372  is housed in the robotic hub  13380 . A surgeon  13371  is initially positioned at the remote command console  13370 . An assistant  13367  holds the handheld surgical instrument  13366 , a circular stapler that extends into the surgical site. The assistant  13367  also holds a secondary display  13364  that communicates with the robotic hub  13380 . The secondary display  13364  is a mobile digital electronic device, which can be secured to the assistant’s forearm, for example. The handheld surgical instrument  13366  includes a wireless communication module. A second surgical hub  13382  is also stationed in the operating room. The surgical hub  13382  includes a generator module and can include additional modules as further described herein and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. 
     Referring primarily to  FIG.  253   , hubs  13380 ,  13382  include wireless communication modules such that a wireless communication link is established between the two hubs  13380 ,  13382 . Additionally, the robotic hub  13380  is in signal communication with the interactive secondary displays  13362 ,  13364  within the sterile field. The hub  13382  is in signal communication with the handheld surgical instrument  13366 . If the surgeon  13371  moves over towards the patient  13361  and within the sterile field (as indicated by the reference character  13371 ′), the surgeon  13371  can use one of the wireless interactive displays  13362 ,  13364  to operate the robot  13372  away from the remote command console  13370 . The plurality of secondary displays  13362 ,  13364  within the sterile field allows the surgeon  13371  to move away from the remote command console  13370  without losing sight of important information for the surgical procedure and controls for the robotic tools utilized therein. 
     The interactive secondary displays  13362 ,  13364  permit the clinician to step away from the remote command console  13370  and into the sterile field while maintaining control of the robot  13372 . For example, the interactive secondary displays  13362 ,  13364  allow the clinician to maintain cooperative and/or coordinated control over the powered handheld surgical instrument(s)  13366  and the robotic surgical system at the same time. In various instances, information is communicated between the robotic surgical system, one or more powered handheld surgical instruments  13366 , surgical hubs  13380 ,  13382 , and the interactive secondary displays  13362 ,  13364 . Such information may include, for example, the images on the display of the robotic surgical system and/or the powered handheld surgical instruments, a parameter of the robotic surgical system and/or the powered handheld surgical instruments, and/or a control command for the robotic surgical system and/or the powered handheld surgical instruments. 
     In various instances, the control unit of the robotic surgical system (e.g. the control unit  13113  of the robotic surgical system  13110 ) is configured to communicate at least one display element from the surgeon’s command console (e.g. the console  13116 ) to an interactive secondary display (e.g. the display  13130 ). In other words, a portion of the display at the surgeon’s console is replicated on the display of the interactive secondary display, integrating the robot display with the interactive secondary display. The replication of the robot display on to the display of the interactive secondary display allows the clinician to step away from the remote command console without losing the visual image that is displayed there. For example, at least one of the interactive secondary displays  13362 ,  13364  can display information from the robot, such as information from the robot display and/or the surgeon’s command console  13370 . 
     In various instances, the interactive secondary displays  13362 ,  13364  are configured to control and/or adjust at least one operating parameter of the robotic surgical system. Such control can occur automatically and/or in response to a clinician input. Interacting with a touch-sensitive screen and/or buttons on the interactive secondary display(s)  13362 ,  13364 , the clinician is able to input a command to control movement and/or functionality of the one or more robotic tools. For example, when utilizing a handheld surgical instrument  13366 , the clinician may want to move the robotic tool  13374  to a different position. To control the robotic tool  13374 , the clinician applies an input to the interactive secondary display(s)  13362 ,  13364 , and the respective interactive secondary display(s)  13362 ,  13364  communicates the clinician input to the control unit of the robotic surgical system in the robotic hub  13380 . 
     In various instances, a clinician positioned at the remote command console  13370  of the robotic surgical system can manually override any robot command initiated by a clinician input on the one or more interactive secondary displays  13362 ,  13364 . For example, when a clinician input is received from the one or more interactive secondary displays  13362 ,  13364 , a clinician positioned at the remote command console  13370  can either allow the command to be issued and the desired function performed or the clinician can override the command by interacting with the remote command console  13370  and prohibiting the command from being issued. 
     In certain instances, a clinician within the sterile field can be required to request permission to control the robot  13372  and/or the robotic tool  13374  mounted thereto. The surgeon  13371  at the remote command console  13370  can grant or deny the clinician’s request. For example, the surgeon can receive a pop-up or other notification indicating the permission is being requested by another clinician operating a handheld surgical instrument and/or interacting with an interactive secondary display  13362 ,  13364 . 
     In various instances, the processor of a robotic surgical system, such as the robotic surgical systems  13000  ( FIG.  239   ),  13400  ( FIG.  240   ),  13150  ( FIG.  246   ),  13100  ( FIG.  248   ), and/or the surgical hub  13380 ,  13382 , for example, is programmed with pre-approved functions of the robotic surgical system. For example, if a clinician input from the interactive secondary display  13362 ,  13364  corresponds to a pre-approved function, the robotic surgical system allows for the interactive secondary display  13362 ,  13364  to control the robotic surgical system and/or does not prohibit the interactive secondary display  13362 ,  13364  from controlling the robotic surgical system. If a clinician input from the interactive secondary display  13362 ,  13364  does not correspond to a pre-approved function, the interactive secondary display  13362 ,  13364  is unable to command the robotic surgical system to perform the desired function. In one instances, a situational awareness module in the robotic hub  13370  and/or the surgical hub  13382  is configured to dictate and/or influence when the interactive secondary display can issue control motions to the robot surgical system. 
     In various instances, an interactive secondary display  13362 ,  13364  has control over a portion of the robotic surgical system upon making contact with the portion of the robotic surgical system. For example, when the interactive secondary display  13362 ,  13364  is brought into contact with the robotic tool  13374 , control of the contacted robotic tool  13374  is granted to the interactive secondary display  13362 ,  13364 . A clinician can then utilize a touch-sensitive screen and/or buttons on the interactive secondary display  13362 ,  13364  to input a command to control movement and/or functionality of the contacted robotic tool  13374 . This control scheme allows for a clinician to reposition a robotic arm, reload a robotic tool, and/or otherwise reconfigure the robotic surgical system. In a similar manner as discussed above, the clinician  13371  positioned at the remote command console  13370  of the robotic surgical system can manually override any robot command initiated by the interactive secondary display  13362 ,  13364 . 
     In one aspect, the robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to receive a first user input from a console and to receive a second user input from a mobile wireless control module for controlling a function of a robotic surgical tool, as described herein. 
     In various aspects, the present disclosure provides a control circuit to receive a first user input from a console and to receive a second user input from a mobile wireless control module for controlling a function of a robotic surgical tool, as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to receive a first user input from a console and to receive a second user input from a mobile wireless control module for controlling a function of a robotic surgical tool, as described herein. 
     A robotic surgical system may include multiple robotic arms that are configured to assist the clinician during a surgical procedure. Each robotic arm may be operable independently of the others. A lack of communication may exist between each of the robotic arms as they are independently operated, which may increase the risk of tissue trauma. For example, in a scenario where one robotic arm is configured to apply a force that is stronger and in a different direction than a force configured to be applied by a second robotic arm, tissue trauma can result. For example, tissue trauma and/or tearing may occur when a first robotic arm applies a strong retracting force to the tissue while a second robotic arm is configured to rigidly hold the tissue in place. 
     In various instances, one or more sensors are attached to each robotic arm of a robotic surgical system. The one or more sensors are configured to sense a force applied to the surrounding tissue during the operation of the robotic arm. Such forces can include, for example, a holding force, a retracting force, and/or a dragging force. The sensor from each robotic arm is configured to communicate the magnitude and direction of the detected force to a control unit of the robotic surgical system. The control unit is configured to analyze the communicated forces and set limits for maximum loads to avoid causing trauma to the tissue in a surgical site. For example, the control unit may minimize the holding force applied by a first robotic arm if the retracting or dragging force applied by a second robotic arm increases. 
       FIG.  255    depicts a robotic surgical system  13800  including a control unit  13820  and a robot  13810 . The robotic surgical system  13800  is similar in many respects to the robotic surgical system  13000  including the robot  13002  ( FIG.  239   ), for example. The control unit  13820  includes a processor  13822  and a display  13824 . The robot  13810  includes two robotic arms,  13830 ,  13840  configured to carry out various surgical functions. Each of the robotic arms  13830 ,  13840  are independently operable and are free to move in a space defining a control envelope of the robotic surgical system  13800 . The one or more robotic arms,  13830 ,  13840 , are configured to receive a tool, such as a stapler, a radio frequency (RF) tool, an ultrasonic blade, graspers, and/or a cutting instrument, for example. Other suitable surgical tool can be used. In various instances, the robotic arms  13830 ,  13840  each include a different tool configured to perform different functions. In other instances, all of the robotic arms  13830 ,  13840  include the same tool, although any suitable arrangement can be used. 
     The first robotic arm  13830  includes a first driver  13834  and a first motor  13836 . When activated by the processor  13822 , the first motor  13836  drives the first driver  13834  actuating the corresponding component of the first robotic arm  13830 . The second robotic arm  13840  includes a second driver,  13844  and a second motor  13846 . When activated by the processor  13822 , the second motor  13846  drives the second driver  13844  actuating the corresponding component of the second robotic arm  13840 . 
     Each of the robotic arms  13830 ,  13840 , includes a sensor  13832 ,  13842  in signal communication with the processor  13822  of the control unit  13820 . The sensors  13832 ,  13842  can be positioned on the drivers  13834 ,  13844 , respectively, and/or on the motors  13836 ,  13846 , respectively. In various instances, the sensors  13832 ,  13842  are configured to detect the location of each individual robotic arm  13830 ,  13840  within the control envelope of the robotic surgical system  13800 . The sensors  13832 ,  13842  are configured to communicate the detected locations to the processor  13822  of the robotic surgical system  13800 . In various instances, the positions of the robotic arms  13830 ,  13840  are displayed on the display  13824  of the control unit  13820 . As described in more detail below, in various instances, the processor  13822  is configured to run an algorithm to implement position limits specific to each robotic arm  13830 ,  13840  in an effort to avoid tissue trauma and damage to the robotic surgical system  13800 , for example. Such position limits may increase the clinician’s ability to cooperatively operate numerous robotic arms  13830 ,  13840  of the robotic surgical system  13800  at the same time. 
     In various instances, the sensors  13832 ,  13842  are configured to detect the force exerted by each robotic arm  13830 ,  13840 . The sensors  13832 ,  13842  can be torque sensors. As stated above, each robotic arm  13830 ,  13840  of the robotic surgical system  13800  is independently operable. During a particular surgical procedure, a clinician may want to perform different surgical functions with each robotic arm  13830 ,  13840 . Upon detecting the exerted forces of each robotic arm  13830 ,  13840 , each sensor  13832 ,  13842  is configured to communicate the detected forces to the processor  13822 . The processor  13822  is then configured to analyze the communicated information and set maximum and/or minimum force limits for each robotic arm  13830 ,  13840  to reduce the risk of causing tissue trauma, for example. In addition, the processor  13822  is configured to continuously monitor the exerted forces by each robotic arm  13830 ,  13840  and, based on the direction and magnitude of the exerted forces, proportionally control each robotic arm  13830 ,  13840  with respect to one another. For example, the opposing force between two robotic arms  13830 ,  13840  can be measured and maintained below a maximum force limit. To maintain the opposing force below a maximum force limit, at least one of the forces can be reduced, which can result in displacement of the robotic arm  13830 ,  13840 . 
     By way of example,  FIG.  256    depicts a surgical site and a portion of the surgical system  13800 , which includes three robotic arms, including a robotic arm  13850  (a third robotic arm) in addition to the robotic arms  13830  and  13840 , which are also schematically depicted in  FIG.  255   . The first robotic arm  13830  is configured to hold a portion of stomach connective tissue. In order to hold the portion of stomach connective tissue, the first robotic arm  13830  exerts an upward force F H1 . The second robotic arm  13840  applies a dragging and/or cutting force F D2  to the tissue. Simultaneously, the third robotic arm  13850  retracts a portion of liver tissue away from the current surgical cut location, further exposing the next surgical cut location. In order to move the portion of liver tissue out of the way of the advancing second robotic arm  13840 , the third robotic arm  13850  applies a retracting force F R3  away from the second robotic arm  13840 . In various exemplifications, as the second robotic arm  13840  advances further into the surgical site, the control unit of the robotic surgical system directs the third robotic arm  13850  to increase the exerted retracting force F R3  to continue exposing the next surgical cut location. While  FIG.  256    depicts a particular surgical procedure and specific robotic arms, any suitable surgical procedure can be performed, and any suitable combination of robotic arms can utilize the control algorithms disclosed herein. 
       FIG.  257    depicts graphical representations  13852 ,  13854  of the forces exerted by the robotic arms  13830 ,  13840 , and  13850  of  FIG.  256    and the relative locations of the robotic arm  13830 ,  13840 , and  13850 , respectively, from the particular surgical procedure detailed above. The graphical display  13852  in  FIG.  257    represents the exerted forces of each robotic arm  13830 ,  13840 , and  13850  over a period of time, while the graphical display  13854  represents the relative positions of each robotic arm  13830 ,  13840 , and  13850  over the same period of time. As discussed above, the first robotic arm  13830  is configured to exert a holding force F H1  on a portion of stomach connective tissue. The holding force F H1  is represented by a solid line on the graphs  13852 ,  13854 . The second robotic arm  13840  is configured to exert a dragging and/or cutting force F D2  on the stomach connective tissue. The dragging force F D2  is represented by a dash-dot line on the graphs  13852 ,  13854 . The third robotic arm  13850  is configured to exert a retracting force F R3  on a portion of liver tissue. The retracting force F R3  is represented by a dotted line on the graphs  13852 ,  13854 . 
     In various instances, the control unit of the robotic surgical system imposes at least one force threshold, such as a maximum force threshold, as depicted in the graphical display  13852 . Thus, the third robotic arm  13850  is prevented from exerting a retraction force F R3  greater than the maximum retraction force threshold. Such maximum force limits are imposed in order to avoid tissue trauma and/or avoid damage to the various robotic arms  13830 ,  13840 , and  13850 , for example. 
     Additionally or alternatively, the control unit  13820  of the robotic surgical system  13800  can impose least one force threshold, such as a minimum force threshold, as depicted in the graphical display  13852 . In the depicted instance, the first robotic arm  13830  is prevented from exerting a holding force F H1  less than the minimum holding force threshold. Such minimum force limits are imposed in order to avoid maintain appropriate tissue tension and/or visibility of the surgical site, for example. 
     In various instances, the control unit  13820  of the robotic surgical system  13800  imposes maximum force differentials detected between various robotic arms during a load control mode. In order to set maximum force differentials, the control unit  13820  of the robotic surgical system is configured to continuously monitor the difference in magnitude and direction of opposing forces by the robotic arms. As stated above, the first robotic arm  13830  is configured to hold a portion of the stomach connective tissue by exerting a holding force F H1 . The second robotic arm  13840  is configured to apply a dragging force F D2 , which opposes the holding force F H1  exerted by the first robotic arm  13830 . In various instances, maximum force differentials prevent inadvertent overloading and/or damaging an object caught between the robotic arms  13830 ,  13840 , and  13850 . Such objects include, for example, surrounding tissue and/or surgical components like clasps, gastric bands, and/or sphincter reinforcing devices. F max  opposing represents the maximum force differential set by the control unit  13820  in this particular exemplification. 
     As can be seen in the graphical display  13852 , the holding force F H1  and the dragging force F D2  both increase in magnitude at the beginning of the surgical procedure. Such an increase in magnitudes can indicate a pulling of the tissue. The holding force F H1  and the dragging force F D2  increase in opposite directions to a point where the difference between the opposing forces is equal to F max  opposing. In the graphic display  13852 , the slanted lines highlight the point in time when F max  opposing is reached. Upon reaching F max  opposing, the processor  13822  instructs the first robotic arm  13830  to reduce the holding force F H1  and continues to allow the second robotic arm  13840  to exert the dragging force F D2  at the same value, and may allow a clinician to increase the dragging force. In various instances, the value of F max  opposing is set by the processor  13822  based on various variables, such as the type of surgery and/or relevant patient demographics. In various instances, F max  opposing is a default value stored in a memory of the processor  13822 . 
     The relative positions of the robotic arms  13830 ,  13840 , and  13850  within the surgical site are depicted in the graph display  13854  of  FIG.  257   . As the first robotic arm  13830  exerts a holding force F H1  on the stomach connective tissue and the third robotic arm  13850  exerts a retracting force F R3  on the liver tissue, the surgical site becomes clear and allows the second robotic arm  13840  to exert a dragging and/or cutting force F D2  on the desired tissue. The second robotic arm  13840  and the third robotic arm  13850  become farther away from the first robotic arm  13830  as the procedure progresses. When the force differential F max  opposing is reached between the holding force F H1  and the dragging force F D2 , the first robotic arm  13830  is moved closer towards the second robotic arm  13840 , lessening the exerted holding force F H1  by the first robotic arm  13830 . In one aspect, the processor  13822  can transition the first robotic arm  13830  from the load control mode into a position control mode such that the position of the first robotic arm  13830  is held constant. As depicted in the graphical representations of  FIG.  257   , when the first robotic arm  13830  is held in a constant position, the force control for the second robotic arm  13840  can continue to displace the second robotic arm  13840 . 
     In various instances, the control unit  13820  of the robotic surgical system directs the first robotic arm  13830  to hold a specific position until a pre-determined force threshold between the first robotic arm  13830  and a second robotic arm  13840  is reached. When the pre-determined force threshold is reached, the first robotic arm  13830  is configured to automatically move along with the second robotic arm  13840  in order to maintain the pre-determined force threshold. The first robotic arm  13830  stops moving (or may move at a different rate) when the detected force of the second robotic arm  13840  no longer maintains the pre-determined force threshold. 
     In various instances, the control unit  13820  of the robotic surgical system is configured to alternate between the position control mode and the load control mode in response to detected conditions by the robotic arms  13830 ,  13840 , and  13850 . For example, when the first robotic arm  13830  and the second robotic arm  13840  of the robotic surgical system  13800  are freely moving throughout a surgical site, the control unit  13820  may impose a maximum force that each arm  13830 ,  13840  can exert. In various instances, the first and second arms  13830 ,  13840  each include a sensor configured to detect resistance. In other instances, the sensors can be positioned on a surgical tool, such as an intelligent surgical stapler or jawed tool. A resistance can be encountered upon contact with tissue and/or other surgical instruments. When such resistance is detected, the control unit  13820  may activate the load control mode and lower the exerted forces by one and/or more than one of the robotic arms  13830 ,  13840  to, for example, reduce damage to the tissue. In various instances, the control unit  13820  may activate the position control mode and move the one and/or more than one of the robotic arms  13830 ,  13840  to a position where such resistance is no longer detected. 
     In one aspect, the processor  13822  of the control unit  13820  is configured to switch from the load control mode to the position control mode upon movement of a surgical tool mounted to one of the robotic arms  13830 ,  13840  outside a defined surgical space. For example, if one of the robotic arms  13830 ,  13840  moves out of a defined boundary around the surgical site, or into abutting contact with an organ or other tissue, or too close to another surgical device, the processor  13822  can switch to a position control mode and prevent further movement of the robotic arm  13830 ,  13840  and/or move the robotic arm  13830 ,  13840  back within the defined surgical space. 
     Turning now to the flow chart shown in  FIG.  258   , an algorithm  13500  is initiated at step  13501  when the clinician and/or the robotic surgical system activates one or more of the robotic arms at step  13505 . The algorithm  13500  can be employed by the robotic surgical system  13800  in  FIG.  255   , for example. Each robotic arm is in signal communication with the processor  13822  of the robotic surgical system. Following activation, each robotic arm is configured to send information to the processor. In various instances, the information may include, for example, identification of the tool attachment and/or the initial position of the activated robotic arm. In various instances, such information is communicated automatically upon attachment of the tool to the robotic arm, upon activation of the robotic arm by the robotic surgical system, and/or after interrogation of the robotic arm by the processor, although the information may be sent at any suitable time. Furthermore, the information may be sent automatically and/or in response to an interrogation signal. 
     Based on the information gathered from each of the activated robotic arms at step  13510 , the processor is configured to set a position limit for each specific robotic arm within a work envelope of the robotic surgical system at step  13515 . The position limit can set three-dimensional boundaries for where each robotic arm can travel. The setting of position limits allows for efficient and cooperative usage of each activated robotic arm while, for example, preventing trauma to surrounding tissue and/or collisions between activated robotic arms. In various instances, the processor includes a memory including a set of stored data to assist in defining each position limit. The stored data can be specific to the particular surgical procedure, the robotic tool attachment, and/or relevant patient demographics, for example. In various instances, the clinician can assist in the definition of the position limit for each activated robotic arm. The processor is configured to determine if the robotic arms are still activated at step  13520 . If the processor determines that the robotic arms are no longer activated, the processor is configured to end position monitoring at step  13522 . Once the processor determines that the robotic arms are still activated, the processor is configured to monitor the position of each activated robotic arm at step  13525 . 
     The processor is then configured to evaluate whether the detected position is within the predefined position limit(s) at step  13530 . In instances where information is unable to be gathered from the robotic arm and clinician input is absent, a default position limit is assigned at step  13533 . Such a default position limit assigns a conservative three-dimensional boundary to minimize, for example, tissue trauma and/or collisions between robotic arms. If the detected limit is within the position limit, the processor is configured to allow the robotic arm(s) to remain in position and/or freely move within the surgical site at step  13535 , and the monitoring process continues as long as the robotic arm is still activated. If the detected limit is outside of the position limit, the processor is configured to move the robotic arm back into the position limit at step  13532 , and the monitoring process continues as long as the robotic arm is still activated. 
     The processor is configured to continuously monitor the position of each robotic arm at step  13525 . In various instances, the processor is configured to repeatedly send interrogation signals in pre-determined time intervals. As discussed above, if the detected position exceeds the position limit set for the specific robotic arm, in certain instances, the processor is configured to automatically move the robotic arm back within the three-dimensional boundary at step  13532 . In certain instances, the processor is configured to re-adjust the position limits of the other robotic arms in response to one robotic arm exceeding its original position limit. In certain instances, prior to moving the robotic arm back within its position limit and/or adjusting the position limits of the other robotic arms, the processor is configured to alert the clinician. If the detected position is within the position limit set for the robotic arm, the processor permits the robotic arm to remain in the same position and/or freely travel until the detected position exceeds the position limit at step  13535 . If the processor is unable to detect the position of the robotic arm, the processor is configured to alert the clinician and/or assign the robotic arm with the default position limit at step  13533 . The processor is configured to monitor the position of each robotic arm until the surgery is completed and/or the robotic arm is deactivated. 
     Similar to the algorithm of  FIG.  258   , the flow chart of  FIG.  259    depicts an algorithm  13600  that is initiated at step  13601  when a clinician and/or a robotic surgical system activates one or more of the robotic arms at step  13605 . The algorithm  13600  can be employed by the robotic surgical system  13800  in  FIG.  255   , for example. Each robotic arm is in signal communication with the processor. Following activation, each robotic arm is configured to send information to the processor at step  13610 . In various instances, the information may include, for example, identification of the tool attachment, exerted forces detected by one or more force sensors on the robotic arm, and/or the initial position of the activated robotic arm. In various instances, such information is communicated automatically upon attachment of the tool to the robotic arm, upon activation of the robotic arm by the robotic surgical system, and/or after interrogation of the robotic arm by the processor, although the information may be sent at any suitable time. Furthermore, the information may be sent automatically and/or in response to an interrogation signal. 
     Based on the information gathered from each of the activated robotic arms, the processor is configured to set a force limit for each specific robotic arm at step  13615 . The force limit sets maximum and minimum force thresholds for forces exerted by each robotic arm. Additionally or alternatively, a force limit can be the maximum force differential between two or more arms. The setting of force limits allows for efficient and cooperative usage of all of the activated robotic arms while, for example, preventing trauma to surrounding tissue and/or damage to the robotic arms. In various instances, the processor includes a memory including a set of stored data to assist in defining each force limit. The stored data can be specific to the particular surgical procedure, the robotic tool attachment, and/or relevant patient demographics, for example. In various instances, the clinician can assist in the definition of the force limit for each activated robotic arm. In instances where information is unable to be gathered from the robotic arm and clinician input is absent, a default force limit is assigned. Such a default force limit assigns conservative maximum and minimum force thresholds to minimize, for example, tissue trauma and/or damage to the robotic arms. 
     The processor is configured to determine if the robotic arm is active at step at step  13620 . If the processor determines that the robotic arm has been deactivated, the processor is configured to end force monitoring at step  13622 . Once it has been determined that the robotic arm is still activated at step  13620 , the processor is configured to continuously monitor the force exerted by each robotic arm at step  13625 . In various instances, the processor is configured to repeatedly send interrogation signals in pre-determined time intervals. If the detected force exceeds the maximum force threshold set for the specific robotic arm, in certain instances, the processor is configured to automatically decrease the force exerted by the robotic arm and/or decrease an opposing force exerted by another robotic arm at step  13632 . In certain instances, the processor is configured to re-adjust the force limits assigned to the other robotic arms in response to one robotic arm exceeding its original force limits. In certain instances, prior to adjusting the force exerted by the robotic arm, adjusting the opposing force exerted by another robotic arm, and/or adjusting the force limits of the other robotic arms, the processor is configured to alert the clinician. If the detected force is within the force limit set for the robotic arm, the robotic arm is permitted to maintain the exertion of the force and/or the clinician can increase or decrease the exerted force until the force is out of the set force limit at step  13635 . If the processor is unable to detect the exerted force of the robotic arm, the processor is configured to alert the clinician and/or assign the robotic arm with a default force limit at step  13633 . The processor is configured to monitor the exerted force of each robotic arm until the surgery is completed and/or the robotic arm is deactivated at step  13620 . 
     Similar to the algorithms of  FIGS.  258  and  259   , the flow chart of  FIG.  260    depicts an algorithm  13700  that is initiated  13701  when a clinician and/or a robotic surgical system activates one or more of the robotic arms  13705 . The algorithm  13700  can be employed by the robotic surgical system  13800  in  FIG.  255   , for example. Each robotic arm is in signal communication with the processor. Following activation, each robotic arm is configured to send information to the processor at step  13710 . In various instances, the information may include, for example, identification of the tool attachment, forces detected by one or more force sensors on the robotic arm, and/or the initial position of the activated robotic arm. In various instances, such information is communicated automatically upon attachment of the tool to the robotic arm, upon activation of the robotic arm by the robotic surgical system, and/or after interrogation of the robotic arm by the processor, although the information may be sent at any suitable time. In various instances, the information is sent automatically and/or in response to an interrogation signal. 
     Based on the information gathered from all of the activated robotic arms, the processor is configured to set both a position limit within a work envelope of the robotic surgical system and a force limit for each specific robotic arm at step  13715 . The position limit sets three-dimensional boundaries for where each robotic arm can travel. The setting of position limits allows for efficient and cooperative usage of all of the activated robotic arms while, for example, preventing trauma to surrounding tissue and/or collisions between activated robotic arms. The force limit sets maximum and/or minimum force thresholds for forces exerted by each robotic arm. Additionally or alternatively, a force limit can be the maximum force differential between two or more arms. The setting of force limits allows for efficient and cooperative usage of the activated robotic arms while, for example, preventing trauma to surrounding tissue and/or damage to the robotic arms. 
     In various instances, the processor includes a memory including a set of stored data to assist in defining each position limit and force limit. The stored data can be specific to the particular surgical procedure, the robotic tool attachment, and/or relevant patient demographics, for example. In various instances, the clinician can assist in the definition of the position limit and force limit for each activated robotic arm. In instances where information is unable to be gathered from the robotic arm and clinician input is absent, a default position limit and/or default force limit is assigned to the robotic arm. Such a default position limit assigns a conservative three-dimensional boundary to minimize, for example, tissue trauma and/or collisions between robotic arms, while the default force limit assigns conservative maximum and/or minimum force thresholds to minimize, for example, tissue trauma and/or damage to the robotic arms. In various instances, the processor is configured to adjust the position limit of one robotic arm based on the force limit of another robotic arm, adjust the force limit of one robotic arm based on the position limit of another robotic arm, and vice versa. 
     The processor is configured to determine whether the robotic arm is active at step  13720 . Once the processor has determined that the robotic arm is activated at step  13720 , the processor is configured to continuously monitor the position of each arm  13737  and the force exerted by each robotic arm at step  13725 . If the robotic arm is no longer activated, the processor is configured to end position monitoring at step  13727  and end force monitoring at step  13722 . In various instances, the processor is configured to repeatedly send interrogation signals in pre-determined time intervals. If the detected position exceeds the position limit set for the specific robotic arm, in certain instances, the processor is configured to automatically move the robotic arm back within the three-dimensional boundary at step  13742 . In certain instances, prior to moving the robotic arm back within its position limit, the processor is configured to alert the clinician. If the detected position is within the position limit set for the robotic arm, the robotic arm is permitted to remain in the same position and/or freely travel until the detected position exceeds the position limit at step  13745 . If the processor is unable to detect the position of the robotic arm, the processor is configured to alert the clinician and/or rewrite the original position limit of the robotic arm with the default position limit at step  13743 . The processor is configured to monitor the position of each robotic arm until the surgery is completed and/or the robotic arm is deactivated. 
     In certain instances, the robotic surgical system includes a manual override configured to control the position of each robotic arm. If the detected force exceeds the maximum force threshold set for the specific robotic arm, in certain instances, the processor is configured to automatically decrease the force exerted by the robotic arm and/or decrease an opposing force exerted by another robotic arm at step  13732 . In certain instances, prior to decreasing the force exerted by the robotic arm and/or decrease the opposing force exerted by another robotic arm, the processor is configured to alert the clinician. If the detected force is within the force limit set for the robotic arm, the robotic arm is permitted to maintain the exertion of the force and/or increase or decrease the exerted force until the force is out of the set force limit at step  13735 . If the processor is unable to detect the exerted force of the robotic arm, the processor is configured to alert the clinician and/or rewrite the original force limit of the robotic arm with the default force limit at step  13733 . The processor is configured to monitor the exerted force of each robotic arm until the surgery is completed and/or the robotic arm is deactivated. 
     In various instances, the position monitoring system and the force monitoring system are interconnected. In certain instances, the force monitoring system can override the resultant decision  13742 ,  14743 ,  14745  of the position detection step  13740 . In certain instances, the position monitoring system can override the resultant decision  13732 ,  13733 ,  13735  of the force detection step  13730 . In other instances, the position monitoring system and the force monitoring system are independent of one another. 
     A clinician can manually override the automatic adjustments implemented in the automatic load and/or position control mode(s) described herein. The manual override can be a one-time adjustment to the surgical robot. In other instances, the manual override can be a setting that turns off the automatic load and/or position mode for a specific surgical action, a specific duration, and/or a global override for the entire procedure. 
     In one aspect, the robotic surgical system includes a processor and a memory communicatively coupled to the processor, as described herein. The processor is communicatively coupled to a first force sensor and a second force sensor, and the memory stores instructions executable by the processor to affect cooperative movement of a first robotic arm and a second robotic arm based on a first input from the first force sensor and from a second input from the second force sensor in a load control mode, as described herein. 
     In various aspects, the present disclosure provides a control circuit to affect cooperative movement of a first robotic arm and a second robotic arm, as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to affect cooperative movement of a first robotic arm and a second robotic arm, as described herein. 
     During a particular surgical procedure, clinicians may rely on one or more powered handheld surgical instruments in addition to a robotic surgical system. In various instances, the instruments are controlled and monitored through different platforms, which may inhibit communication between the instruments and the robotic surgical system. For example, the instruments can be produced by different manufacturers and even by competitors. Such instruments may have different communication packages and/or communication and/or linking protocols. The lack of communication between a powered instrument and the robotic surgical system may hinder cooperative and/or coordinated usage and may complicate the surgical procedure for the clinician. For example, each surgical instrument may include an individual display to communicate various information and operating parameters. In such a scenario, a clinician may have to look at numerous instrument-specific displays to monitor the operating status of and analyze data gathered by each device. 
     In various instances, a robotic surgical system is configured to detect the presence of other powered surgical instruments that are controlled by platforms other than the robotic surgical system. The robotic surgical system can incorporate a hub, i.e., a robotic hub like the robotic hubs  122  ( FIG.  2   ) and  222  ( FIG.  9   ), which can detect other powered surgical instruments, for example. In other instances, a stand-alone surgical hub like the hub  106  ( FIGS.  1 - 3   ) or the hub  206  ( FIG.  9   ) in communication with the robotic surgical system can facilitate detection of the non-robotic surgical instruments and cooperative and/or coordinated usage of the detected surgical instruments with the robotic surgical system. The hub, which can be a robotic hub or a surgical hub, is configured to display the position and orientation of the powered surgical instruments with respect to the work envelope of the robotic surgical system. In certain instances, the work envelope can be an operating room, for example. A surgical hub having spatial awareness capabilities is further described herein and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. In one aspect, the hub can first ascertain the boundaries of the work envelope and then detect the presence of other powered surgical instruments within the work envelope. 
       FIG.  261    depicts a surgical system  13860  including a robotic surgical system  13865 , a surgical instrument  13890 , and a surgical hub  13870 . The surgical instrument  13890  is a powered handheld instrument, and can be a motorized surgical stapler, such as the motorized linear stapler depicted in  FIG.  262   , for example. The surgical system  13865  can be similar in many respects to the robotic surgical system  13000  ( FIG.  239   ), for example. As described herein, the surgical hub  13870  can be incorporated into the robotic surgical system  13865 , for example. The surgical hub  13870  is configured to be in signal communication with the robotic surgical system  13865  and the surgical instrument  13890 . In other instances, the surgical system  13860  can include additional handheld surgical instruments. The robotic surgical system  13865  includes a robot  13861 , which can be similar to the robot  13002 , for example. The robotic surgical system  13865  also includes a control unit  13862  and a surgeon’s command console, or remote control module,  13864 . The surgeon’s command console  13864  is configured to receive a clinician input. The control unit  13862  includes a robot display  13868  and a processor  13866 . The surgical instrument  13890  includes a display  13894  and a processor  13892 . 
     In various instances, the surgical hub  13870  includes a surgical hub display  13880 , which can be similar to the displays of the visualization system  108  ( FIG.  1   ). The surgical hub display  13880  can include, for example, a heads up display. The surgical hub  13880  is configured to detect the presence of the surgical instrument  13890  within a certain distance of the surgical hub  13870 . For example, the surgical hub  13870  is configured to detect the presence of all activated surgical instruments  13890  within one operating room, although any suitable distance can be monitored. In various instances, the surgical hub  13870  is configured to display the presence of all activated surgical instruments  13890  on the surgical hub display  13880 . 
     A particular handheld surgical instrument communicates via a first communication process through a first language. A particular robotic surgical system communicates via a second communication process through a second language. In various instances, the first communication process is the same as the second communication process. When the first communication process is the same as the second communication process, the surgical instrument  13890  is configured to directly communicate information to the surgical hub  13870  and/or to the robotic surgical system  13865 . Such information includes, for example, a model number and/or type of the surgical instrument, a position of the surgical instrument, an operating status of the surgical instrument, and/or any other relevant parameter of the surgical instrument. 
     In various instances, the first communication process is different from the second communication process. For example, a surgical system (e.g. a robot) developed by a first manufacturer may utilize a first proprietary language or communication scheme and a surgical system (e.g. a handheld surgical tool) developed by a second manufacturer may utilize a second, different proprietary language or communication scheme. Despite the language difference/barrier, the surgical hub  13870  and/or surgical robot  13865  is configured to sense surgical instruments  13890  that operate on different communication processes. When the surgical hub  13870  does not recognize the communication process utilized by a particular powered handheld surgical instrument, the surgical hub  13870  is configured to detect various signals, such as Wi-Fi and Bluetooth transmissions emitted by activated powered handheld surgical instruments. Based on the detected signal transmissions, the surgical hub  13870  is configured to alert the clinician of all powered handheld surgical instruments that do not use the same communication process as the robotic surgical system  13865 . All data received from newly-detected powered handheld surgical instruments can be stored within the surgical hub  13870  so that the newly-detected powered handheld surgical instruments are recognized by the surgical hub  13870  in the future. 
     In various instances, the surgical hub  13870  is configured to detect the presence of powered handheld surgical instruments by sensing a magnetic presence of a battery, power usage, and/or electro-magnetic field emitted from activated powered handheld surgical instruments, regardless of whether the activated powered handheld surgical instruments made any attempt to communicate with another surgical instrument, such as the robotic surgical system. 
     The robot  13861  and the surgical instrument  13890  are exemplified in an example surgical procedure in  FIG.  262   . In this exemplification, the surgical instrument  13890  is an articulating linear stapler. As depicted in  FIG.  262   , the surgical instrument  13890  includes a motor  13895  in the handle  13892  thereof. In other instances, the surgical instrument  13890  can include a plurality of motors positioned throughout the surgical instrument. The motor  13895  is configured to emit an electromagnetic field  13896 , which can be detected by the robotic surgical system  13865  or the surgical hub  13870 . For example, the main robot tower or the modular control tower of the surgical hub  13870  can include a receiver for detecting the electromagnetic fields within the operating room. 
     In one aspect, a processor of the robotic surgical system (e.g. a processor of the control unit  13862 ) is configured to calculate a boundary around the surgical instrument  13890 . For example, based on the electromagnetic field  13896  and corresponding type of surgical instrument, the processor can determine the dimensions of the surgical instrument  13890  and possible range of positions thereof. For example, when the surgical instrument  13890  includes one or more articulation joints  13891 , the range of positions can encompass the articulated positions of the surgical instrument  13890 . 
     In one instance, the robotic surgical system can calculate a first wider boundary B 2  around the surgical instrument. When a robotic surgical tool approaches the wider boundary B 2 , the robotic surgical tool  13861  can issue a notification or warning to the surgeon that the robotic surgical tool attached to the robot  13861  is approaching another surgical instrument  13890 . In certain instances, if the surgeon continues to advance the robotic surgical tool toward the surgical instrument  13890  and to a second narrower boundary B 1 , the robotic surgical system  13865  can stop advancing the robotic surgical tool. For example, if the robotic surgical tool crosses the narrower boundary B 1 , advancement of the robotic surgical tool can be stopped. In such instances, if the surgeon still desires to continue advancing the robotic surgical tool within the narrower boundary B 1 , the surgeon can override the hard stop feature of the robotic surgical system  13865 . 
     Referring again to  FIG.  261   , the surgical system  13860  includes multiple display monitors. Each handheld surgical instrument  13890  and the robotic surgical system  13865  is configured to communicate a video and/or image feed representative of the display on each device to the surgical hub  13870  and/or the hub display  13880 . Such video and/or image feeds can include operating parameters of and/or detected conditions by each handheld surgical instrument  13890  and/or the robotic surgical system  13865 . The hub  13870  is configured to control the displayed video and/or image feeds on each of the one or more display monitors throughout the system  13800 . In various instances, each of the display monitors displays an individual video and/or image feed from a particular surgical device or system. In various instances, the individual video and/or image feed can be overlaid with additional information and/or video and/or image feeds from other devices or systems. Such information can include operating parameters and/or detected conditions. The surgical hub  13870  is configured to request which display monitor displays which video and/or image feed. In other words, the communication link between the surgical hub  13870  and the hub display  13880  allows the surgical hub  13870  to dictate which video and/or image feed is assigned to which display monitor, while direct control of the one or more display monitors remains with the video hub. In various instances, the hub display  13880  is configured to separate one or more of the display monitors from the surgical hub  13870  and allow a different surgical hub or surgical device to display relevant information on the separated display monitors. 
     In various instances, the surgical hub is configured to communicate stored data with other data systems within an institution data barrier allowing for cooperative utilization of data. Such established data systems may include, for example, an electronic medical records (EMR) database. The surgical hub is configured to utilize the communication between the surgical hub and the EMR database to link overall surgical trends for the hospital with local data sets recorded during use of the surgical hub. 
     In various instances, the surgical hub is located in a particular operating room at a hospital and/or surgery center. As shown in  FIG.  263   , the hospital and/or surgery center includes operating rooms, OR 1 , OR 2 , OR 3 , and OR 4 . Three of the operating rooms OR 2 , OR 3 , and OR 4  shown in  FIG.  263    includes a surgical hub  13910 ,  13920 ,  13930 , respectively, however any suitable number of surgical hubs can be used. Each surgical hub  13910 ,  13920 ,  13930  is configured to be in signal communication with one another, represented by signal arrows A. Each surgical hub  13910 ,  13920 ,  13930  is also configured to be in signal communication with a primary server  13940 , represented by signal arrows B in  FIG.  263   . 
     In various exemplifications, as data is communicated between the surgical hub(s)  13910 ,  13920 ,  13930  and the various surgical instruments during a surgical procedure, the surgical hub(s)  13910 ,  13920 ,  13930  are configured to temporarily store the communicated data. At the end of the surgical procedure and/or at the end of a pre-determined time period, each surgical hub  13910 ,  13920 ,  13930  is configured to communicate the stored information to the primary server  13940 . Once the stored information is communicated to the primary server  13940 , the information can be deleted from the memory of the individual surgical hub  13910 ,  13920 ,  13930 . The stored information is communicated to the primary server  13940  to alleviate the competition amongst the surgical hubs  13910 ,  13920 ,  13930  for bandwidth to transmit the stored data to cloud analytics “C”, for example. Instead, the primary server  13940  is configured to compile and store and communicated data. The primary server  13940  is configured to be the single clearinghouse for communication of information back to the individual surgical hubs  13910 ,  13920 ,  13930  and/or for external downloading. In addition, as all of the data is stored in one location in the primary server  13940 , the data is better protected from data destructive events, such as power surges and/or data intrusion, for example. In various instances, the primary server  13940  includes additional server-level equipment that allows for better data integrity. Examples of cloud systems are further described herein and in U.S. Provisional Pat. Application Serial No. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. 
     Referring to  FIGS.  263  and  264   , as data begins to be communicated from each control hub  13910 ,  13920 ,  13930  to the primary server  13940 , a queue  13990  is created to prioritize the order in which data is communicated. In various instances, the queue  13990  prioritizes data as first in, first out, although any suitable prioritization protocol can be used. In various instances, the queue  13990  is configured to re-prioritize the order in which received data is communicated when priority events and/or abnormal data are detected. As illustrated in  FIG.  264   , a first surgical hub communicates a first set of data at a time t=1 at block  13960 . As the first set of data is the only data in the queue for external output at block  13992 , the first set of data is the first to be communicated. Thus, the queue  13990  prioritizes the first set of data for external output at block  13965 . A second surgical hub communicates a second set of data at a time t=2 at block  13970 . At the time t=2, the first set of data has not been externally communicated at block  13994 . However, because no priority events and/or abnormal data are present in the second set of data, the second set of data is the second in line to be externally communicated at block  13975 . A third surgical hub communicates a third set of data flagged as urgent at a time t=3 at block  13980 . At the time t=3, the first set of data and the second set of data have not been externally communicated, however a priority event has been detected in the third set of data at block  13985 . The queue is configured to re-prioritize the sets of data to allow the prioritized third set of data to be in the first position for external output at block  13996  above the first set of data and the second set of data collected at time t=1 and t=2, respectively. 
     In one aspect, the surgical hub includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to detect the presence of a powered surgical instrument and represent the powered surgical instrument on a hub display, as described herein. 
     In various aspects, the present disclosure provides a control circuit to detect the presence of a powered surgical instrument and represent the powered surgical instrument on a hub display, as described herein. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to detect the presence of a powered surgical instrument and represent the powered surgical instrument on a hub display, as described herein. 
     Another robotic surgical system is the VERSIUS® robotic surgical system by Cambridge Medical Robots Ltd. of Cambridge, England. An example of such a system is depicted in  FIG.  265   . Referring to  FIG.  265   , the surgical robot includes an arm  14400  which extends from a base  14401 . The arm  14400  includes a number of rigid limbs  14402  that are coupled together by revolute joints  14403 . The most proximal limb  14402   a  is coupled to the base  14401  by a joint  14403   a . The most proximal limb  14402   a  and the other limbs (e.g. limbs  14402   b  and  14402   c ) are coupled in series to further limbs at the joints  14403 . A wrist  14404  can be made up of four individual revolute joints. The wrist  14404  couples one limb (e.g. limb  14402   b ) to the most distal limb (e.g. the limb  14402   c  in  FIG.  265   ) of the arm  14400 . The most distal limb  14402   c  carries an attachment  14405  for a surgical tool  14406 . Each joint  14403  of the arm  14400  has one or more motors  14407 , which can be operated to cause rotational motion at the respective joint, and one or more position and/or torque sensors  14408 , which provide information regarding the current configuration and/or load at that joint  14403 . The motors  14407  can be arranged proximally of the joints  14403  whose motion they drive, so as to improve weight distribution, for example. For clarity, only some of the motors and sensors are shown in  FIG.  265   . The arm  14400  may be generally as described in Patent Application PCT/GB2014/053523 and International Patent Application Publication No. WO 2015/025140, titled DISTRIBUTOR APPARATUS WITH A PAIR OF INTERMESHING SCREW ROTORS, filed Aug. 18, 2014, which published on Feb. 26, 2015, and which is herein incorporated by reference in its entirety. Torque sensing is further described in U.S. Pat. Application Publication No. 2016/0331482, titled TORQUE SENSING IN A SURGICAL ROBOTIC WRIST, filed May 13, 2016, which published on Nov. 17, 2016, which is herein incorporated by reference in its entirety. 
     The arm  14400  terminates in the attachment  14405  for interfacing with the surgical tool  14406 . The attachment  14405  includes a drive assembly for driving articulation of the surgical tool  14406 . Movable interface elements of a drive assembly interface mechanically to engage corresponding movable interface elements of the tool interface in order to transfer drive motions from the robot arm  14400  to the surgical tool  14406 . One surgical tool may be exchanged for another surgical tool one or more times during a typical operation. The surgical tool  14406  can be attachable and detachable from the robot arm  14400  during the operation. Features of the drive assembly interface and the tool interface can aid in their alignment when brought into engagement with each other, so as to reduce the accuracy with which they need to be aligned by the user. A bar for guiding engagement of a robotic arm and surgical tool is further described in U.S. Pat. Application Publication No. 2017/0165012, titled GUIDING ENGAGEMENT OF A ROBOT ARM AND SURGICAL INSTRUMENT, filed Dec. 9, 2016, which published on Jun. 15, 2017, which is herein incorporated by reference in its entirety. 
     The surgical tool  14406  further includes an end effector for performing an operation. The end effector may take any suitable form. For example, the end effector may include smooth jaws, serrated jaws, a gripper, a pair of shears, a needle for suturing, a camera, a laser, a knife, a stapler, one or more electrodes, an ultrasonic blade, a cauterizer, and/or a suctioner. Alternative end effectors are further described herein. The surgical tool  14406  can include an articulation junction between the shaft and the end effector, which can permit the end effector to move relative to the shaft of the tool. The joints in the articulation junction can be actuated by driving elements, such as pulley cables. Pulley arrangements for articulating the surgical tool  14406  are described in U.S. Pat. Application Publication No. 2017/0172553, titled PULLEY ARRANGEMENT FOR ARTICULATING A SURGICAL INSTRUMENT, filed Dec. 9, 2016, which published on Jun. 22, 2017, which is herein incorporated by reference in its entirety. The driving elements for articulating the surgical tool  14406  are secured to the interface elements of the tool interface. Thus, the robot arm  14400  can transfer drive motions to the end effector as follows: movement of a drive assembly interface element moves a tool interface element, which moves a driving element in the tool  14406 , which moves a joint of the articulation junction, which moves the end effector. Control of a robotic arm and tool, such as the arm  14400  and the tool  14406 , are further described in U.S. Pat. Application Publication No. 2016/0331482, titled TORQUE SENSING IN A SURGICAL ROBOTIC WRIST, filed May 13, 2016 and which was published on Nov. 17, 2016, and in International Patent Application Publication No. WO 2016/116753, titled ROBOT TOOL RETRACTION, filed Jan. 21, 2016 and which was published on Jul. 28, 2016, each of which is herein incorporated by reference in its entirety. 
     Controllers for the motors  14407  and the sensors  14408  (e.g. torque sensors and encoders) are distributed within the robot arm  14400 . The controllers are connected via a communication bus to a control unit  14409 . Examples of communication paths in a robotic arm, such as the arm  14400 , are further described in U.S. Pat. Application Publication No. 2017/0021507, titled DRIVE MECHANISMS FOR ROBOT ARMS and in U.S. Pat. Application Publication No. 2017/0021508, titled GEAR PACKAGING FOR ROBOTIC ARMS, each of which was filed Jul. 22, 2016 and published on Jan. 26, 2017, and each of which is herein incorporated by reference in its entirety. The control unit  14409  includes a processor  14410  and a memory  14411 . The memory  14411  can store software in a non-transient way that is executable by the processor  14410  to control the operation of the motors  14407  to cause the arm  14400  to operate in the manner described herein. In particular, the software can control the processor  14410  to cause the motors  14407  (for example via distributed controllers) to drive in dependence on inputs from the sensors  14408  and from a surgeon command interface  14412 . 
     The control unit  14409  is coupled to the motors  14407  for driving them in accordance with outputs generated by execution of the software. The control unit  14409  is coupled to the sensors  14408  for receiving sensed input from the sensors  14408 , and to the command interface  14412  for receiving input from it. The respective couplings may, for example, each be electrical or optical cables, and/or may be provided by a wireless connection. The command interface  14412  includes one or more input devices whereby a user can request motion of the end effector in a desired way. The input devices could, for example, be manually operable mechanical input devices such as control handles or joysticks, or contactless input devices such as optical gesture sensors. The software stored in the memory  14411  is configured to respond to those inputs and cause the joints of the arm  14400  and the tool  14406  to move accordingly, in compliance with a pre-determined control strategy. The control strategy may include safety features which moderate the motion of the arm  144400  and the tool  14406  in response to command inputs. In summary, a surgeon at the command interface  14412  can control the surgical tool  14406  to move in such a way as to perform a desired surgical procedure. The control unit  14409  and/or the command interface  14412  may be remote from the arm  14400 . 
     Additional features and operations of a surgical robot system, such as the robotic surgical system depicted in  FIG.  265   , are further described in the following references, each of which is herein incorporated by reference in its entirety:
     International Patent Application Publication No. WO 2016/116753, titled ROBOT TOOL RETRACTION, filed Jan. 21, 2016, which published on Jul. 28, 2016;   U.S. Pat. Application Publication No. 2016/0331482, titled TORQUE SENSING IN A SURGICAL ROBOTIC WRIST, filed May 13, 2016, which published on Nov. 17, 2016;   U.S. Pat. Application Publication No. 2017/0021507, titled DRIVE MECHANISMS FOR ROBOT ARMS, filed Jul. 22, 2016, which published on Jan. 27, 2017;   U.S. Pat. Application Publication No. 2017/0021508, titled GEAR PACKAGING FOR ROBOTIC ARMS, filed Jul. 22, 2016, which published on Jan. 27, 2017;   U.S. Pat. Application Publication No. 2017/0165012, titled GUIDING ENGAGEMENT OF A ROBOT ARM AND SURGICAL INSTRUMENT, filed Dec. 9, 2016, which published on Jun. 15, 2017; and   U.S. Pat. Application Publication No. 2017/0172553, titled PULLEY ARRANGEMENT FOR ARTICULATING A SURGICAL INSTRUMENT, filed Dec. 9, 2016, which published on Jun. 22, 2017.   

     In one instance, the robotic surgical systems and features disclosed herein can be employed with the VERSIUS® robotic surgical system and/or the robotic surgical system of  FIG.  265   . The reader will further appreciate that various systems and/or features disclosed herein can also be employed with alternative surgical systems including the computer-implemented interactive surgical system  100 , the computer-implemented interactive surgical system  200 , the robotic surgical system  110 , the robotic hub  122 , the robotic hub  222 , and/or the robotic surgical system  15000 , for example. 
     In various instances, a robotic surgical system can include a robotic control tower, which can house the control unit of the system. For example, the control unit  14409  of the robotic surgical system depicted in  FIG.  265    can be housed within a robotic control tower. The robotic control tower can include a robot hub such as the robotic hub  122  ( FIG.  2   ) or the robotic hub  222  ( FIG.  9   ), for example. Such a robotic hub can include a modular interface for coupling with one or more generators, such as an ultrasonic generator and/or a radio frequency generator, and/or one or more modules, such as an imaging module, a suction module, an irrigation module, a smoke evacuation module, and/or a communication module, for example. 
     The reader will readily appreciate that the computer-implemented interactive surgical system  100  ( FIG.  1   ) and the computer-implemented interactive surgical system  200  ( FIG.  9   ) disclosed herein can incorporate the robotic arm  14400 . Additionally or alternatively, the robotic surgical system depicted in  FIG.  265    can include various features and/or components of the computer-implemented interactive surgical systems  100  and  200 . 
     A robotic hub can include a situational awareness module, which can be configured to synthesize data from multiple sources to determine an appropriate response to a surgical event. For example, a situational awareness module can determine the type of surgical procedure, step in the surgical procedure, type of tissue, and/or tissue characteristics, as further described herein. Moreover, such a module can recommend a particular course of action or possible choices to the robotic system based on the synthesized data. In various instances, a sensor system encompassing a plurality of sensors distributed throughout the robotic system can provide data, images, and/or other information to the situational awareness module. Such a situational awareness module can be incorporated into a control unit, such as the control unit  14409 , for example. In various instances, the situational awareness module can obtain data and/or information from a non-robotic surgical hub and/or a cloud, such as the surgical hub  106 , the surgical hub  206 , the cloud  104 , and/or the cloud  204 , for example. Situational awareness of a surgical system is further disclosed herein and in U.S. Provisional Pat. Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, and in U.S. Provisional Pat. Application Serial No. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure of each of which is herein incorporated by reference in its entirety. 
     Referring again to  FIG.  265   , the robotic arm  14400  does not include a linear slide mechanism for moving the attached surgical tool  14406  along a longitudinal axis of the tool  14406 . Rather, the limbs  14402  of the arm  14400  are configured to rotate about the various joints  14403  of the arm  14400  to move the surgical tool  14406 . In other words, even movement of the surgical tool  14406  along the longitudinal axis A T  thereof requires the articulation of various limbs  14402 . For example, to move the surgical tool  14406  along the longitudinal axis A T , the robotic arm  14400  would move at multiple revolute joints  14403  thereof. In effect, linear displacement of the tool  14406  for extending the end effector through a trocar, retracting the end effector from the trocar, and/or for localized displacements of the surgical tool  14406  along the longitudinal axis A T , such as during a suturing process, for example, would require the actuation of multiple revolute joints  14403  and the corresponding movement of multiple rigid limb portions  14402  of the arm  14400 . 
     In instances in which a robotic surgical system lacks a linear slide mechanism, as described herein, intelligent sensing systems, additional communication paths, and/or interactive displays can enable more precise control of the robotic arm including the implementation of control motions that involve a linear displacement of the surgical tool along an axis thereof. For example, to ensure the accurate positioning of the tool  14406  and to avoid inadvertent collisions within an operating room, it may be desirable to include additional systems in the robotic system for determining the position of a surgical tool  14406  and/or portions of the robotic arm  14400 , for repositioning of the robotic arm  14400  from within the sterile field, for communicating the position of the surgical tool  14406  relative to the surgical site, for visualizing the surgical tool  14406  at the surgical site, and/or for manipulating the surgical tool  14406  around the surgical site, for example. 
     In one aspect, a robotic surgical system can include a primary control mechanism for positioning the tool and a secondary means for directly and/or independently measuring the position of the tool. In one aspect, a redundant or secondary sensing system can be configured to determine and/or verify a position of a robotic arm and/or a surgical tool attached to the robotic arm. The secondary sensing system can be independent of a primary sensing system. 
     In one instance, the primary control mechanism can rely on closed-loop feedback to calculate the position of the tool. For example, a control unit of a robotic surgical system can issue control motions for the robotic arm, including the various motors and/or drivers thereof to move portions of the robotic arm in a three-dimensional space, as further described herein. Such a control unit can determine the position and/or orientation of the portions of the robotic arm based on torque sensors on the motors and/or displacement sensors on the drivers, for example. In such instances, the position of the surgical tool, the end effector, and/or components thereof can be determined by proximally-located sensors. The proximally-located sensors can be located in a proximal housing or mounting portion of the tool and/or the robotic arm. In one instance, such proximally-located sensors can be positioned outside the sterile field, for example. The position of a surgical tool mounted to a robotic arm can be determined by measuring the angle(s) of each joint of the arm, for example. The control unit and sensors in communication therewith, which determine the position of the arm based on the control motions delivered thereto, can be considered a primary or first sensing system of the robotic surgical system. 
     In addition to a primary sensing system, as described herein, a redundant or secondary sensing system can be employed by the robotic surgical system. The secondary sensing system can include one or more distally-located sensors. The distally-located sensors can be positioned within the sterile field and/or on the end effector, for example. The distally-located sensors are distal to the proximally-located sensors of the primary sensing system, for example. In one instance, the distally-located sensors can be “local” sensors because they are local to the sterile field and/or the surgical site, and the proximally-located sensors can be “remote” sensors because they are remote from the sterile field and/or the surgical site. 
     Referring now to  FIG.  273   , portions of a robotic surgical system  14300  are schematically depicted. The robotic surgical system  14300  is similar in many respects to the robotic surgical system of  FIG.  265   . For example, the robotic surgical system  14300  includes a plurality of movable components  14302 . In one aspect, the movable components  14302  are rigid limbs that are mechanically coupled in series at revolute joints. Such moveable components  14302  can form a robotic arm, similar to the robotic arm  14440  ( FIG.  265   ), for example. The distal-most component  14302  includes an attachment for releasably attaching interchangeable surgical tools, such as the surgical tool  14306 , for example. Each component  14302  of the robotic arm has one or more motors  14307  and motor drivers  14314 , which can be operated to affect rotational motion at the respective joint. 
     Each component  14302  includes one or more sensors  14308 , which can be position sensors and/or torque sensors, for example. The sensors  14308  can provide information regarding the current configuration and/or load at the respective joint between the components  14402 . The motors  14307  can be controlled by a control unit  14309 , which is configured to receive inputs from the sensors  14308  and/or from a surgical command interface, such as surgical command interface  14412  ( FIG.  265   ), for example. 
     A primary sensing system  14310  is incorporated into the control unit  14309 . In one aspect, the primary sensing system  14310  can be configured to detect the position of one or more components  14302 . For example, the primary sensing system  14310  can include the sensors  14308  for the motors  14307  and/or the drivers  14314 . Such sensors  14308  are remote from the patient P and located outside of the sterile field. Though located outside of the sterile field, the primary sensing system  14310  can be configured to detect the position(s) of the component(s)  14302  and/or the tool  14306  within the sterile field, such as at the position of the distal end of the robotic arm and/or the attachment portion thereof. Based on the position of the robotic arm and components  14302  thereof, the control unit  14309  can extrapolate the position of the surgical tool  14306 , for example. 
     The robotic surgical system  14300  of  FIG.  273    also includes a secondary sensing system  14312  for directly tracking the position and/or orientation or various parts of the robotic surgical system  14300  and/or parts of an associated, non-robotic system such as handheld surgical instruments  14350 . Referring still to  FIG.  273   , the secondary sensing system  14312  includes a magnetic field emitter  14320  that is configured to emit a magnetic field in the vicinity of one or more magnetic sensors to detect the positions thereof. Components  14302  of the robotic arm include magnetic sensors  14322 , which can be utilized to determine and/or verify the position of the respective components  14302 . The magnetic sensors  14322  are remote to the motors  14307  and the drivers  14308 , for example. In any event, the torque through the motor and/or the displacement of a driver may not affect the output from the magnetic sensors. Consequently, the sensing systems are independent. 
     In certain instances, the magnetic sensors  14322  can be positioned within the sterile field. For example, the surgical tool  14306  can include the magnetic sensor  14324 , which can be utilized to determine and/or verify the position of the surgical tool  14306  attached to the robotic arm and/or to determine and/or verify the position of a component of the surgical tool  14306 , such as a firing element, for example. Additionally or alternatively, one or more patient sensors  14326  can be positioned within the patient P to measure the patient’s location and/or anatomic orientation. Additionally or alternatively, one or more trocar sensors  14328  can be positioned on a trocar  14330  to measure the trocar’s location and/or orientation, for example. 
     Referring again to the robotic arm  14400  depicted in  FIG.  265   , the surgical tool  14406  is attached to the attachment portion  14405  at the distal end of the robotic arm  14400 . When the surgical tool  14406  is positioned within a trocar, the robotic surgical system can establish a virtual pivot which can be fixed by the robotic surgical system, such that the arm  14400  and/or the surgical tool  14406  can be manipulated thereabout to avoid and/or minimize the application of lateral forces to the trocar. In certain instances, applying force(s) to the trocar may damage the surrounding tissue, for example. Thus, to avoid inadvertent damage to tissue, the robotic arm  14400  and/or the surgical tool  14406  can be configured to move about the virtual pivot of the trocar without upsetting the position thereof and, thus, without upsetting the corresponding position of the trocar. Even when applying a linear displacement of the surgical tool  14406  to enter or exit the trocar, the virtual pivot can remain undisturbed. 
     In one aspect, the trocar sensor(s)  14328  in  FIG.  273 A  can be positioned at a virtual pivot  14332  on the trocar  14330 . In other instances, the trocar sensors  14328  can be adjacent to the virtual pivot  14332 . Placement of the trocar sensors  14328  at and/or adjacent to the virtual pivot  14332  thereof can track the position of the trocar  14330  and virtual pivot  14332  and help to ensure that the trocar  14330  does not move during displacement of the surgical tool  14306 , for example. In such instances, without physically engaging or holding the trocar  14330 , the robotic surgical system  14300  can confirm and/or maintain the location of the trocar  14330 . For example, the secondary sensing system  14312  can confirm the location of the virtual pivot  14332  of the trocar  14330  and the surgical tool  14306  relative thereto. 
     Additionally or alternatively, one or more sensors  14352  can be positioned on one or more handheld surgical instruments  14350 , which can be employed during a surgical procedure in combination with the surgical tools  14306  utilized by the robotic surgical system  14300 . The secondary sensing system  14312  is configured to detect the position and/or orientation of one or more handheld surgical instruments  14350  within the surgical field, for example, within the operating room and/or sterile field. Such handheld surgical instruments  14350  can include autonomous control units, which may not be robotically controlled, for example. As depicted in  FIG.  273   , the handheld surgical instruments  14350  can include sensors  14352 , which can be detected by the magnetic field emitter  14320 , for example, such that the position and/or location of the handheld surgical instruments  14350  can be ascertained by the robotic surgical system  14300 . In other instances, components of the handheld surgical instruments  14350  can provide a detectable output. For example, a motor and/or battery pack can be detectable by a sensor in the operating room. 
     In one aspect, the magnetic field emitter  14320  can be incorporated into a main robot tower. The sensors  14322 ,  14324 ,  14326 ,  14328 , and/or  14352  within the sterile field can reflect the magnetic field back to the main robot tower to identity the positions thereof. In various instances, data from the magnetic field emitter  14320  can be communicated to a display  14340 , such that the position of the various components of the surgical robot, surgical tool  14302 , trocar  14330 , patient P, and/or handheld surgical instruments  14350  can be overlaid onto a real-time view of the surgical site, such as views obtained by an endoscope at the surgical site. For example, the display  14340  can be in signal communication with the control unit of the robotic surgical system and/or with a robotic hub, such as the hub  106 , robotic hub  122 , the hub  206 , and/or the robot hub  222  ( FIG.  9   ), for example. 
     In other instances, the magnetic field emitter  14320  can be external to the robot control tower. For example, the magnetic field emitter  14320  can be incorporated into a hub. 
     Similar to the secondary sensing system  14312 , which includes the magnetic field emitter  14320 , in certain instances, time-of-flight sensors can be positioned on one or more of the robot component(s)  14302 , the surgical tool(s)  14306 , the patient P, the trocar(s)  14328 , and/or the handheld surgical instrument(s)  14350  to provide an array of distances between the emitter and the reflector points. Such time-of-flight sensors can provide primary or secondary (e.g. redundant) sensing of the position of the robot component(s)  14302 , the surgical tool(s)  14306 , the patient P, the trocar(s)  14328 , and/or the handheld surgical instrument(s)  14350 , for example. In one instance, the time-of-flight sensor(s) can employ an infrared light pulse to provide distance mapping and/or facilitate 3D imaging within the sterile field. 
     In one instance, the secondary sensing system  14312  can include a redundant sensing system that is configured to confirm the position of the robotic components and/or tools. Additionally or alternatively, the secondary sensing system  14312  can be used to calibrate the primary sensing system  14310 . Additionally or alternatively, the secondary sensing system  14312  can be configured to prevent inadvertent entanglement and/or collisions between robotic arms and/or components of a robotic surgical system. 
     Referring again to  FIG.  273   , in one instance, the components  14302  of the robotic surgical system  14300  can correspond to discrete robotic arms, such as the robotic arms  15024  in the robotic surgical system  15000  ( FIG.  22   ) and/or the robotic arms depicted in  FIG.  2   , for example. The secondary sensing system  14312  can be configured to detect the position of the robotic arms and/or portions thereof as the multiple arms are manipulated around the surgical theater. In certain instances, as one or more arms are commanded to move towards a potential collision, the secondary sensing system  14312  can alert the surgeon via an alarm and/or an indication at the surgeon’s console in order to prevent an inadvertent collision of the arms. 
     Referring now to  FIG.  274   , a flow chart for a robotic surgical system is depicted. The flow chart can be utilized by the robotic surgical system  14300  ( FIG.  273   ), for example. In various instances, two independent sensing systems can be configured to detect the location and/or orientation of a surgical component, such as a portion of a robotic arm and/or a surgical tool. The first sensing system, or primary sensing system, can rely on the torque and/or load sensors on the motors and/or motor drivers of the robotic arm. The second sensing system, or secondary sensing system, can rely on magnetic and/or time-of-flight sensors on the robotic arm and/or surgical tool. The first and second sensing systems are configured to operate independently and in parallel. For example, at step  14502 , the first sensing system determines the location and orientation of a robotic component and, at step  14504 , communicates the detected location and orientation to a control unit. Concurrently, at step  14506 , the second sensing system determines the location and orientation of the robotic component and, at step  14508 , communicates the detected location and orientation to the control unit. 
     The independently-ascertained locations and orientations of the robotic component are communicated to a central control unit at step  14510 , such as to the robotic control unit  14309  and/or a surgical hub. Upon comparing the locations and/or orientations, the control motions for the robotic component can be optimized at step  14512 . For example, discrepancies between the independently-determined positions can be used to improve the accuracy and precision of control motions. In certain instances, the control unit can calibrate the control motions based on the feedback from the secondary sensing system. The data from the primary and secondary sensing systems can be aggregated by a hub, such as the hub  106  or the hub  206 , for example, and/or data stored in a cloud, such as the cloud  104  or the cloud  204 , for example, to further optimize the control motions of the robotic surgical system. 
     In certain instances, the robotic system  14300  can be in signal communication with a hub, such as the hub  106  of the hub  206 , for example. The hubs  106 ,  206  can include a situational awareness module, as further described herein. In one aspect, at least one of the first sensor system  14310  and the second sensor system  14312  are data sources for the situational awareness module. For example, the sensor systems  14310  and  14312  can provide position data to the situational awareness module. Further, the hub  106 ,  206  can be configured to optimize and/or calibrate the control motions of the robotic arm  14300  and/or the surgical tool  14306  based on the data from the sensor systems in combination with the situational awareness, for example. In one aspect, a sensing system, such as the secondary sensing system  14312  can inform the hub  106 ,  206  and situational awareness module thereof when a handheld surgical instrument  14350  has entered the operating room or surgical theater and/or when an end effector has been fired, for example. Based on such information, the hub  106 ,  206  can determine and/or confirm the particular surgical procedure and/or step thereof. 
     The reader will appreciate that various independent and redundant sensing systems disclosed herein can be utilized by a robotic surgical system to improve the accuracy of the control motions, especially when moving the surgical tool along a longitudinal axis without relying on a linear slide mechanism, for example. 
     In one aspect, the surgical hub includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to detect a position of a robotically-controlled component independent of a primary sensing system, as described above. 
     In various aspects, the present disclosure provides a control circuit configured to detect a position of a robotically-controlled component independent of a primary sensing system, as described above. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to detect a position of a robotically-controlled component independent of a primary sensing system, as described above. 
     In one aspect, a robotic surgical system can be configured to wirelessly communicate with one or more intelligent surgical tools mounted to a robotic arm thereof. The control unit of the robotic system can communicate with the one or more intelligent surgical tools via a wireless connection, for example. Additionally or alternatively, the robotic surgical system can include a robotic hub, which can wirelessly communicate with the intelligent surgical tool(s) mounted to the robotic arm(s). In still other instances, a non-robotic surgical hub can wirelessly communicate with the intelligent surgical tool(s) mounted to a robotic arm. In certain instances, information and/or commands can be provided to the intelligent surgical tool(s) from the control unit via the wireless connection. For example, certain functions of a surgical tool can be controlled via data received through a wireless communication link on the surgical tool. Similarly, in one aspect, closed-loop feedback can be provided to the robotic surgical system via data received via the wireless communication link to the surgical tool. 
     Referring primarily to  FIGS.  270 - 272   , a surgical tool  14206  is mounted to a robotic arm  14000  of a surgical robot. The robotic arm  14000  is similar in many respects to the robotic arm  14400  in  FIG.  265   . For example, the arm  14000  includes a plurality of movable components  14002 . In one aspect, the movable components  14002  are rigid limbs that are mechanically coupled in series at revolute joints  14003 . Such moveable components  14002  form the robotic arm  14400 , similar to the arm  14400  ( FIG.  265   ), for example. A distal-most component  14002   c  of the robotic arm  14400  includes an attachment  14005  for releasably attaching interchangeable surgical tools, such as the surgical tool  14206 . Each component  14002  of the arm  14000  has one or more motors and motor drivers, which can be operated to affect rotational motion at the respective joint  14003 . 
     Each component  14002  includes one or more sensors, which can be position sensors and/or torque sensors, for example, and can provide information regarding the current configuration and/or load at the respective joint between the components  14002 . The motors can be controlled by a control unit, such as the control unit  14409  ( FIG.  265   ), which is configured to receive inputs from the sensors  14008  and/or from a command interface, such as the surgeon’s command console  14412  ( FIG.  265   ), for example. 
     The surgical tool  14206  is a linear stapler including a wireless communication module  14208  ( FIG.  271   ). The linear stapler can be an intelligent linear stapler and can include an intelligent fastener cartridge, an intelligent end effector, and/or an intelligent shaft, for example. Intelligent surgical components can be configured to determine various tissue properties, for example. In one instance, one or more advanced end effector functions may be implemented based on the detected tissue properties. A surgical end effector can include one or more sensors for determining tissue thickness, compression, and/or impedance, for example. Moreover, certain sensed parameters can indicate tissue variations, such as the location of a tumor, for example. Intelligent surgical devices for sensing various tissue properties are further disclosed the following references:
     U.S. Pat. No. 9,757,128, filed Sep. 5, 2014, titled MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR’S OUTPUT OR INTERPRETATION, which issued on Sep. 12, 2017;   U.S. Pat. Application No. 14/640,935, titled OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION, filed Mar. 6, 2015, now U.S. Patent Application Publication No. 2016/0256071, which published on Sep. 8, 2016;   U.S. Pat. Application No. 15/382,238, titled MODULAR BATTERY POWERED HANDHELD SURGICAL INSTRUMENT WITH SELECTIVE APPLICATION OF ENERGY BASED ON TISSUE CHARACTERIZATION, filed Dec. 16, 2016, now U.S. Patent Application Publication No. 2017/0202591, which published on Jul. 20, 2017; and   U.S. Pat. Application No. 15/237,753, titled CONTROL OF ADVANCEMENT RATE AND APPLICATION FORCE BASED ON MEASURED FORCES, filed Aug. 16, 2016, now U.S. Pat. Application Publication No. 2018/0049822, which published on Feb. 22, 2018;   
 each of which is herein incorporated by reference in its entirety.
     As depicted in  FIG.  270   , a wireless communication link  14210  is provided between the surgical tool  14206  and a hub  14212 . The hub  14212  is a surgical hub, like the hub  106  or the hub  206 , for example. In other instances, the hub  14212  can be a robotic hub, like the robotic hub  122  or the robotic hub  222 , for example. In  FIG.  270   , the wireless communication module  14208  includes a wireless signal transmitter that is located near the distal end of the end effector of the surgical tool  14206 . In other instances, the wireless transmitter can be positioned on a proximal portion of the end effector or on the shaft of the surgical tool  14206 . 
     The wireless communication link  14212  between the surgical tool  14206  and the surgical hub  14212  provides real-time data transfer through a sterile barrier  14230 . Additionally or alternatively, the wireless communication module  14208  can be configured to communicate with a robot control tower and/or the control unit, which issues the control motions to the robotic arm  14000  and actuations to the surgical tool  14206  based on inputs at the surgeon’s command console. In certain instances, the control unit for the robotic arm  14000  can be incorporated into the surgical hub  14212  and/or a robotic hub, such as the robotic hub  122  ( FIG.  2   ) or the robotic hub  222  ( FIG.  9   ), for example. 
     In certain instances, it can be difficult to confirm the position of the surgical tool  14206  within the surgical theater, around the surgical site, and/or relative to the targeted tissue. For example, lateral displacement of the surgical tool  14206  can be constrained by a physical boundary, such as a longitudinally-extending trocar, for example. In such instances, lateral displacement of the surgical tool  14206  can be determined by a resistance force from and/or on the trocar. Conversely, linear displacement of the surgical tool  14206  can be unconstrained by physical boundaries of the surgical system. In such instances, when the control unit directs linear displacement of the surgical tool  14206  or a portion thereof, and the various movable links  14002  and joints  14003  articulate to affect the linear displacement, it can be difficult to determine and/or confirm the position of the surgical tool  14206  and respective portions thereof. 
     When the surgical tool  14206  is moved along the longitudinal axis of the tool A T  ( FIG.  271   ), which is collinear with the shaft of the surgical tool  14206 , it can be difficult to determine and/or confirm the exact position of the surgical tool  14206 . In certain instances, as provided herein, the robotic surgical system can include a secondary sensing system, which is configured to detect the position of the surgical tool  14206 . For example, the wireless communication module  14208  can be in signal communication with a secondary sensing system, such as the secondary sensing system  14312  ( FIG.  273   ) and/or a sensor thereof. Moreover, the wireless communication module  14208  can communicate the position of the surgical tool  14206 , as detected by the secondary sensing system  14312 , to the surgical hub  14212  via the wireless communication link  14210 . Additionally or alternatively, the wireless communication module  14208  can communicate information from the various sensors and/or systems of the intelligent surgical tool  14206  to the surgical hub  14212 . The surgical hub  14212  can disseminate the information to displays within the operating room or external displays, to a cloud, and/or to one or more hubs and/or control units used in connection with the surgical procedure. 
     Referring primarily to  FIG.  271   , in one instance, the surgical tool  14206  can be employed to remove a cancerous tumor  14242  from patient tissue T. To ensure complete removal of the tumor  14242  while minimizing the removal of healthy tissue, a predefined margin zone  14240  can be defined around the tumor  14242 . The margin zone can be determined by the surgeon based on patient data, aggregated data from a hub and/or a cloud, and/or data sensed by one or more intelligent components of the surgical system, for example. During the operation, the surgical tool  14206  can transect the tissue T along the margin zone  14240  such that the margin zone  14240  is removed along with the tumor  14242 . The primary and secondary sensing systems  14310  and  14312  ( FIG.  273   ) can determine the position of the surgical tool  14206  relative to the margin zone, for example. Moreover, the wireless communication module  14208  can communicate the detected position(s) to the control unit. 
     In certain instances, the robotic system of  FIGS.  271  and  272    can be configured to actuate (e.g. fire) the surgical tool  14206  when the surgical tool  14206  moves within the margin zone  14240 . For example, referring primarily to  FIG.  272   , a graphical display  14250  of distance and force-to-close over time for the linear stapler  14206  during the surgical procedure of  FIG.  270    is depicted. As the surgical tool  14206  approaches the margin zone  14240  at time ti, the force-to-close (FTC) increases indicating that the surgical tool  14206  is being clamped on tissue T around the tumor  14242  between time t 1  and time t 2 . More specifically, the surgical tool  14206  is clamped when moved into position a distance between distances D 1  and D 2 . The distance D 1  can refer to the outer boundary of the margin zone  14240  around the tumor  14242 , for example, and the distance D 2  can refer to the inner boundary of the margin zone  14240 , which can be assumed boundary of the tumor  14242 , for example. 
     In various instances, the control unit and the processor thereof can automatically affect the clamping motion when the surgical tool  14206  is positioned at the appropriate distance based on input from a primary sensing system and/or a secondary sensing system. In other instances, the control unit and the processor thereof can automatically alert the surgeon that the surgical tool  14206  is positioned at the appropriate distance. Similarly, in certain instances, the processor can automatically fire the surgical tool  14206  and/or suggest to the surgeon that the surgical tool  14206  be fired based on the detected position(s) of the surgical tool  14206 . The reader will readily appreciate that other actuation motions are envisioned, such as energizing an energy tool and/or articulating and articulatable end effector, for example. 
     In certain instances, the hub  14212  can include a situational awareness system, as further described herein. In one aspect, the position of the tumor  14242  and/or the margin zone  14240  therearound can be determined by the situational awareness system or module of the hub  14212 . In certain instances, the wireless communication module  14208  can be in signal communication with the situational awareness module of the hub  14212 . For example, referring again to  FIG.  86   , the stapler data and/or the cartridge data provided at steps  5220  and  5222  can be provided via the wireless communication module  14208  of the stapling tool  14206 , for example. 
     In one aspect, sensors positioned on the surgical tool  14206  can be utilized to determine and/or confirm the position of the surgical tool  14206  (i.e. a secondary sensing system). Moreover, the detected position of the linear stapler can be communicated to the surgical hub  14212  across the wireless communication link  14210 , as further described herein. In such instances, the surgical hub  14212  can obtain real-time, or near real-time, information regarding the position of the surgical tool  14206  relative to the tumor  14242  and the margin zone  14240  based on the data communicated via the wireless communication link  14230 . In various instances, the robotic surgical system can also determine the position of the surgical tool  14206  based on the motor control algorithms utilized to position the robotic arm  14000  around the surgical theater (i.e. a primary sensing system). 
     In one aspect, a robotic surgical system can integrate with an imaging system. Real-time feeds from the surgical site, which are obtained by the imaging system, can be communicated to the robotic surgical system. For example, referring again to  FIGS.  2  and  3   , real-time feeds from the imaging module  138  in the hub  106  can be communicated to the robotic surgical system  110 . For example, the real-time feeds can be communicated to the robotic hub  122 . In various instances, the real-time feed can be overlaid onto one or more active robot displays, such as the feeds at the surgeon’s command console  118 . Overlaid images can be provided to one or more displays within the surgical theater, such as the displays  107 ,  109 , and  119 , for example. 
     In certain instances, the overlay of real-time feeds onto a robot display can enable the surgical tools to be precisely controlled within an axes system that is defined by the surgical tool and/or the end effector(s) thereof as visualized by the real-time imaging system. In various instances, cooperating between the robotic surgical system  110  and the imaging system  138  can provide triangulation and instrument mapping of the surgical tools within the visualization field, which can enable precise control of the tool angles and/or advancements thereof. Moreover, shifting control from a standard multi-axes, fixed Cartesian coordinate system to the axis defined by the currently-mounted tool and/or to the end effector thereof can enable the surgeon to issue commands along clear planes and/or axes. For example, a processor of the robotic surgical system can direct a displacement of a surgical tool along the axis of the elongate shaft of the surgical tool or a rotation of the surgical tool at a specific angle from the current position based on a selected point to rotate about. In one exemplification, the overlaid feed of a surgical tool can incorporate a secondary or redundant sensing system, as further described herein, to determine the location and/or orientation of the surgical tool. 
     In certain instances, a robotic arm, such as the robotic arm  14400  ( FIG.  265   ) can be significantly heavy. For example, the weight of a robotic arm can be such that manually lifting or repositioning the robotic arm is difficult for most able-bodied clinicians. Moreover, the motors and drive mechanisms of the robotic arm may only be controlled by a primary control system located at the control unit based on inputs from the surgeon’s command console. Stated differently, a robotic surgical system, such as the system depicted in  FIG.  265   , for example, may not include a secondary control system for the robotic arm  14400  that is local to the robotic arm  14400  and within the sterile field. 
     A robotic arm in a robotic surgical system may be prone to inadvertent collisions with equipment and/or people within the sterile field. For example, during a surgical procedure, surgeon(s), nurse(s), and/or medical assistant(s) positioned within the sterile field may move around the sterile field and/or around the robotic arms. In certain instances, the surgeon(s), nurse(s), and/or medical assistant(s), for example, may reposition equipment within the sterile field, such as tables and/or carts, for example. When a surgeon positioned outside of the sterile field is controlling the robotic arm, another surgeon, nurse, and/or medical assistant positioned within the sterile field may also want to manually move and/or adjust the position of one of more robotic arms in order to avoid a potential collision with the arm(s), entanglement of the arm with other equipment and/or other arms, and/or to replace, reload, and/or reconfigure a surgical tool mounted to the arm. However, to reposition the robotic arm, the surgeon may need to power down the robotic surgical system to enable the clinician within the sterile field to manually reposition the robotic arm. In such instances, the clinician can be required to carry the significant weight of the unpowered, or powered down, robotic arm. 
     In one instance, a robotic surgical system can include an interactive display that is local to the sterile field and/or local to the robotic arm(s). Such a local display can facilitate manipulation and/or positioning of the arm(s) by a clinician within the sterile field. Stated differently, an operator other than the surgeon at the command console can control the position of the robotic arm(s). 
     Referring now to  FIG.  266   , a clinician is applying a force to the robotic arm  14000  to manually adjust the position of the robotic arm  14000 . In certain instances, the robotic surgical system employing the robotic arm  14000  can employ a passive power assist mode, in which the robotic arm  14400  can easily be repositioned by a clinician within the sterile field. For example, though the robotic arm  14000  is powered and is controlled by a remote control unit, the clinician can manually adjust the position of the robotic arm  14000  without requiring the clinician to carry the entire weight of the robotic arm  14000 . The clinician can pull and/or push the robotic arm  14000  to adjust the position thereof. In the passive power assist mode, the power to the robotic arm  14000  can be constrained and/or limited to permit the passive repositioning by the clinician. 
     Referring now to  FIG.  267   , a graphical display  14050  of force over time of the robotic arm  14000  ( FIG.  266   ) in a passive power assist mode is depicted. In the passive power assist mode, a clinician can apply a manual force to the robotic arm  14000  to initiate the repositioning of the robotic arm  14000 . The clinician can be within the sterile field. In certain instances, the passive power assist mode can be activated when the robotic arm 14000 senses a manual manipulation. 
     As depicted in  FIG.  267   , the manual force exerted by a clinician can increase to exceed a predefined threshold, such as the 15-lb limit indicated in  FIG.  267   , for example, to affect repositioning of the robotic arm  14000 . In certain instances, the predefined threshold can correspond to the maximum force an able-bodied assist can easily exert on the robotic arm  14000  without undue stress or strain. In other instances, the predefined threshold can correspond to a minimum threshold force on the robotic arm  14000  in order to avoid providing a powered assist to unintentional or inadvertent contacts with the robotic arm  14000 . 
     When the user exerts a force on the robotic arm  14000  above the predefined threshold, one or more motors (e.g. motors  14407  in  FIG.  265   ) of the robotic surgical system can apply an assisting force to the robotic arm  14000  to help reposition the robotic arm  14000  in the direction indicated by the operator’s force on the robotic arm  14000 . In such instances, the operator can easily manipulate the position of the arm to avoid inadvertent collisions and/or entanglements and, when the operator’s force exceeds a comfortable threshold force, the motors can assist or cooperate in the repositioning of the arm. The passive power assist provided by the motors of the robotic surgical system can compensate for the weight of the robotic arm  14000 . In other instances, the assisting force can be less than the weight of the robotic arm  14000 . In certain instances, the assisting force can be capped at a maximum force, such as the 5-lb limit indicated in  FIG.  267   , for example. Capping the assisting force may ensure that the robotic arm  14000  does not forcefully collide with a person, surgical equipment, and/or another robotic arm in the surgical theater. 
     In one aspect, the passive power assist mode can be deactivated or locked out during portions of a surgical procedure. For example, when a surgical tool is positioned at the surgical site or within a predefined radius of the surgical site and/or the target tissue, the passive power assist mode can be locked out. Additionally or alternatively, during certain steps of a surgical procedure the passive power assist mode can be locked out. Situational awareness can be configured to determine whether the passive power assist mode should be locked out. For example, based on information that a hub knows regarding the step of the surgical procedure (see, e.g.  FIG.  86   ), a passive power assist mode may be ill-advised by the situational awareness module. Similarly, the passive power assist mode can be activated during certain portions of the surgical timeline shown in  FIG.  86   . 
     In one aspect, the control unit for operating a robotic arm includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to operate in a passive power assist mode in which the processor is configured to process a manual force applied to the robotic arm and, if the manual force exceeds a predefined threshold, to direct one or more motors of the robotic arm to provide an assisting force to reposition the robotic arm in the direction indicated by the manual force. 
     In various aspects, the present disclosure provides a control circuit configured to operate a passive power assist mode, as described above. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to operate a passive power assist mode, as described above. 
     Referring now to  FIGS.  268  and  269   , a clinician within the sterile field is utilizing a local control module  14160  within a sterile field to affect repositioning of a robotic arm  14100 . The robotic arm  14100  is similar in many respects to the robotic arm  14400  in  FIG.  265   . For example, the robotic arm  14100  includes a plurality of movable components  14102 . The movable components  14102  are rigid limbs that are mechanically coupled in series at revolute joints  14103 . The moveable components  14102  form the robotic arm  14100 , similar to the robotic arm  14400  ( FIG.  265   ), for example. A distal-most component  14102   c  includes an attachment  14105  for releasably attaching interchangeable surgical tools, such as the surgical tool  14106 , for example. Each component  14102  of the robotic arm  14100  has one or more motors and motor drivers, which can be operated to affect rotational motion at the respective joint  14103 . 
     Each component  14102  includes one or more sensors, which can be position sensors and/or torque sensors, for example, and can provide information regarding the current configuration and/or load at the respective joint between the components  14102 . The motors can be controlled by a control unit, such as the control unit  14409  ( FIG.  265   ), which is configured to receive inputs from the sensors and/or from a surgical command interface, such as the surgical command interface  14412  ( FIG.  265   ), for example. 
     The local control module  14160  includes an interactive display  14164  and a touch screen  14166  that is configured to accept inputs, such as inputs from a finger and/or a stylus  14168 , for example. The local control module  14160  is a handheld, mobile digital electronic device. For example, the local control module  14160  can be an iPad® tablet or other mobile tablet or smart phone, for example. In use, the clinician provides repositioning instructions to the robotic arm  14100  via the display  14164  and/or the touch screen  14166  of the local control module  14160 . The local control module  14160  is a wireless communication module  14162  such that the inputs from the clinician can be communicated to the robotic arm  14140  to affect arm control motions. The local control module  14140  can wirelessly communicate with the robotic arm  14140  and/or a control unit (e.g. the control unit  14409  in  FIG.  265   ) of the robotic system via a Wi-Fi connection, for example. 
     The robotic arm  14100  includes six degrees of freedom indicated by the six arrows in  FIG.  268   . The proximal degrees of freedom can be controlled by the local control module  14160  and the distal degrees of freedom can be controlled by the remote control module. In one instance, the three most-proximal degrees of freedom (articulation about the two most-proximal joints  14103  and rotation of the intermediate limb  14102  about the axis thereof) can be controlled by the local control module and the three most-distal degrees of freedom (articulation about the most-distal joint  14103 , rotation of the most-distal limb  14102   c  about the axis thereof, and displacement of the surgical tool  14106  along the axis thereof) can be controlled by the remote control module. In such instances, the clinician within the sterile field can affect gross robotic arm control motions, such as control motions of the proximal arms and/or joints. For example, the clinician within the sterile field can quickly and easily move a robotic arm to a general position, such as a pre-operative position, tool exchanging position, and/or reloading position via the local control module  14160 . In such instances, the local control module  14160  is a secondary control system for the robotic arm  14100 . The surgeon outside the sterile field can affect more localized or finessed robotic arm control motions via inputs at the surgeon’s command interface  14412  ( FIG.  265   ). In such instances, the surgeon’s command interface  14412  outside the sterile field is the primary control system. 
     The reader will readily appreciate that fewer or greater than six degrees of freedom are contemplated. Alternative degrees of freedom are also contemplated. Moreover, different degrees of freedom can be assigned to the local control module  14160  and/or the remote control module. In certain instances, one or more degrees of freedom can be assigned to both the local control module  14106  and the remote control module. 
     Referring primarily now to  FIG.  269   , a graphical display  14150  of force over time of the robotic arm  14100  is depicted. From time 0 to time t 1 , locally-actuated, in-field forces are applied to the robotic arm  14100  by a clinician within the sterile field to adjust the general position of the robotic arm  14100 . In certain instances, the force attributable to inputs from the local control module  14160  can be capped at a first maximum force (for example the 50-lb limit indicated in  FIG.  269   ). By utilizing the local control module  14160 , the clinician within the sterile field can quickly reposition the robotic arm  14100  to exchange and/or reload the surgical tool  14160 , for example. Time 0 to time t 1  can correspond to a local actuation mode. Active setup or reloading time in a surgical procedure can occur during the local actuation mode. For example, during the local actuation mode, the robotic arm  14100  can be out of contact with patient tissue and/or outside a predefined boundary around the surgical site, for example. 
     Thereafter, the surgeon at the surgeon’s command console can further actuate the robotic arm  14100 . For example, from time t 2  to time t 3 , the remotely-actuated forces are attributable to inputs from the surgeon’s command console. The remotely-actuated forces can be capped at a second maximum force (for example the 5-lb limit indicated in  FIG.  269   ), which is less than the first maximum force. By limiting the second maximum force, a surgeon is less likely to cause a high-force or high-speed collision within the sterile field while the larger first maximum force allows the robotic arm  14100  to be quickly repositioned in certain instances. Time t 2  to time t 3  can correspond to a remote actuation mode during a surgical procedure, which can include when the robotic tool  14106  is actively manipulating tissue (grasping, pulling, holding, transecting, sealing, etc.) and/or when the robotic arm  14100  and/or surgical tool  14106  thereof is within the predefined boundary around the surgical site. 
     In one aspect, the local actuation mode and/or the remote actuation mode can be deactivated or locked out during portions of a surgical procedure. For example, the local actuation mode can be locked out when the surgical tool is engaged with tissue or otherwise positioned at the surgical site. Situational awareness can be configured to determine whether the local actuation mode should be locked out. For example, based on information that a hub knows regarding the step of the surgical procedure (see, e.g.  FIG.  86   ), a local actuation mode may be ill-advised by the situational awareness module. Similarly, the remote actuation mode may be ill-advised during other portions of the surgical procedure. 
     In one aspect, the control unit for operating a robotic arm includes a processor and a memory communicatively coupled to the processor, as described herein. The memory stores instructions executable by the processor to provide control motions to the robotic arm based on input from a local control module during portion(s) of a surgical procedure and to provide control motions to the robotic arm based on input from a remote control module during portion(s) of the surgical procedure. A first maximum force can limit the control motions from the local control module and a second maximum force can limit the control motions from the remote control module. 
     In various aspects, the present disclosure provides a control circuit configured to operate a robotic arm via a local control module and a remote control module, as described above. In various aspects, the present disclosure provides a non-transitory computer readable medium storing computer readable instructions which, when executed, cause a machine to operate a robotic arm via a local control module and a remote control module, as described above. 
     The entire disclosures of:
     U.S. Pat. No. 9,072,535, filed May 27, 2011, titled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, which issued Jul. 7, 2015;   U.S. Pat. No. 9,072,536, filed Jun. 28, 2012, titled DIFFERENTIAL LOCKING ARRANGEMENTS FOR ROTARY POWERED SURGICAL INSTRUMENTS, which issued Jul. 7, 2015;   U.S. Pat. No. 9,204,879, filed Jun. 28, 2012, titled FLEXIBLE DRIVE MEMBER, which issued on Dec. 8, 2015;   U.S. Pat. No. 9,561,038, filed Jun. 28, 2012, titled INTERCHANGEABLE CLIP APPLIER, which issued on Feb. 7, 2017;   U.S. Pat. No. 9,757,128, filed Sep. 5, 2014, titled MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR’S OUTPUT OR INTERPRETATION, which issued on Sep. 12, 2017;   U.S. Pat. Application Serial No. 14/640,935, titled OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION, filed Mar. 6, 2015, now U.S. Pat. Application Publication No. 2016/0256071;   U.S. Pat. Application Serial No. 15/382,238, titled MODULAR BATTERY POWERED HANDHELD SURGICAL INSTRUMENT WITH SELECTIVE APPLICATION OF ENERGY BASED ON TISSUE CHARACTERIZATION, filed Dec. 16, 2016, now U.S. Pat. Application Publication No. 2017/0202591; and   U.S. Pat. Application No. 15/237,753, titled CONTROL OF ADVANCEMENT RATE AND APPLICATION FORCE BASED ON MEASURED FORCES, filed Aug. 16, 2016, now U.S. Pat. Application Publication No. 2018/0049822;   
 are herein incorporated by reference in their respective entireties.
     The embodiments disclosed herein are configured for use with surgical suturing instruments and systems such as those disclosed in U.S. Pat. Application Serial No. 13/832,786, now U.S. Pat. No. 9,398,905, entitled CIRCULAR NEEDLE APPLIER WITH OFFSET NEEDLE AND CARRIER TRACKS; U.S. Pat. Application Serial No. 14/721,244, now U.S. Pat. Application Publication No. 2016/0345958, entitled SURGICAL NEEDLE WITH RECESSED FEATURES; and U.S. Pat. Application Serial No. 14/740,724, now U.S. Pat. Application Publication No. 2016/0367243, entitled SUTURING INSTRUMENT WITH MOTORIZED NEEDLE DRIVE, which are incorporated by reference in their entireties herein. The embodiments discussed herein are also usable with the instruments, systems, and methods disclosed in U.S. Pat. Application Serial No. 15/908,021, entitled SURGICAL INSTRUMENT WITH REMOTE RELEASE, filed on Feb. 28, 2018, U.S. Pat. Application Serial No. 15/908,012, entitled SURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OF END EFFECTOR MOVEMENT, filed on Feb. 28, 2018, U.S. Pat. Application Serial No. 15/908,040, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed on Feb. 28, 2018, U.S. Pat. Application Serial No. 15/908,057, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed on Feb. 28, 2018, U.S. Pat. Application Serial No. 15/908,058, entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES, filed on Feb. 28, 2018, and U.S. Pat. Application Serial No. 15/908,143, entitled SURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS, filed on Feb. 28, 2018, which are incorporated in their entireties herein. The embodiments discussed herein are also usable with the instruments, systems, and methods disclosed in U.S. Provisional Pat. Application No. 62/659,900, entitled METHOD OF HUB COMMUNICATION, filed on Apr. 19, 2018, U.S. Provisional Pat. Application No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on Dec. 28, 2017, U.S. Provisional Pat. Application No. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on Dec. 28, 2017, and U.S. Provisional Pat. Application No. 62/611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on Dec. 28, 2017, which are incorporated by reference in their entireties herein. Generally, these surgical suturing instruments comprise, among other things, a shaft, an end effector attached to the shaft, and drive systems positioned within the shaft to transfer motion from a source motion to the end effector. The motion source can comprise a manually driven actuator, an electric motor, and/or a robotic surgical system. The end effector comprises a body portion, a needle track defined within the body portion, and a needle driver configured to drive a needle through a rotational firing stroke. The needle is configured to be guided through its rotational firing stroke within the body portion by the needle track. In various instances, the needle driver is similar to that of a ratchet system. In at least one instance, the needle driver is configured to drive the needle through a first half of the rotational firing stroke which places the needle in a hand-off position - a position where a tissue-puncturing end of the needle has passed through the target tissue and reentered the body portion of the end effector. At such point, the needle driver can be returned to its original position to pick up the tissue-puncturing end of the needle and drive the needle through a second half of its rotational firing stroke. Once the needle driver pulls the needle through the second half of its rotational firing stroke, the needle driver is then returned to its original unfired position to grab the needle for another rotational firing stroke. The drive systems can be driven by one or more motors and/or manual drive actuation systems. The needle comprises suturing material, such as thread, for example, attached thereto. The suturing material is configured to be pulled through tissue as the needle is advanced through its rotational firing stroke to seal the tissue and/or attached the tissue to another structure, for example. 
       FIGS.  275 - 279    depict a surgical suturing instrument  94000  configured to suture the tissue of a patient. The surgical suturing instrument  94000  comprises a handle  94100 , a shaft  94200  extending distally from the handle  94100 , and an end effector  94300  attached to the shaft  94200  by way of an articulation joint  94210 . The handle  94100  comprises a firing trigger  94110  configured to actuate a firing drive of the surgical suturing instrument  94000 , a first rotational actuator  94120  configured to articulate the end effector  94300  about an articulation axis AA defined by the articulation joint  94210 , and a second rotational actuator  94130  configured to rotate the end effector  94300  about a longitudinal axis LA defined by the end effector  94300 . The surgical suturing instrument  94000  further comprises a flush port  94140 . Examples of surgical suturing devices, systems, and methods are disclosed in U.S. Pat. Application Serial No. 13/832,786, now U.S. Pat. No. 9,398,905, entitled CIRCULAR NEEDLE APPLIER WITH OFFSET NEEDLE AND CARRIER TRACKS; U.S. Pat. Application Serial No. 14/721,244, now U.S. Pat. Application Publication No. 2016/0345958, entitled SURGICAL NEEDLE WITH RECESSED FEATURES; and U.S. Pat. Application Serial No. 14/740,724, now U.S. Pat. Application Publication No. 2016/0367243, entitled SUTURING INSTRUMENT WITH MOTORIZED NEEDLE DRIVE, which are incorporated by reference in their entireties herein. 
       FIGS.  280 - 282    depict a needle sensing system  91000  configured to be used with a surgical suturing instrument system. The needle sensing system  91000  comprises a resistive sensing circuit configured to allow a control program of a control interface to determine the position of a needle during its firing stroke by monitoring the resistance of the resistive sensing circuit. The needle sensing system  91000  comprises a needle sensing circuit  91100  and a needle  91200 . The needle sensing circuit  91100  comprises a supply portion, or leg,  91110  terminating at a first terminal  91112  and comprising a first resistance R1. The needle sensing circuit  91100  further comprises a return portion  91120  comprising a first return leg  91130  terminating at a first return terminal  91132  and a second return leg  91140  terminating a second return terminal  91142 . The first return leg  91130  and the second return leg  91140  are wired in parallel with respect to each other. The first return leg  91130  comprises a second resistance R2 and the second return leg  91140  comprises a third resistance R3. Discussed in greater detail below, the needle  91210  is configured to act as a switch for the needle sensing circuit  91100  by contacting the terminals  91112 ,  91132 , and  91142  during its firing stroke as the needle  91200  moves in a rotational direction to suture tissue. The resistance of such a circuit can be monitored by a processor to determine the location of the needle  91200  during its firing stroke. 
     The needle  91200  comprises a tip  91213 , a butt end  91211 , and an arcuate shaft  91212  extending between the tip  91213  and the butt end  91211 . The needle  91200  further comprises suturing material  91220  attached to the butt end  91211  of the needle  91200 . The tip  91213  comprises a bevel, or point,  91215  configured to pierce tissue during a firing stroke of the needle  91200 . As the needle  91200  moves through its firing stroke, it is configured to move into and out of contact with the terminals  91112 ,  91132 , and  91142 . In its starting, or home, position ( FIG.  280   ), the needle  91200  is in contact with all three terminals  91112 ,  91132 , and  91142 . The total resistance of the circuit  91100  in this configuration can be detected by the control system of the suturing instrument to identify that the needle  91200  is in its starting position. The total resistance of the circuit  91100  in this configuration is shown in the circuit diagram  91000 ′ of  FIG.  280    and can be referred to as the starting position resistance. Once the needle  91200  is advanced out of its starting position and the butt end  91211  of the needle  91200  moves out of contact with the terminal  91112 , the needle  91200  has been partially fired and is now only in contact with two terminals  91132 ,  91142  ( FIG.  281   ). The total resistance of the circuit  91100  in this configuration can be detected by the control system to identify that the needle  91200  is in a first partially-fired position. The total resistance of the circuit  91100  in this configuration is shown in the circuit diagram  91000 ′ of  FIG.  281    and can be referred to as the first partially-fired position resistance. Once the needle  91200  is advanced out of contact with the second terminal  91132  and back into contact with the first terminal  91112 , the circuit  91100  now comprises a third total resistance that is different from the starting position resistance and the first-partially fired position resistance. This can be referred to as the second partially-fired position resistance ( FIG.  282   ). Because the second partially-fired position resistance is different than the starting position resistance and the first partially-fired position resistance, the second partially-fired position resistance can be detected to determine that the needle  91200  has moved into the second partially-fired position. 
     The system  91100  permits the needle location to be detected directly. Monitoring the needle location over a period of time can provide means for determining the rate of advancement of the needle and/or changes in rate of advancement of the needle during its firing stroke. In various instances, if the needle is sensed to be moving at a rate slower than preferred, for example, the instrument can automatically adjust a power control program of the motor which is advancing the needle through its firing stroke to speed up the needle. Similarly, if the needle is sensed to be moving at a rate faster than preferred, for example, the instrument can automatically adjust the power control program of the motor which is advancing the needle through its firing stroke to slow down the needle. This arrangement allows the control program to adapt the rate and/or sequence at which the needle is fired during a procedure and/or during each firing stroke of the needle to better accommodate variable conditions such as, for example, variable tissue thicknesses during suturing. 
       FIG.  283    illustrates a logic flow diagram of a process  93800  depicting a control program for controlling a surgical suturing instrument. The process  93800  comprises monitoring  93801  a position sensing circuit output. For example, the output resistance of the system  91110  can be monitored throughout the operation of a surgical suturing instrument. The process  93800  further includes determining  93803  if the control motions applied to the needle need to be adjusted based on the position sensing circuit output. A processor, for example, can monitor the position sensing circuit output over a period of time and calculate the speed of the needle during its firing stroke. If the speed is too fast or too slow for the present tissue thickness, for example, the control program can adjust  93807  the control motions applied to the needle to change the speed of the needle firing stroke. If the speed of the needle is consistent with a predetermined speed profile for the present tissue thickness, the control program can continue  93805  normal operation of the instrument. Other position sensing systems disclosed herein can be used with this process. 
       FIG.  284    depicts a needle sensing system  91300  configured to allow a control system of a suturing instrument to monitor the motions of the needle within the end effector against the anticipated, or expected, motions of the needle. In various instances, backlash in a motor-driven needle drive system, for example, could cause the drive system to produce a shorter needle stroke than expected for a given amount of motor rotations. The needle sensing system  91300  comprises an end effector  91310 , a needle track  91312  defined within the end effector  91310 , and a needle  91320 . Similar to the above, the needle  91320  is configured to be actuated by a needle driver to move the needle  91320  through a circular firing stroke. The needle  91320  is guided by the needle track  91312  as the needle  91320  is actuated by the needle driver. The needle sensing system  91300  comprises a plurality of sensors  91340  designated as S1, S2, S3, and S4 which, as discussed below, are configured to track the motion of the needle  91320 . The sensors  91340  may be any suitable position-detecting sensor such that, as the needle  91320  engages, or trips, a sensor  91340 , that sensor sends a voltage signal to the control system that the sensor  91340  has detected that the needle  91320  indicating the position of the needle  91320 . The needle  91320  comprises a tip  91322  that is configured to initially trip the sensors  91340  as the tip  91322  approaches and contacts, or otherwise trips, the sensors  91340 . The end effector  91310  further comprises a tissue opening  91314  defined therein. In use, the end effector  91310  is pressed against the patient tissue such that the tissue enters the opening  91314 . At such point, the tip  91322  can pierce tissue in the opening  91314  and then re-enter the needle track  91312  on the other side of the end effector  91310 . The needle  91320  is dimensioned to have a larger length than the distance of the opening  91314  so that the needle  91320  can be guided by the needle track  91312  back into the needle track  91312  before a butt end of the needle exits the end effector  91310  into the opening  91314 . 
       FIG.  285    is a graph  91350  depicting a portion of a needle firing stroke using the needle sensing system  91300  of  FIG.  284   . As can be seen in the graph  91350  illustrated in  FIG.  285   , there is an overlap of detection for each neighboring sensor. During a needle firing stroke, each sensor is configured to detect the tip  91322  of the needle  91320  before the previous sensor no longer detects the needle  91320 . In another embodiment, more than two sensors are configured to sense the needle during the needle firing stroke. 
     The sensors  91340  can be used in combination with a control program to ensure that a motor driving the needle  91320  through its firing stroke is driving the needle  91320  the expected amount. For example, a certain amount of rotation from the needle drive motor should produce a corresponding travel length of the needle  91320 . Monitoring the position of the needle  91320  in the end effector  91310  along with rotational motion of the motor can provide a way to make sure that the motor is producing the anticipated drive motions of the needle. An example of a needle stroke where the rotational motion of the motor and the actual length of needle travel are monitored is depicted in the graph  91360  illustrated in  FIG.  286   . If the motion of the needle is not as anticipated, the control system can adjust the power delivered to the motor to account for these differences and assure that the needle is being driven all the way around its firing path during a firing stroke. For example, if the motor takes more rotations than expected to cause the needle to travel a certain distance, the control system can increase the number of rotations for the needle to complete the firing stroke. Such instances could be due to backlash in the drive system, for example. 
     If the actual motions sensed by a needle position sensing system are not as expected, the control program can place the system in a limp mode, for example, to prevent premature failure of components. 
     The needle sensing system  91300  can also monitor the current drawn by the needle drive motor while monitoring the input from the sensors  91340 . In such an embodiment, a control program can the reverse actuation of the needle  91320  in the event that a substantial increase in current is detected in the motor and the subsequent sensor  91340  has not been tripped – possibly indicating that the needle is jammed. In the same and/or another embodiment, an encoder can be used to measure the number of rotations being provided by the motor. A control program can compare the number of rotations being provided by the motor to the input from the sensors  91340 . In an instance where the sensors  91340  are not being tripped as expected by a given amount of rotation from the motor, the control program can interrogate the motor current to assess why the needle is not traveling the expected distance. If the motor current is substantially high, this could indicate a jam, as discussed above. If the motor current is substantially low, this could indicate that the needle and the needle driver are no longer coupled, for example, and that the needle driver is freely moving without driving the needle. In an alternative embodiment, motor torque can be sensed instead of motor current. An example of current monitoring can be seen in the graph  91370  illustrated in  FIG.  287   . 
       FIGS.  288 - 290    depict a surgical suturing instrument  91500  comprising a shaft  91510 , an end effector  91530 , and a needle drive system  91550 . The surgical suturing instrument  91500  is designed to provide a suturing bite width that is larger than the diameter of the shaft  91510  by using an expandable/collapsible needle guide element. Various suturing devices are limited to a bite width that is constrained by the diameter of their shafts. The surgical suturing instrument  91500  comprises a movable needle guide  91560  rotatably mounted to a body  91540  of the end effector  91530  configured to permit the use of a needle  91570 , which also comprises a length that exceeds the width of the shaft diameter. To actuate the movable needle guide  91560 , a linear actuator  91512  connected to a proximal end  91562  of the movable needle guide  91560  is configured to be pushed and pulled to pivot the movable needle guide  91560  about its pivot point  91562 .  FIG.  288    illustrates the movable needle guide  91560  in an expanded configuration where the surgical suturing instrument  91500  is ready to be fired. To pivot the movable needle guide  91560  into its closed configuration ( FIG.  289   ), the linear actuator  91512  is pulled proximally. When the movable needle guide  91560  is in its closed configuration, the surgical suturing instrument  91500  is in a configuration sufficient to be passed through a trocar. 
     The needle drive system  91550  comprises a linear actuator  91520 , a proximal needle feed wheel  91552  configured to be rotated about its pivot  91552  by way of the linear actuator  91520  and rotatably mounted within the body  91540  of the end effector  91530 , and a distal needle feed wheel  91554  configured to be rotated about its pivot  91555  by a connecting link  91556  by way of the proximal needle feed wheel  91552  and rotatably mounted within the body  91540  of the end effector  91530 . The feed wheels  91552 ,  91554  are configured to be rotated together to move the flexible needle  91570  through the body  91540  of the end effector  91530  and out of the body  91540  of the end effector  91530  against the movable needle guide  91560 . The movable needle guide  91560  comprises a curved tip  91563  configured to guide the flexible needle  91570  back into the body  91540  of the end effector  91530  so that the distal needle feed wheel  91554  can begin guiding the flexible needle  91570  back toward the proximal needle feed wheel  91552 . The feed wheels  91552 ,  91554  are connected by a coupler bar such that they rotate at the same time. 
     In various instances, the needle  91570  may need to be repaired or replaced. To remove the needle  91570  from the end effector  91530 , the movable needle guide  91560  may be pivoted outwardly to provide access to the needle  91570  ( FIG.  290   ). 
     The needle  91570  comprises an arc length A. The distance between the pivots  91553 ,  91555  of the feed wheels  91552 ,  91554  is labeled length B. The arc length A of the needle  91570  must be greater than the length B in order to be able to guide the flexible needle  91570  back into the end effector body  91540  with the proximal needle feed wheel  91553 . Such an arrangement allows a capture, or bite, width  91580  of the surgical suturing instrument  91500  to be larger than the diameter of the shaft  91510 . In certain instances, a portion of the end effector containing the needle drive system  91550  can be articulated relative to the end effector body  91540  so that the capture width, or opening,  91580  can hinge outwardly and face tissue distally with respect to the instrument  91500 . This arrangement can prevent a user from having to preform the suturing procedure with respect to the side of the instrument  91500 . Such a feature may utilize a hinge mechanism with snap features to rigidly hold the end effector body  91540  in a firing position as opposed to a position suitable for insertion through a trocar. 
     As outlined above, a portion of the end effector  91530  is movable to increase or decrease the width of the end effector  91530 . Decreasing the width of the end effector  91530  allows the end effector  91530  to be inserted through a narrow trocar passageway. Increasing the width of the end effector  91530  after it has been passed through the trocar allows the end effector  91530  to make larger suture loops in the patient tissue, for example. In various instances, the end effector  91530  and/or the needle  91570  can be flexible so that they can be compressed as they are inserted through the trocar and then re-expand once they have passed through the trocar. Such an arrangement, as described above, allows a larger end effector to be used. 
       FIG.  291    depicts a collapsible suturing device  92300  comprising a shaft  92310  and an end effector  92320  configured to be articulated relative to the shaft  92310 . The device  92300  comprises a tissue bite region having a larger width than its shaft diameter. The end effector  92320  is hingedly coupled to the shaft  92310 . The collapsible suturing device  92300  comprises a separate actuation member to rotate the end effector  92320  relative to the shaft  92310 . In other embodiments, the end effector  92320  can be spring biased into a straight configuration where a user may apply torque to a distal end of the end effector  92320  by pressing the end effector  92320  against tissue to rotate the end effector  92320  relative to the shaft  92310 . In either event, such an arrangement provides the device  92300  with a distal-facing tissue bite region  92321  which can permit a user to more accurately and/or easily target tissue to be sutured. The tissue bite region  92321  is larger than the diameter of the shaft  92310 . 
     During use, a user would insert the collapsible suturing device  92300  into a trocar while the device  92300  is in its straight configuration. After the device  92300  is inserted through the trocar, the user may actively rotate the end effector  92320  with an actuator to orient the end effector  92320  properly to prepare to suture the tissue. Once the end effector  92320  is oriented to face the tissue to be sutured, a movable needle guide may be actuated outwardly to prepare to advance the needle through a needle firing stroke. In this configuration, the end effector  92320  can then be pressed against the tissue to be sutured and the needle can be advanced through a needle firing stroke. Once suturing is complete, the needle guide can be collapsed and the end effector  92320  can be rotated back into its straight configuration to be removed from the patient through the trocar. The needle may be taken out of the end effector  92320  before or after the end effector  92320  has passed back out of the patient through the trocar. 
       FIG.  292    depicts a collapsible suturing device  92400  comprising a shaft  92410  and an end effector  92420  attached to the distal end of the shaft  92410 . The device  92400  comprises a tissue bite region having a larger width than its shaft diameter. The end effector  92420  further comprises a needle driving system  92430  configured to drive a flexible needle through a needle firing stroke against a movable needle guide  92440 . The needle driving system  92430  comprises a proximal feed wheel  92431 , a distal feed wheel  92433 , and an intermediate feed wheel  92435  configured to feed the flexible needle through the end effector  92420 . The intermediate feed wheel  92435  permits the use of a longer flexible needle than arrangements without an intermediate feed wheel. Embodiments are envisioned where the intermediate feed wheel is actively connected the needle driving system. In other instances, the intermediate feed wheel is an idler component and rotates freely. In at least one embodiment, the needle comprises a width that is larger than the width of the shaft with which is used. 
       FIGS.  293 - 295    depict a surgical suturing end effector  91600  configured to provide a suturing device with a variable needle stroke. In various instances, the needle stroke of the end effector  91600  can be different every time the end effector  91600  is fired. The end effector  91600  also can provide a suturing bite width that is wider than the diameter of its shaft. The surgical suturing end effector  91600  comprises a body portion  91610  having a tissue-engaging opening  91612 , a needle track  91620  defined within the body portion  91610 , and a needle  91630  configured to be guided through a firing stroke by the needle track  91620 .  FIG.  293    illustrates the needle  91630  in its parked position where the end effector  91600  can be passed through a trocar. Once the end effector  91600  is passed through a trocar, the needle  91630  is advanced linearly from a park track portion  91621  of the needle track  91620  - by way of its proximal end  91633  – to a ready-to-fire position ( FIG.  294   ). As can be seen in  FIG.  294   , the needle  91630  extends outwardly beyond the body  91610  of the end effector  91600  when the needle  91630  is in its ready-to-fire position. Such an arrangement allows for an instrument to have a tissue bite width that is larger than the diameter of the instrument’s shaft. The needle  91630  comprises a canoe-like shape but can comprise any suitable shape to achieve this. 
     When a clinician wants to complete a suture stroke, discussed in greater detail below, the needle  91630  is moved to the position shown in  FIG.  295    referred to as the hand-off position. To get to this position, the proximal end  91633  of the needle  91630  is rotated and advanced linearly within a first track portion  91622  of the track  91620  until the proximal end  91633  of the needle  91630  reaches a distal end  91623  of the first track portion  91622  and a tip portion  91634  of the needle  91630  engages a distal end  91625  of a second track portion  91624  of the track  91620 . This engagement allows a needle driver that rotates and linearly advances the needle  91630  within the track  91620  to move along the track  91620  to the distal end  91625  of the second track portion  91624  to grab the tip portion  91634  and pull the needle  91630  through the end effector  91600  by pulling the needle  91630  proximally and rotating the needle  91630  to prepare for a second firing stroke of the needle  91630 . At a certain point after the needle  91630  attains the hand-off position ( FIG.  295   ), the needle driver can re-connect, or re-engage, with the proximal end  91633  of the needle  91630  to begin a second firing stroke to return the needle  91630  to its ready-to-fire position illustrated in  FIG.  294   . The firing stroke of the needle  91630 , having a canoe-like shape, can resemble a box-shaped, or diamond-shaped, path. 
       FIG.  296    is a stress-strain diagram  91700  of the loads experienced by a needle during a firing stroke. A control system of a surgical suturing instrument can monitor input from a strain gauge and adjust the operation of the surgical suturing instrument based on the monitored strain and/or display the strain to a user during use. The surgical suturing instrument can alert a user when the needle has reached 75%  91701  of its yield strength during a suturing procedure. The surgical instrument can provide the clinician with an option to adjust the advancement speed of the needle to help prevent further spikes of the strain and/or stress within the needle. If the needle reaches 100%  91703  of its yield strength, overstress may be reported to the user and the control system will report the overstress to the system disclosed in U.S. Pat. Application Serial No. 15/908,021, entitled SURGICAL INSTRUMENT WITH REMOTE RELEASE, filed on Feb. 28, 2018, U.S. Pat. Application Serial No. 15/908,012, entitled SURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OF END EFFECTOR MOVEMENT, filed on Feb. 28, 2018, U.S. Pat. Application Serial No. 15/908,040, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed on Feb. 28, 2018, U.S. Pat. Application Serial No. 15/908,057, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed on Feb. 28, 2018, U.S. Patent Application Serial No. 15/908,058, entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES, filed on Feb. 28, 2018, and U.S. Pat. Application Serial No. 15/908,143, entitled SURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS, filed on Feb. 28, 2018, which are incorporated in their entireties herein. If the needle reaches 125%  91705  of its yield strength, the user is alerted of this threshold and the control program automatically slows the speed and may disable the instrument from actuating the needle any further, and/or request action to be taken before any further use of the surgical suturing instrument. 
       FIGS.  297  and  298    depict a method for detecting the proper and/or improper attachment of a modular shaft to a surgical instrument handle and/or surgical robot, for example.  FIG.  297    depicts an attachment assembly  91800  attachable to an attachment interface  91810  – which can be a surgical instrument handle and/or robotic attachment, or control, interface. Monitoring the torque of a drive system coupled at the attachment interface  91810  can provide a way to determine if the attachment interface  91810  and the modular attachment  91820  have been successfully attached or not. 
     Referring to the graph  91830 , the solid plot line represents a scenario where an attempt at attaching the modular attachment  91820  to the attachment interface  91810  was made, and the modular attachment  91820  and the attachment  91830  slipped out of engagement thereby causing a reduction in torque of the actuation drive system below a minimum torque threshold representing an unsuccessful attachment and engagement of drive systems. The torque of a failed attempt is noticeably different than the torque of a successful attempt which is also illustrated in the graph  91830 . In another embodiment, the current of the motor that drives the drive system can be directly monitored. Referring now to the graph  91830 ′, the surgical instrument is equipped with a control system that shuts off the motor in this scenario (1) when the torque sensed drops below the minimum threshold torque. The control system can also alert a user that the motor has been stopped because attachment was not successful. Referring again to the graph  91830 , a second scenario is illustrated by a dashed plot line where attachment is made, however, the torque sensed increases above a maximum torque threshold. This could indicate a jam between the attachment interface  91810  and the modular attachment  91820 . Referring again to the graph  91830 ′, the surgical instrument is equipped with a control system that limits the torque delivered by the drive system when the torque sensed increases above the maximum threshold torque, as illustrated in the dashed plot line representing the second scenario (2). Such a limiting of torque delivery can prevent the breaking of components in the modular attachment  91820  and/or the attachment interface  91810 . 
     In various embodiments, strain gauges can be fitted to frame elements of the modular attachments to monitor force applied to tissue with the frame elements themselves. For example, a strain gauge can be fitted to an outer shaft element to monitor the force experienced by the shaft as the modular attachment is pushed against tissue and/or as the modular attachment pulls tissue. This information can be communicated to the user of the instrument so that the user is aware of the pressure being applied to the tissue by the grounded elements of the modular attachment due to manipulation and movement of the modular attachment within the surgical site. 
       FIGS.  299  and  300    depict a surgical instrument system  91910  that is configured to monitor unexpected electrical potential applied to a surgical instrument during an operation that involves using a mono-polar bridge instrument.  FIG.  299    depicts a system  91910  comprising a grasper  91912  and a mono-polar bridge instrument  91914  being used in the same surgical site. In one scenario, now referring to the graph  91930  in  FIG.  300   , the voltage potential of the grasper  91912  can be monitored throughout the use of the system  91910  during an operation. Stage (1) of the graph  91920  represents the beginning of articulation of the grasper  91912  using motorized articulation. Stage (2) represents a spike in detected voltage potential of the grasper  91912 . Such a spike in voltage potential can be conducted to the grasper  91912  by way of the mono-polar bridge instrument  91914 . At this stage, the system  91910  can automatically reverse the motor direction Stage (3) of articulation to move the grasper  91912  away from the mono-polar bridge instrument  91914  until the unexpected voltage spike subsides Stage (4). The control program of the system  91910  can then instruct the articulation motor to automatically reverse the articulation a predetermined amount passed the point when the system  91910  no longer detects the voltage spike to ensure that this voltage spike will not occur again due to minor inadvertent movement of either the grasper  91912  and/or the mono-polar bridge instrument  91914 . 
     The surgical instrument can also alert the user when an unexpected voltage potential is detected and await further action by a user of the instrument. If the user is using the instrument that experiences the voltage spike as a mono-polar bridge instrument then the user could inform the instrument of this to continue actuation of the instrument. The instrument can also include an electrical circuit, or ground path, to interrupt the flow of electricity beyond a dedicated position when the instrument experiences an unexpected voltage potential. In at least one instance, the ground path can extend within a flex circuit extending throughout the shaft. 
       FIG.  301    illustrates a logic diagram of a process  93900  depicting a control program for controlling a surgical instrument. The process  93900  comprises sensing  93901  an electrical potential applied to the instrument. For example, the voltage of an electrical circuit which includes the instrument can be monitored. The process  93900  further includes determining  93903  if the sensed electrical potential is above a predetermined threshold based on the sensed electrical potential. A processor, for example, can monitor the voltage and, if a voltage spike occurs, the processor can change the operation of the surgical instrument. For instance, the process can adjust  93907  the control motions of the instrument such as reversing a previous motion, for example. If the sensed electrical potential is below the predetermined threshold, the control program can continue  93905  the normal operation of the instrument. 
     In various embodiments, surgical suturing instruments can include means for detecting the tension of the suture during the suturing procedure. This can be achieved by monitoring the force required to advance a needle through its firing stroke. Monitoring the force required to pull the suturing material through tissue can indicate stitch tightness and/or suture tension. Pulling the suturing material too tight during, for example, tying a knot can cause the suturing material to break. The instrument can use the detected forces to communicate stitch tightness to the user during a suturing procedure and let the user know that the stitch is approaching its failure tightness or, on the other hand, is not tight enough to create a sufficient stitch. The communicated stitch tightness can be shown to a user during a suturing procedure in an effort to improve the stitch tightness throughout the procedure. 
     In various embodiments, a surgical suturing instrument comprises a method for detecting load within the end effector, or head, of the instrument, and a control program to monitor this information and automatically modify, and/or adjust, the operation of the instrument. In one instance, a needle holder and/or a needle drive can comprise a strain gauge mounted thereon to monitor the force and stress being experienced by the needle during its firing stroke. A processor of the instrument can monitor the strain sensed by the strain gauge by monitoring the voltage reading that the strain gauge provides and, if the force detected is above a predetermined threshold, the processor can slow the needle and/or alert a user of the instrument that the needle is experiencing a force greater than a certain threshold. Other parameters, such as needle velocity and/or acceleration, for example, can be monitored and used to modify the operation of the surgical instrument. 
     Many different forces experienced by a surgical suturing instrument can be monitored throughout a suturing procedure to improve efficiency of the operation.  FIG.  302    depicts a surgical suturing instrument  92200  comprising a shaft  92210 , an end effector  92230 , and an articulation joint  92220  attaching the end effector  92230  to the shaft  92210  and permitting articulation of the end effector  92230  relative to the shaft  92210 . The end effector  92230  comprises a frame  92232  and a suture cartridge  92234 . The cartridge  92234  comprises a needle  92236  comprising suturing material  92238  attached thereto configured to pass through tissue T. 
     Various parameters of the instrument  92200  can be monitored during a surgical suturing procedure. The force, or load, experienced by the needle  92236  can be monitored, the torque load that resists distal head rotation of the end effector  92230  can be monitored, and/or the bending load of the shaft  92210  that can cause drive systems within the shaft to bind up can be monitored. The monitoring of these parameters is illustrated in the graph  92100  in  FIG.  303   . The surgical instrument  92200  is configured to limit corresponding motor current if certain thresholds of the parameters are exceeded. The force experienced by the needle  92236  is represented by the solid plot line in the graph  92100 . This force can directly correspond to the current drawn by the motor that fires the needle  92236 . As the load on the needle  92236  increases, the motor that is firing the needle slows down thereby reducing the load on the needle and reducing current through the motor. If this force, or current, exceeds a certain pre-determined threshold, the power applied to the needle firing motor can be limited to prevent possible failure of drive system components and/or driving a needle through an unintended target. This limiting event is labeled (1) in the reaction graph  92120 . The torque load experienced by the end effector  92230  is represented by the dashed plot in the graph  92100 . This torque load can be a result of trying to rotate the end effector  92230  while the suturing material  92238  is still connected to tissue T and the needle  92236 . This torque load can directly correspond to the current of the motor that rotates the end effector  92230 . If this torque load, or current, exceeds a certain pre-determined threshold, power to the motor that rotates the end effector  92230  can be limited. This limiting event is labeled (2) in the reaction graph  92120 . The bending load experienced by the shaft  92210  is represented by the dash-dot plot in the graph  92100  and can be sensed by using a strain gauge placed on the shaft  92210 , for example. If this bending load exceeds a certain pre-determined threshold, power to the motor that rotates the end effector  92230  can be limited and reduced. This limiting event is labeled (3) in the reaction graph  92120 . 
       FIG.  304    illustrates a logic diagram of a process  94000  depicting a control program for controlling a surgical suturing instrument. The process  94000  comprises monitoring  94001  one or more detectable parameters of the surgical suturing instrument. For example, the force experienced by the suturing needle, the torque load experienced by the shaft of the instrument, and/or the torque load experienced by the end effector of the instrument can be monitored. In fact, any combination of detectable parameters can be monitored. The process  94000  further includes determining  94003  if the detected parameters warrant a change in the operation of the instrument. For example, if the shaft is experiencing a torque load that is greater than a predetermined threshold, the control program can adjust  94007  the control motions applied to the end effector, such as stopping the actuation of the instrument, until the torque experienced by the shaft falls below the predetermined threshold. If all of the detected parameters are within operational conditions, the control program can continue  94005  the normal operation of the instrument. 
     Another system for detecting and/or monitoring the location of the suturing needle during its firing stroke can include utilizing one or more magnets and Hall Effect sensors. In such an embodiment, a permanent magnet can be placed within and/or on the needle and a Hall Effect sensor can be placed within, or adjacent to, the needle track, for example. In such an instance, movement of the needle will cause the magnet to move into, within, and/or out of the field created by the Hall Effect sensor thereby providing a way to detect the location of the needle. In the same embodiment, and/or in another embodiment, a magnet can be placed on one side of the needle track and a corresponding Hall Effect sensor can be placed on the other side of the needle track. In such an embodiment, the needle itself can interrupt the magnetic field between the magnet and the Hall Effect sensor as the needle passes between the two magnets, thereby providing a way to detect the location of the needle. 
       FIGS.  305  and  306    depict a surgical suturing end effector assembly  93100  configured to suture the tissue of a patient during a surgical suturing procedure. The end effector assembly  93100  comprises a shaft  93110  and an end effector  93120  extending distally from the shaft  93110 . The end effector  93120  comprises a first jaw  93130  and a second jaw  93140  configured to receive a replaceable suturing cartridge  93141  therein. The suturing cartridge  93141  comprises a needle  93152  and suture material  93150  attached thereto configured to be driven through a needle firing stroke and guided by a needle track  93142  in the suturing cartridge  93141 . 
     The surgical suturing end effector assembly  93100  further comprises a needle sensing system comprising a magnet  93162  and a Hall Effect sensor  93164 . The magnet  93162  and Hall Effect sensor  93164  are positioned within the suturing cartridge  93141  such that the needle  93152  is configured to interrupt the magnetic field between the magnet  93162  and the Hall Effect sensor  93164 . Such an interruption can indicate to a control program the position of the needle  93152  relative to the suturing cartridge  93141  and/or within its firing stroke. The sensor and magnet may be embedded within the cartridge and/or placed adjacent the needle track such as, for example, on top of, on bottom of, and/or on the sides of the needle track. 
       FIG.  307    depicts a needle sensing system  93200  positioned within a suturing cartridge  93240 . The suturing cartridge  93240  comprises a needle  93252  and a needle track  93242  configured to guide the needle  93252  through a needle firing stroke. The needle sensing system  93200  comprises a magnet  93264  and a Hall Effect sensor  93262  positioned above and below, respectively, the needle track  93242 . The Hall Effect sensor  93262  and the magnet  93264  are configured to indicate the position of the needle to a control circuit as the needle interrupts the magnetic field between the Hall Effect sensor  93262  and the magnet  93264 . Such an arrangement can provide a more localized needle position detection system. In at least one embodiment, a suturing cartridge can contain more than one Hall Effect sensor and magnet arranged in this manner to provide multiple detection locations along the needle track. That said, any suitable sensor arrangement can be used. A control program can determine the position of the needle based on the sensor reading(s) of the Hall Effect sensor(s). A control program of the surgical instrument can adjust control motions applied to the surgical suturing instrument based on the readings from the Hall Effect sensor(s). For example, if the needle is detected to be moving slower than preferred during a firing stroke based on the time it takes for the needle to trip consecutive sensors, the control program can increase the speed of the motor driving the needle through its firing stroke. Also, for example, the control program can compensate for a lag in the position of the needle during its stroke. In at least one instance, the electrical motor of the needle firing drive can be left on for a few additional rotations to reposition the needle in its stroke. 
     Another system for detecting and/or monitoring the location of the suturing needle during its firing stroke can include utilizing one or more proximity sensors near the needle and/or the needle driver. As discussed above, the needle driver is configured to drive the needle out of its needle track and back into the other side of the needle track, release the needle, and return to its original position to grab the needle on the other side of the track to prepare for a second half of a firing stroke. The proximity sensor(s) can be used to monitor the location of the needle and/or the needle driver. In an instance where multiple proximity sensors are used, a first proximity sensor can be used near the entry point on the needle track and a second proximity sensor can be used near the exit point on the needle track, for example. 
       FIG.  308    depicts a needle sensing system  93300  positioned within a suturing cartridge  93340 . The suturing cartridge  93340  comprises a needle  93352  and a needle track  93342  configured to guide the needle  93352  through a needle firing stroke. The needle sensing system  93300  comprises a plurality of proximity sensors  93362  positioned within the needle track  93342 . In at least one embodiment, the sensors  93362  are molded into a sidewall  93343  of the needle track  93342 . In the same embodiment and/or another embodiment, the sensors  93362  are molded into a top, or bottom, surface  93345  of the needle track  93342 . Any suitable location within the end effector assembly can be used. The sensor information can be used to determine the location of the needle  93352  which can then be used to modify the operation of the surgical instrument if appropriate. 
     In at least one embodiment, a plurality of proximity sensors can be used within the end effector of a suturing device to determine if a needle of the suturing device has been de-tracked or fallen out of its track. To achieve this, an array of proximity sensors can be provided such that the needle contacts at least two sensors at all times during its firing stroke. If a control program determines that only one sensor is contacted based on the data from the proximity sensors, the control system can then determine that the needle has been de-tracked and modify the operation of the drive system accordingly. 
       FIG.  309    depicts a needle sensing system  93400  positioned within a suturing cartridge  93440 . The suturing cartridge  93440  comprises a needle  93452  and a needle track  93442  configured to guide the needle  93452  through a needle firing stroke. The needle sensing system  93400  comprises a plurality of conductive sensors  93462  positioned within the needle track  93442 . In one embodiment, the sensors  94362  are positioned adjacent a sidewall  93443  of the needle track  93442  such that the needle  93452  may progressively contact the sensors  94362  as the needle  93452  progresses through a needle firing stroke. In the same embodiment and/or another embodiment, the sensors  93462  are positioned adjacent a top, or bottom, surface  93445  of the needle track  93442 . Any suitable location within the end effector assembly can be used. The sensor information can be used to determine the location of the needle  93452  which can then be used to modify the operation of the surgical instrument if appropriate. 
     Another system for detecting and/or monitoring the location of the suturing needle during its firing stroke can include placing a circuit in communication with the needle track. For example, a conductive supply leg can be wired in contact with one side of the needle track and a conductive return leg can be wired in contact with the other side of the needle track. Thus, as the needle passes by the circuit, the needle can act as a circuit switch and complete the circuit to lower the resistance within the circuit thereby providing a way to detect and/or monitor the location of the needle. Several of these circuits can be placed throughout the needle track. To aid the needle conductivity between the circuit contacts, brushes can be used to cradle the needle as the needle passes the circuit location. A flex circuit can also be used and can be adhered to inner walls of the needle track, for example. The flex circuit can contain multiple contacts, and/or terminals. In at least one instance, the contacts can be molded directly into the walls. In another instance, the contacts of the flex circuit can be folded over an inner wall of the needle track and stuck to the wall with an adhesive, for example, such that the contacts face the needle path. In yet another instance, both of these mounting options can be employed. 
     Another system for detecting and/or monitoring the location of the suturing needle during its firing stroke can include one or more inductive sensors. Such sensors can detect the needle and/or the needle grabber, or driver. 
     Another system for detecting and/or monitoring the location of the suturing needle during its firing stroke can include using a light source and a photodetector which are positioned such that movement of the needle interrupts the detection of the light source by the photodetector. A light source can be positioned within, and/or near, the needle track, for example, and faced toward the needle path. The photodetector can be positioned opposite the light source such that needle can pass between the light source and the photodetector thereby interrupting the detection of light by the photodetector as the needle passes between the light source and the photodetector. Interruption of the light provided by the light source can indicate the needle’s presence or lack thereof. The light source may be an infrared LED emitter, for example. Infrared light may be preferred due to its ability to penetrate tissue and organic debris, especially within a suturing site, which otherwise could produce a false positive reading by the photodetector. That said, any suitable light emitter could be used. 
       FIG.  310    depicts a needle sensing system  93500  positioned within a suturing cartridge  93540 . The suturing cartridge  93540  comprises a needle  93552  and a needle track  93542  configured to guide the needle  93552  through a needle firing stroke. The needle sensing system  93500  comprises a light source  93562  positioned at an entry point  93545  of the needle track  93542  and a photodetector  93564  positioned at an exit point  93543  of the needle track  93542 . When the needle  93552  is in its home position as illustrated in  FIG.  310   , the light source  93562  is configured to emit light that spans across the capture opening of the suturing cartridge  93540  to indicate that the needle  93552  is in its home position. Once the needle  93552  interrupts the path between the light source  93562  and the photodetector  93564 , a control program can determine that the needle is not in its home position. The location of the needle  93552  can be determined by a control program based on the interruption of light between the light sources and photodetectors which can then be used to modify the operation of the surgical instrument if appropriate. 
       FIG.  311    depicts a needle sensing system  93600  positioned within a suturing cartridge  93640 . The suturing cartridge  93640  comprises a needle  93652  and a needle track  93642  configured to guide the needle  93652  through a needle firing stroke. The needle sensing system  93600  comprises a light source  93662  and a photodetector  93664  positioned at an exit point  93643  of the needle track  93642 . The light source  93662  is configured to emit light that spans across the needle track cavity of the suturing cartridge  96640  to indicate the position of the needle  93652 . In another embodiment, another photodetector and light source are positioned at an exit point  93645  of the needle track  93642 . In yet another embodiment, an array of photodetectors and light sources are placed along the length of the needle track  93642 . The location of the needle  93652  can be determined by a control program based on the interruption of light between the light source  93662  and the photodetector  93664 . 
     In at least one embodiment, a surgical suturing needle can comprise a helical profile to provide helical suturing strokes. Such a needle comprises a length spanning 360 degrees where a butt end of the needle and a tip of the needle do not reside in the same plane and define a vertical distance therebetween. This needle can be actuated through a helical, or coil shaped, stroke to over-sew a staple line, for example, providing a three dimensional needle stroke. A needle having the helical shape discussed above provides a three dimensional suturing path. 
       FIGS.  312  and  313    depict a helical suturing needle assembly  93700  for use with a surgical suturing instrument. The suturing needle assembly  93700  comprises a tip  93704 , a proximal end  93706 , and a helical body portion  93702  extending therebetween. The helical body portion  93702  comprises a catch feature  93701  that a needle driver of a surgical suturing instrument is configured to catch on a return stroke of the driver. The tip  93704  and the proximal end  93706  reside in different horizontal planes and comprise a vertical distance therebetween; however, the tip  93704  and the proximal end  93706  terminate along a common axis A ( FIG.  313   ). The needle assembly  93700  can be actuated through a helical, or coil shaped, stroke to over-sew a staple line, for example, providing a three dimensional needle stroke. 
     In various instances, the needle comprises a circular configuration that is less than 360 degrees in circumference. In at least one instance, the needle can be stored in the end effector in an orientation which stores the needle within the profile of the end effector. Once the end effector is positioned within the patient, the needle can be rotated out of its stored position to then perform a firing stroke. 
     In various embodiments, a surgical suturing instrument can accommodate different needle and suture sizes for different suturing procedures. Such an instrument can comprise a means for detecting the size of the needle and/or suture loaded into the instrument. This information can be communicated to the instrument so that the instrument can adjust the control program accordingly. Larger diameter needles may be rotated angularly at a slower rate than smaller diameter needles. Needles with different lengths may also be used with a single instrument. In such instances, a surgical instrument can comprise means for detecting the length of the needle. This information can be communicated to a surgical instrument to modify the needle driver’s path, for example. A longer needle may require a smaller stroke path from the needle driver to sufficiently advance the longer needle through its firing stroke as opposed to a smaller needle which may require a longer stroke path from the needle driver to sufficiently advance the shorter needle through its firing stroke in the same needle track. 
       FIG.  314    depicts a logic diagram of a process  94100  depicting a control program for controlling a surgical instrument. The process  94100  comprises detecting  94101  the type of suturing cartridge installed within the surgical suturing instrument. In various instances, different suture cartridges may have different suture lengths, needle lengths, needle diameters, and/or suture materials, for example. The type of suture cartridge and/or its characteristics can be communicated to a control circuit by an identification chip positioned within the cartridge such that, when a suture cartridge is installed within a surgical instrument, the control circuit can identify what type of cartridge has been installed and assess the characteristics of the suture cartridge. In order to accommodate different cartridge types, a control circuit may adjust the control motions that will be applied to the suture cartridge. For example, firing speeds may differ for different sized needles. Another example may include adjusting the range of angular needle rotation based on different needle lengths, or sizes. To accommodate such differences, the process  94100  implemented by a process, for example, comprises adjusting  94103  a motor control program of the instrument based on what type of suture cartridge is installed. 
     In at least one embodiment, a suture needle is stored in a suturing instrument in a folded manner. In at least one such instance, the suture needle comprises two portions which are hingedly connected to one another at a hinge. After the end effector has been passed through the trocar, the suture needle can be unfolded and locked into its unfolded configuration. In at least one instance, a one-way snap feature can be used to rigidly hold the suture needle in its unfolded configuration. 
     In at least one embodiment, a surgical instrument is configured to apply a suture to the tissue of a patient which comprises a lockout system. The lockout system comprises a locked configuration and an unlocked configuration. The surgical instrument further comprises a control circuit and is configured to identify if a cartridge is installed or not installed within an end effector of the surgical instrument. The control circuit is configured to place the lockout system in the locked condition when a cartridge is not installed in the end effector and place the lockout system in the unlocked condition when a cartridge is installed in the end effector. Such a lockout system can include an electrical sensing circuit of which a cartridge can complete upon installation indicating that a cartridge has been installed. In at least one instance, the actuator comprises an electric motor and the lockout system can prevent power from being supplied to the electric motor. In at least one instance, the actuator comprises a mechanical trigger, and the lockout system blocks the mechanical trigger from being pulled to actuate the suture needle. When the lockout system is in the locked configuration, the lockout system prevents an actuator from being actuated. When the lockout system is in the unlocked configuration, the lockout system permits the actuator to deploy the suture positioned within the cartridge. In one embodiment, the control circuit provides haptic feedback to a user of the surgical instrument when the electrical sensing circuit places the surgical instrument in the locked configuration. In one embodiment, the control circuit prevents the actuation of an electric motor configured to actuate the actuator when the electrical sensing circuit determines that the lockout system is in the locked configuration. In one embodiment, the lockout system is in the unlocked configuration when a cartridge is positioned in the end effector and the cartridge has not been completely expended. 
       FIGS.  315  and  316    depict a handle assembly  95200  that is operable for use a surgical suturing instrument. The handle assembly  95200  is connected to a proximal end of a shaft. The handle assembly  95200  includes a motor  95202  and a transmission assembly  95210 . The motor  95202  is configured to actuate a needle of a surgical suturing end effector by way of a needle driver, articulate the end effector, and rotate the end effector by way of the transmission assembly  95210 . The transmission assembly  95210  is shifted between three states by a double acting solenoid, for example, so as to allow the motor  95202  to be used to actuate a needle of a surgical suturing end effector, articulate the end effector, and/or rotate the end effector. In at least one embodiment, the handle assembly  95200  could take the form of a robotic interface or a housing comprising gears, pulleys, and/or servomechanisms, for example. Such an arrangement could be used with a robotic surgical system. 
       FIG.  317    depicts a suturing cartridge  93590  comprising a lower body  93581 , an upper body  93582 , and a needle cover  93583 . The cartridge  93590  further comprises a drive system comprising a needle driver  93586 , a rotary input  93594 , and a link  93585  connecting the needle driver  93586  and the rotary input  93594 . The needle driver  93586 , rotary input  93594 , and link  93585  are captured between the lower body  93581  and the upper body  93582 . The needle driver  93586 , the link  93585 , and the rotary input  93594  are configured to be actuated to drive a needle  93570  through a needle firing stroke by way of a motor-driven system, a manually-driven handheld system, and/or a robotic system, for example. The lower and upper bodies  93581 ,  93582  are attached to one another using any suitable technique, such as, for example, welds, pins, adhesives, and/or the like to form the cartridge body. The needle  93570  comprises a leading end  93571  configured to puncture tissue, a trailing end  93572 , and a length of suture  93573  extending from and attached to the trailing end  93572 . The needle  93570  is configured to rotate in a circular path defined by a needle track  93584 . The needle track  93584  is defined in the cartridge body. The needle  93570  is configured to exit one of a first arm  95393 A and a second arm  95393 B of the cartridge body and enter the other of the first arm  95393 A and the second arm  95393 B during a needle firing stroke. Recessed features  93574  are provided to so that the needle driver  93586  can engage and drive the needle  93570  through the needle firing stroke in a ratchet-like motion. The needle  93570  is positioned between the needle track  93584  and the needle cover  93583 . The suturing cartridge  93590  further comprises a cage  93587  that is configured to slide over the cartridge body to attach the needle cover  93583  to the lower body  93581 . 
     A surgical system  128000  is illustrated in  FIG.  318   . The surgical system  128000  comprises a handle, a shaft  128020  extending from the handle, and an end effector  128030  extending from the shaft  128020 . In alternative embodiments, the surgical system  128000  comprises a housing configured to be mounted to a robotic surgical system. In at least one such embodiment, the shaft  128020  extends from the robotic housing mount instead of the handle. In either event, the end effector  128030  comprises jaws  128040  and  128050  which are closeable to grasp a target, such as the tissue T of a patient and/or a suture needle, for example, as discussed in greater detail below. The jaws  128040  and  128050  are also openable to dissect the tissue of a patient, for example. In at least one instance, the jaws  128040  and  128050  are insertable into the patient tissue to create an otomy therein and then spread to open the otomy, as discussed in greater detail below. 
     Referring again to  FIG.  318   , the jaws  128040  and  128050  are pivotably coupled to the shaft  128020  about a pivot joint  128060 . The pivot joint  128060  defines a fixed axis of rotation, although any suitable arrangement could be used. The jaw  128040  comprises a distal end, or tip,  128041  and an elongate profile which narrows from its proximal end to its distal end  128041 . Similarly, the jaw  128050  comprises a distal end, or tip,  128051  and an elongate profile which narrows from its proximal end to its distal end  128051 . The distance between the tips  128041  and  128051  define the mouth width, or opening,  128032  of the end effector  128030 . When the tips  128041  and  128051  are close to one another, or in contact with one another, the mouth  128032  is small, or closed, and the mouth angle e is small, or zero. When the tips  128041  and  128051  are far apart, the mouth  128032  is large and the mouth angle e is large. 
     Further to the above, the jaws of the end effector  128030  are driven by a jaw drive system including an electric motor. In use, a voltage potential is applied to the electric motor to rotate the drive shaft of the electric motor and drive the jaw drive system. The surgical system  128000  comprises a motor control system configured to apply the voltage potential to the electric motor. In at least one instance, the motor control system is configured to apply a constant DC voltage potential to the electric motor. In such instances, the electric motor will run at a constant speed, or an at least substantially constant speed. In various instances, the motor control system comprises a pulse width modulation (PWM) circuit and/or a frequency modulation (FM) circuit which can apply voltage pulses to the electric motor. The PWM and/or FM circuits can control the speed of the electric motor by controlling the frequency of the voltage pulses supplied to the electric motor, the duration of the voltage pulses supplied to the electric motor, and/or the duration between the voltage pulses supplied to the electric motor. 
     The motor control system is also configured to monitor the current drawn by the electric motor as a means for monitoring the force being applied by the jaws of the end effector  128030 . When the current being drawn by the electric motor is low, the loading force on the jaws is low. Correspondingly, the loading force on the jaws is high when the current being drawn by the electric motor is high. In various instances, the voltage being applied to the electric motor is fixed, or held constant, and the motor current is permitted to fluctuate as a function of the force loading at the jaws. In certain instances, the motor control system is configured to limit the current drawn by the electric motor to limit the force that can be applied by the jaws. In at least one embodiment, the motor control system can include a current regulation circuit that holds constant, or at least substantially constant, the current drawn by the electric motor to maintain a constant loading force at the jaws. 
     The force generated between the jaws of the end effector  128030 , and/or on the jaws of the end effector  128030 , may be different depending on the task that the jaws are being used to perform. For instance, the force needed to hold a suture needle may be high as suture needles are typically small and it is possible that a suture needle may slip during use. As such, the jaws of the end effector  128030  are often used to generate large forces when the jaws are close together. On the other hand, the jaws of the end effector  128030  are often used to apply smaller forces when the jaws are positioned further apart to perform larger, or gross, tissue manipulation, for example. 
     Referring to the upper portion  128110  of the graph  128100  illustrated in  FIG.  319   , the loading force, f, experienced by the jaws of the end effector  128030  can be limited by a force profile stored in the motor control system. The force limit profile  128110   o  for opening the jaws  128040  and  128050  is different than the force limit profile  128110   c  for closing the jaws  128040  and  128050 . This is because the procedures performed when forcing the jaws  128040  and  128050  open are typically different than the procedures performed when forcing the jaws  128040  and  128050  closed. That said, the opening and closing force limit profiles could be the same. While it is likely that the jaws  128040  and  128050  will experience some force loading regardless of whether the jaws  128050  are being opened or closed, the force limit profiles typically come into play when the jaws  128040  and  128050  are being used to perform a particular procedure within the patient. For instance, the jaws  128040  and  128050  are forced open to create and expand an otomy in the tissue of a patient, as represented by graph sections  128115  and  128116 , respectively, of graph  128100 , while the jaws  128040  and  128050  are forced closed to grasp a needle and/or the patient tissue, as represented by graph sections  128111  and  128112 , respectively, of graph  128100 . 
     Referring again to  FIG.  319   , the opening and closing jaw force limit profiles  128110   o  and  128110   c , respectively, are depicted on the opposite sides of a zero force line depicted in the graph  128100 . As can be seen in the upper section  128110  of graph  128100 , the jaw force limit threshold is higher – for both force limit profiles  128110   o  and  128110   c  – when the jaws  128040  and  128050  are just being opened from their fully-closed position. As can also be seen in the upper section  128110  of graph  128100 , the jaw force limit threshold is lower – for both force limit profiles  128110   o  and  128110   c  – when the jaws  128040  and  128050  are reaching their fully-opened position. Such an arrangement can reduce the possibility of the jaws  128040  and  128050  damaging adjacent tissue when the being fully opened, for example. In any event, the force that the jaws  128040  and  128050  are allowed to apply is a function of the mouth opening size between the jaws and/or the direction in which the jaws are being moved. For instance, when the jaws  128040  and  128050  are opened widely, or at their maximum, to grasp large objects, referring to graph section  128114  of upper graph section  128110 , the jaw force f limit is very low as compared to when the jaws  128040  and  128050  are more closed to perform gross tissue manipulation, referring to graph section  128113  of upper graph section  128110 . Moreover, different jaw force limit profiles can be used for different jaw configurations. For instance, Maryland dissectors, which have narrow and pointy jaws, may have a different jaw force limit profile than a grasper having blunt jaws, for example. 
     In addition to or in lieu of the above, the speed of the jaws  128040  and  128050  can be controlled and/or limited by the motor control system as a function of the mouth opening size between the jaws  128040  and  128050  and/or the direction the jaws are being moved. Referring to the middle portion  128120  and lower portion  128130  of the graph  128100  in  FIG.  319   , the rate limit profile for moving the jaws  128040  and  128050  permits the jaws to be moved slowly when the jaws are near their closed position and moved quickly when the jaws are near their open position. In such instances, the jaws  128040  and  128050  are accelerated as the jaws are opened. Such an arrangement can provide fine control over the jaws  128040  and  128050  when they are close together to facilitate the fine dissection of tissue, for example. Notably, the rate limit profile for opening and closing the jaws  128040  and  128050  is the same, but they could be different in other embodiments. In alternative embodiments, the rate limit profile for moving the jaws  128040  and  128050  permits the jaws to be moved quickly when the jaws are near their closed position and slowly when the jaws are near their open position. In such instances, the jaws  128040  and  128050  are decelerated as the jaws are opened. Such an arrangement can provide fine control over the jaws  128040  and  128050  when the jaws are being used to stretch an otomy, for example. The above being said, the speed of the jaws  128040  and  128050  can be adjusted once the jaws experience loading resistance from the patient tissue, for example. In at least one such instance, the jaw opening rate and/or the jaw closing rate can be reduced once the jaws  128040  and  128050  begin to experience force resistance above a threshold, for example. 
     In various instances, further to the above, the handle of the surgical system  128000  comprises an actuator, the motion of which tracks, or is supposed to track, the motion of the jaws  128040  and  128050  of the end effector  128030 . For instance, the actuator can comprise a scissors-grip configuration which is openable and closable to mimic the opening and closing of the end effector jaws  128040  and  128050 . The control system of the surgical system  128000  can comprise one or more sensor systems configured to monitor the state of the end effector jaws  128040  and  128050  and the state of the handle actuator and, if there is a discrepancy between the two states, the control system can take a corrective action once the discrepancy exceeds a threshold and/or threshold range. In at least one instance, the control system can provide feedback, such as audio, tactile, and/or haptic feedback, for example, to the clinician that the discrepancy exists and/or provide the degree of discrepancy to the clinician. In such instances, the clinician can make mental compensations for this discrepancy. In addition to or in lieu of the above, the control system can adapt its control program of the jaws  128040  and  128050  to match the motion of the actuator. In at least one instance, the control system can monitor the loading force being applied to the jaws and align the closed position of the actuator with the position of the jaws when the jaws experience the peak force loading condition when grasping tissue. Similarly, the control system can align the open position of the actuator with the position of the jaws when the jaws experience the minimum force loading condition when grasping tissue. In various instances, the control system is configured to provide the clinician with a control to override these adjustments and allow the clinician to use their own discretion in using the surgical system  128000  in an appropriate manner. 
     A surgical system  128700  is illustrated in  FIGS.  320  and  321   . The surgical system  128700  comprises a handle, a shaft assembly  128720  extending from the handle, and an end effector  128730  extending from the shaft assembly  128720 . In alternative embodiments, the surgical system  128700  comprises a housing configured to be mounted to a robotic surgical system. In at least one such embodiment, the shaft  128720  extends from the robotic housing mount instead of the handle. In either event, the end effector  128730  comprises shears configured to transect the tissue of a patient. The shears comprise two jaws  128740  and  128750  configured to transect the patient tissue positioned between the jaws  128740  and  128750  as the jaws  128740  and  128750  are being closed. Each of the jaws  128740  and  128750  comprises a sharp edge configured to cut the tissue and are pivotably mounted to the shaft  128720  about a pivot joint  128760 . Such an arrangement can comprise bypassing scissors shears. Other embodiments are envisioned in which one of the jaws  128740  and  128750  comprises a knife edge and the other comprises a mandrel against the tissue is supported and transected. Such an arrangement can comprise a knife wedge in which the knife wedge is moved toward the mandrel. In at least one embodiment, the jaw comprising the knife edge is movable and the jaw comprising the mandrel is stationary. The above being said, embodiments are envisioned in which the tissue-engaging edges of one or both of the jaws  128740  and  128750  are not necessarily sharp. 
     As discussed above, the end effector  128730  comprises two scissor jaws  128740  and  128750  movable between an open position and a closed position to cut the tissue of a patient. The jaw  128740  comprises a sharp distal end  128741  and the jaw  128750  comprises a sharp distal end  128751  which are configured to snip the tissue of the patient at the mouth  128731  of the end effector  128730 , for example. That said, other embodiments are envisioned in which the distal ends  128741  and  128751  are blunt and can be used to dissect tissue, for example. In any event, the jaws are driven by a jaw drive system including an electric drive motor, the speed of which is adjustable to adjust the closure rate and/or opening rate of the jaws. Referring to the graph  128400  of  FIG.  322   , the control system of the surgical system is configured to monitor the loading, or shear, force on the jaws  128740  and  128750  as the jaws  128740  and  128750  are being closed and adaptively slow down the drive motor when large forces, or forces above a threshold Fc, are experienced by the jaws  128740  and  128750 . Such large forces often occur when the tissue T being cut by the jaws  128740  and  128750  is thick, for example. Similar to the above, the control system can monitor the current drawn by the drive motor as a proxy for the loading force being experienced by the jaws  128740  and  128750 . In addition to or in lieu of this approach, the control system can be configured to measure the jaw loading force directly by one or more load cells and/or strain gauges, for example. Once the loading force experienced by the jaws  128740  and  128750  drops below the force threshold Fc, the control system can adaptively speed up the jaw closure rate. Alternatively, the control system can maintain the lower closure rate of the jaws  128740  and  128750  even though the force threshold is no longer being exceeded. 
     The above-provided discussion with respect to the surgical system  128700  can provide mechanical energy or a mechanical cutting force to the tissue of a patient. That said, the surgical system  128700  is also configured to provide electrosurgical energy or an electrosurgical cutting force to the tissue of a patient. In various instances, the electrosurgical energy comprises RF energy, for example; however, electrosurgical energy could be supplied to the patient tissue at any suitable frequency. In addition to or in lieu of AC power, the surgical system  128700  can be configured to supply DC power to the patient tissue. The surgical system  128700  comprises a generator in electrical communication with one or more electrical pathways defined in the instrument shaft  128720  which can supply electrical power to the jaws  128740  and  128750  and also provide a return path for the current. In at least one instance, the jaw  128740  comprises an electrode  128742  in electrical communication with a first electrical pathway in the shaft  128720  and the jaw  128750  comprises an electrode  128752  in electrical communication with a second electrical pathway in the shaft  128720 . The first and second electrical pathways are electrically insulated, or at least substantially insulated, from one another and the surrounding shaft structure such that the first and second electrical pathways, the electrodes  128742  and  128752 , and the tissue positioned between the electrodes  128742  and  128752  forms a circuit. Such an arrangement provides a bipolar arrangement between the electrodes  128742  and  128752 . That said, embodiments are envisioned in which a monopolar arrangement could be used. In such an arrangement, the return path for the current goes through the patient and into a return electrode positioned on or under the patient, for example. 
     As discussed above, the tissue of a patient can be cut by using a mechanical force and/or an electrical force. Such mechanical and electrical forces can be applied simultaneously and/or sequentially. For instance, both forces can be applied at the beginning of a tissue cutting actuation and then the mechanical force can be discontinued in favor of the electrosurgical force finishing the tissue cutting actuation. Such an approach can apply an energy-created hemostatic seal to the tissue after the mechanical cutting has been completed. In such arrangements, the electrosurgical force is applied throughout the duration of the tissue cutting actuation. In other instances, the mechanical cutting force, without the electrosurgical cutting force, can be used to start a tissue cutting actuation which is then followed by the electrosurgical cutting force after the mechanical cutting force has been stopped. In such arrangements, the mechanical and electrosurgical forces are not overlapping or co-extensive. In various instances, both the mechanical and electrosurgical forces are overlapping and co-extensive throughout the entire tissue cutting actuation. In at least one instance, both forces are overlapping and co-extensive throughout the entire tissue cutting actuation but in magnitudes or intensities that change during the tissue cutting actuation. The above being said, any suitable combination, pattern, and/or sequence of mechanical and electrosurgical cutting forces and energies could be used. 
     Further to the above, the surgical system  128700  comprises a control system configured to co-ordinate the application of the mechanical force and electrosurgical energy to the patient tissue. In various instances, the control system is in communication with the motor controller which drives the jaws  128740  and  128750  and, also, the electrical generator and comprises one or more sensing systems for monitoring the mechanical force and electrosurgical energy being applied to the tissue. Systems for monitoring the forces within a mechanical drive system are disclosed elsewhere herein. Systems for monitoring the electrosurgical energy being applied to the patient tissue include monitoring the impedance, or changes in the impedance, of the patient tissue via the electrical pathways of the electrosurgical circuit. In at least one instance, referring to the graph  128800  in  FIG.  323   , the RF current/voltage ratio of the electrosurgical power being applied to the patient tissue by the generator is evaluated by monitoring the current and voltage of the power being supplied by the generator. The impedance of the tissue and the RF current/voltage ratio of the electrosurgical power are a function of many variables such as the temperature of the tissue, the density of the tissue, the thickness of the tissue, the type of tissue between the jaws  128740  and  128750 , the duration in which the power is applied to the tissue, among others, which change throughout the application of the electrosurgical energy. 
     Further to the above, the control system and/or generator of the surgical system  128700  comprises one or more ammeter circuits and/or voltmeter circuits configured to monitor the electrosurgical current and/or voltage, respectively, being applied to the patient tissue. Referring again to  FIG.  323   , a minimum amplitude limit and/or a maximum amplitude limit on the current being applied to the patient tissue can be preset in the control system and/or can be controllable by the user of the surgical instrument system through one or more input controls. The minimum and maximum amplitude limits can define a current envelope within which the electrosurgical portion of the surgical system  128700  is operated. 
     In various instances, the control system of the surgical system  128700  is configured to adaptively increase the electrosurgical energy applied to the patient tissue when the drive motor slows. The motor slowing can be a reaction to an increase in the tissue cutting load and/or an adaptation of the control system. Similarly, the control system of the surgical system  128700  is configured to adaptively increase the electrosurgical energy applied to the patient tissue when the drive motor stops. Again, the motor stopping can be a reaction to an increase in the tissue cutting load and/or an adaptation of the control system. Increasing the electrosurgical energy when the electric motor slows and/or stops can compensate for a reduction in mechanical cutting energy. In alternative embodiments, the electrosurgical energy can be reduced and/or stopped when the electric motor slows and/or stops. Such embodiments can afford the clinician to evaluate the situation in a low-energy environment. 
     In various instances, the control system of the surgical system  128700  is configured to adaptively decrease the electrosurgical energy applied to the patient tissue when the drive motor speeds up. The motor speeding up can be a reaction to a decrease in the cutting load and/or an adaptation of the control system. Decreasing the electrosurgical energy when the electric motor slows and/or stops can compensate for, or balance out, an increase in mechanical cutting energy. In alternative embodiments, the electrosurgical energy can be increased when the electric motor speeds up. Such embodiments can accelerate the closure of the jaws and provide a clean, quick cutting motion. 
     In various instances, the control system of the surgical system  128700  is configured to adaptively increase the speed of the drive motor when the electrosurgical energy applied to the patient tissue decreases. The electrosurgical energy decreasing can be a reaction to a change in tissue properties and/or an adaptation of the control system. Similarly, the control system of the surgical system  128700  is configured to adaptively increase the speed of the drive motor when electrosurgical energy applied to the patient tissue stops in response to an adaptation of the control system. Increasing the speed of the drive motor when the electrosurgical energy decreases or is stopped can compensate for a reduction in electrosurgical cutting energy. In alternative embodiments, the speed of the drive motor can be reduced and/or stopped when the electrosurgical energy decreases and/or is stopped. Such embodiments can afford the clinician to evaluate the situation in a low-energy and/or static environment. 
     In various instances, the control system of the surgical system  128700  is configured to adaptively decrease the speed of the electric motor when the electrosurgical energy applied to the patient tissue increases. The electrosurgical energy increasing can be a reaction to a change in tissue properties and/or an adaptation of the control system. Decreasing the drive motor speed when the electrosurgical energy increases can compensate for, or balance out, an increase in electrosurgical cutting energy. In alternative embodiments, the drive motor speed can be increased when the electrosurgical energy increases. Such embodiments can accelerate the closure of the jaws and provide a clean, quick cutting motion. 
     In various instances, the surgical system  128700  comprises controls, such as on the handle of the surgical system  128700 , for example, that a clinician can use to control when the mechanical and/or electrosurgical forces are applied. In addition to or in lieu of manual controls, the control system of the surgical system  128700  is configured to monitor the mechanical force and electrical energy being applied to the tissue and adjust one or the other, if needed, to cut the tissue in a desirable manner according to one or more predetermined force-energy curves and/or matrices. In at least one instance, the control system can increase the electrical energy being delivered to the tissue once the mechanical force being applied reaches a threshold limit. Moreover, the control system is configured to consider other parameters, such as the impedance of the tissue being cut, when making adjustments to the mechanical force and/or electrical energy being applied to the tissue. 
       FIG.  324    is a logic diagram of a control system  75000  for use with any of the various suturing instruments described herein. The control system  75000  comprises a control circuit. The control circuit includes a microcontroller  75040  comprising a processor  75020  and a memory  75030 . One or more sensors, such as sensor  75080 , sensor  75090 , sensor  71502 , and sensor array  71940 , for example, provide real time feedback to the processor  75020 . The control system  75000  further comprises a motor driver  75050  configured to control an electric motor  75010  and a tracking system  75060  configured to determine the position of one or more movable components in the suturing instruments, such as a needle, needle drive system, suture, and/or suture spool, for example. The tracking system  75060  provides position information to the processor  75020 , which can be programmed or configured to, among other things, determine the position of the suture needle, for example. The motor driver  75050  may be an A3941 available from Allegro Microsystems, Inc., for example; however, other motor drivers may be readily substituted for use in the tracking system  75060 . A detailed description of an absolute positioning system is described in U.S. Pat. Application Publication No. 2017/0296213, entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, the entire disclosure of which is hereby incorporated herein by reference. 
     The microcontroller  75040  may be any single core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments, for example. In at least one instance, the microcontroller  75040  is a LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas Instruments, for example, comprising on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), internal read-only memory (ROM) loaded with StellarisWare® software, 2 KB electrically erasable programmable read-only memory (EEPROM), one or more pulse width modulation (PWM) modules and/or frequency modulation (FM) modules, one or more quadrature encoder inputs (QEI) analog, one or more 12-bit Analog-to-Digital Converters (ADC) with 12 analog input channels, for example, details of which are available from the product datasheet. 
     In various instances, the microcontroller  75040  comprises a safety controller comprising two controller-based families such as TMS570 and RM4x known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options. 
     The microcontroller  75040  is programmed to perform various functions such as precisely controlling the speed and/or position of the suture needle, for example. The microcontroller  75040  is also programmed to precisely control the rotational speed and position of the end effector of the suturing instrument and the articulation speed and position of the end effector of the suturing instrument. In various instances, the microcontroller  75040  computes a response in the software of the microcontroller  75040 . The computed response is compared to a measured response of the actual system to obtain an “observed” response, which is used for actual feedback decisions. The observed response is a favorable, tuned, value that balances the smooth, continuous nature of the simulated response with the measured response, which can detect outside influences on the system. 
     The motor  75010  is controlled by the motor driver  75050 . In various forms, the motor  75010  is a DC brushed driving motor having a maximum rotational speed of approximately 25,000 RPM, for example. In other arrangements, the motor  75010  includes a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor driver  75050  may comprise an H-bridge driver comprising field-effect transistors (FETs), for example. The motor driver  75050  may be an A3941 available from Allegro Microsystems, Inc., for example. The A3941 motor driver  75050  is a full-bridge controller for use with external N-channel power metal oxide semiconductor field effect transistors (MOSFETs) specifically designed for inductive loads, such as brush DC motors. In various instances, the motor driver  75050  comprises a unique charge pump regulator provides full (&gt;10 V) gate drive for battery voltages down to 7 V and allows the A3941 motor driver  75050  to operate with a reduced gate drive, down to 5.5 V. A bootstrap capacitor may be employed to provide the above-battery supply voltage required for N-channel MOSFETs. An internal charge pump for the high-side drive allows DC (100% duty cycle) operation. The full bridge can be driven in fast or slow decay modes using diode or synchronous rectification. In the slow decay mode, current recirculation can be through the high-side or the lowside FETs. The power FETs are protected from shoot-through by resistor adjustable dead time. Integrated diagnostics provide indication of undervoltage, overtemperature, and power bridge faults, and can be configured to protect the power MOSFETs under most short circuit conditions. Other motor drivers may be readily substituted. 
     The tracking system  75060  comprises a controlled motor drive circuit arrangement comprising one or more position sensors, such as the sensor  75080 , sensor  75090 , sensor  71502 , and sensory array  71940 , for example. The position sensors for an absolute positioning system provide a unique position signal corresponding to the location of a displacement member. As used herein, the term displacement member is used generically to refer to any movable member of any of the surgical instruments disclosed herein. In various instances, the displacement member may be coupled to any position sensor suitable for measuring linear displacement or rotational displacement. Linear displacement sensors may include contact or non-contact displacement sensors. The displacement sensors may comprise linear variable differential transformers (LVDT), differential variable reluctance transducers (DVRT), a slide potentiometer, a magnetic sensing system comprising a movable magnet and a series of linearly arranged Hall Effect sensors, a magnetic sensing system comprising a fixed magnet and a series of movable linearly arranged Hall Effect sensors, an optical sensing system comprising a movable light source and a series of linearly arranged photo diodes or photo detectors, or an optical sensing system comprising a fixed light source and a series of movable linearly arranged photo diodes or photo detectors, or any combination thereof. 
     The position sensors  75080 ,  75090 ,  71502 , and  71940  for example, may comprise any number of magnetic sensing elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors encompass many aspects of physics and electronics. The technologies used for magnetic field sensing include search coil, fluxgate, optically pumped, nuclear precession, SQUID, Hall-Effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive/piezoelectric composites, magnetodiode, magnetotransistor, fiber optic, magnetooptic, and microelectromechanical systems-based magnetic sensors, among others. 
     In various instances, one or more of the position sensors of the tracking system  75060  comprise a magnetic rotary absolute positioning system. Such position sensors may be implemented as an AS5055EQFT single-chip magnetic rotary position sensor available from Austria Microsystems, AG and can be interfaced with the controller  75040  to provide an absolute positioning system. In certain instances, a position sensor comprises a low-voltage and low-power component and includes four Hall-Effect elements in an area of the position sensor that is located adjacent a magnet. A high resolution ADC and a smart power management controller are also provided on the chip. A CORDIC processor (for Coordinate Rotation Digital Computer), also known as the digit-by-digit method and Volder’s algorithm, is provided to implement a simple and efficient algorithm to calculate hyperbolic and trigonometric functions that require only addition, subtraction, bitshift, and table lookup operations. The angle position, alarm bits, and magnetic field information are transmitted over a standard serial communication interface such as an SPI interface to the controller  75040 . The position sensors can provide 12 or 14 bits of resolution, for example. The position sensors can be an AS5055 chip provided in a small QFN 16-pin 4x4x0.85 mm package, for example. 
     The tracking system  75060  may comprise and/or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power source converts the signal from the feedback controller into a physical input to the system, in this case voltage. Other examples include pulse width modulation (PWM) and/or frequency modulation (FM) of the voltage, current, and force. Other sensor(s) may be provided to measure physical parameters of the physical system in addition to position. In various instances, the other sensor(s) can include sensor arrangements such as those described in U.S. Pat. No. 9,345,481, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which is hereby incorporated herein by reference in its entirety; U.S. Pat. Application Publication No. 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which is hereby incorporated herein by reference in its entirety; and U.S. Pat. Application Serial No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, which is hereby incorporated herein by reference in its entirety. In a digital signal processing system, absolute positioning system is coupled to a digital data acquisition system where the output of the absolute positioning system will have finite resolution and sampling frequency. The absolute positioning system may comprise a compare and combine circuit to combine a computed response with a measured response using algorithms such as weighted average and theoretical control loop that drives the computed response towards the measured response. The computed response of the physical system takes into account properties like mass, inertial, viscous friction, inductance resistance, etc., to predict what the states and outputs of the physical system will be by knowing the input. 
     The absolute positioning system provides an absolute position of the displacement member upon power up of the instrument without retracting or advancing the displacement member to a reset (zero or home) position as may be required with conventional rotary encoders that merely count the number of steps forwards or backwards that the motor  75010  has taken to infer the position of a device actuator, the needle driver, and the like. 
     A sensor  75080  and/or  71502  comprising a strain gauge or a micro-strain gauge, for example, is configured to measure one or more parameters of the end effector of the suturing instrument, such as, for example, the strain experienced by the needle during a suturing operation. The measured strain is converted to a digital signal and provided to the processor  75020 . A sensor  75090  comprising a load sensor, for example, can measure another force applied by the suturing instrument. In various instances, a current sensor  75070  can be employed to measure the current drawn by the motor  75010 . The force required to throw, or rotate, the suturing needle can correspond to the current drawn by the motor  75010 , for example. The measured force is converted to a digital signal and provided to the processor  75020 . A magnetic field sensor can be employed to measure the thickness of the captured tissue. The measurement of the magnetic field sensor can also be converted to a digital signal and provided to the processor  75020 . 
     The measurements of the tissue thickness and/or the force required to rotate the needle through tissue as measured by the sensors can be used by the controller  75040  to characterize the position and/or speed of the movable member being tracked. In at least one instance, the memory  75030  may store a technique, an equation, and/or a look-up table which can be employed by the controller  75040  in the assessment. In various instances, the controller  75040  can provide the user of the suturing instrument with a choice as to the manner in which the suturing instrument should be operated. To this end, a display  75044  can display a variety of operating conditions of the suturing instrument and can include touch screen functionality for data input. Moreover, information displayed on the display  75044  may be overlaid with images acquired via the imaging modules of one or more endoscopes and/or one or more additional surgical instruments used during the surgical procedure. 
     As discussed above, the suturing instruments disclosed herein may comprise control systems. Each of the control systems can comprise a circuit board having one or more processors and/or memory devices. Among other things, the control systems are configured to store sensor data, for example. They are also configured to store data which identifies the type of suturing instrument attached to a handle or housing. More specifically, the type of suturing instrument can be identified when attached to the handle or housing by the sensors and the sensor data can be stored in the control system. Moreover, they are also configured to store data including whether or not the suturing instrument has been previously used and/or how many times the suture needle has been cycled. This information can be obtained by the control system to assess whether or not the suturing instrument is suitable for use and/or has been used less than a predetermined number of times, for example. 
     The surgical instrument systems described herein are motivated by an electric motor; however, the surgical instrument systems described herein can be motivated in any suitable manner. In certain instances, the motors disclosed herein may comprise a portion or portions of a robotically controlled system. U.S. Pat. Application Serial No. 13/118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, now U.S. Pat. No. 9,072,535, for example, discloses several examples of a robotic surgical instrument system in greater detail, the entire disclosure of which is incorporated by reference herein. 
     The surgical instrument systems described herein can be used in connection with the deployment and deformation of staples. Various embodiments are envisioned which deploy fasteners other than staples, such as clamps or tacks, for example. Moreover, various embodiments are envisioned which utilize any suitable means for sealing tissue. For instance, an end effector in accordance with various embodiments can comprise electrodes configured to heat and seal the tissue. Also, for instance, an end effector in accordance with certain embodiments can apply vibrational energy to seal the tissue. In addition, various embodiments are envisioned which utilize a suitable cutting means to cut the tissue. 
     The entire disclosures of:
     U.S. Pat. Application Serial No. 11/013,924, entitled TROCAR SEAL ASSEMBLY, now U.S. Pat. No. 7,371,227;   U.S. Pat. Application Serial No. 11/162,991, entitled ELECTROACTIVE POLYMER-BASED ARTICULATION MECHANISM FOR GRASPER, now U.S. Pat. No. 7,862,579;   U.S. Pat. Application Serial No. 12/364,256, entitled SURGICAL DISSECTOR, now U.S. Pat. Application Publication No. 2010/0198248;   U.S. Pat. Application Serial No. 13/536,386, entitled EMPTY CLIP CARTRIDGE LOCKOUT, now U.S. Pat. No. 9,282,974;   U.S. Pat. Application Serial No. 13/832,786, entitled CIRCULAR NEEDLE APPLIER WITH OFFSET NEEDLE AND CARRIER TRACKS, now U.S. Pat. No. 9,398,905;   U.S. Pat. Application Serial No. 12/592,174, entitled APPARATUS AND METHOD FOR MINIMALLY INVASIVE SUTURING, now U.S. Pat. No. 8,123,764;   U.S. Pat. Application Serial No. 12/482,049, entitled ENDOSCOPIC STITCHING DEVICES, now U.S. Pat. No. 8,628,545;   U.S. Pat. Application Serial No. 13/118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, now U.S. Pat. No. 9,072,535;   U.S. Pat. Application Serial No. 11/343,803, entitled SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES, now U.S. Pat. No. 7,845,537;   U.S. Pat. Application Serial No. 14/200,111, entitled CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS, now U.S. Pat. No. 9,629,629;   U.S. Pat. Application Serial No. 14/248,590, entitled MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS, now U.S. Pat. No. 9,826,976;   U.S. Pat. Application Serial No. 14/813,242, entitled SURGICAL INSTRUMENT COMPRISING SYSTEMS FOR ASSURING THE PROPER SEQUENTIAL OPERATION OF THE SURGICAL INSTRUMENT, now U.S. Pat. Application Publication No. 2017/0027571;   U.S. Pat. Application Serial No. 14/248,587, entitled POWERED SURGICAL STAPLER, now U.S. Pat. No. 9,867,612;   U.S. Pat. Application Serial No. 12/945,748, entitled SURGICAL TOOL WITH A TWO DEGREE OF FREEDOM WRIST, now U.S. Pat. No. 8,852,174;   U.S. Pat. Application Serial No. 13/297,158, entitled METHOD FOR PASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTE ACTUATOR INTO AN INDEPENDENTLY ROTATING MEMBER, now U.S. Pat. No. 9,095,362;   International Application No. PCT/US2015/023636, entitled SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION, now International Patent Publication No. WO 2015/153642 A1;   International Application No. PCT/US2015/051837, entitled HANDHELD ELECTROMECHANICAL SURGICAL SYSTEM, now International Patent Publication No. WO 2016/057225 A1;   U.S. Patent Application Serial No. 14/657,876, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, U.S. Pat. Application Publication No. 2015/0182277;   U.S. Pat. Application Serial No. 15/382,515, entitled MODULAR BATTERY POWERED HANDHELD SURGICAL INSTRUMENT AND METHODS THEREFOR, U.S. Pat. Application Publication No. 2017/0202605;   U.S. Pat. Application Serial No. 14/683,358, entitled SURGICAL GENERATOR SYSTEMS AND RELATED METHODS, U.S. Pat. Application Publication No. 2016/0296271;   U.S. Pat. Application Serial No. 14/149,294, entitled HARVESTING ENERGY FROM A SURGICAL GENERATOR, U.S. Pat. No. 9,795,436;   U.S. Pat. Application Serial No. 15/265,293, entitled TECHNIQUES FOR CIRCUIT TOPOLOGIES FOR COMBINED GENERATOR, U.S. Pat. Application Publication No. 2017/0086910; and   U.S. Pat. Application Serial No. 15/265,279, entitled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, U.S. Pat. Application Publication No. 2017/0086914, are hereby incorporated by reference herein.   

     Although various devices have been described herein in connection with certain embodiments, modifications and variations to those embodiments may be implemented. Particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined in whole or in part, with the features, structures or characteristics of one ore more other embodiments without limitation. Also, where materials are disclosed for certain components, other materials may be used. Furthermore, according to various embodiments, a single component may be replaced by multiple components, and multiple components may be replaced by a single component, to perform a given function or functions. The foregoing description and following claims are intended to cover all such modification and variations. 
     The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, a device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps including, but not limited to, the disassembly of the device, followed by cleaning or replacement of particular pieces of the device, and subsequent reassembly of the device. In particular, a reconditioning facility and/or surgical team can disassemble a device and, after cleaning and/or replacing particular parts of the device, the device can be reassembled for subsequent use. Those skilled in the art will appreciate that reconditioning of a device can 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. 
     The devices disclosed herein may be processed before surgery. First, a new or used instrument may be obtained and, when necessary, cleaned. The instrument may then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, and/or high-energy electrons. The radiation may kill bacteria on the instrument and in the container. The sterilized instrument may then be stored in the sterile container. The sealed container may keep the instrument sterile until it is opened in a medical facility. A device may also be sterilized using any other technique known in the art, including but not limited to beta radiation, gamma radiation, ethylene oxide, plasma peroxide, and/or steam. 
     While several forms have been illustrated and described, it is not the intention of the applicant to restrict or limit the scope of the appended claims to such detail. Numerous modifications, variations, changes, substitutions, combinations, and equivalents to those forms may be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. Moreover, the structure of each element associated with the described forms can be alternatively described as a means for providing the function performed by the element. Also, where materials are disclosed for certain components, other materials may be used. It is therefore to be understood that the foregoing description and the appended claims are intended to cover all such modifications, combinations, and variations as falling within the scope of the disclosed forms. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents. 
     The foregoing detailed description has set forth various forms of the devices and/or processes via the use of block diagrams, flowcharts, and/or examples. Insofar as such block diagrams, flowcharts, and/or examples contain one or more functions and/or operations, it will be understood by those within the art that each function and/or operation within such block diagrams, flowcharts, and/or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein, in whole or in part, can be equivalently implemented in integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and or firmware would be well within the skill of one of skilled in the art in light of this disclosure. In addition, those skilled in the art will appreciate that the mechanisms of the subject matter described herein are capable of being distributed as one or more program products in a variety of forms and that an illustrative form of the subject matter described herein applies regardless of the particular type of signal-bearing medium used to actually carry out the distribution. 
     Instructions used to program logic to perform various disclosed aspects can be stored within a memory in the system, such as DRAM, cache, flash memory, or other storage. Furthermore, the instructions can be distributed via a network or by way of other computer-readable media. Thus a machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to, floppy diskettes, optical disks, CD-ROMs, magneto-optical disks, ROM, RAM, EPROM, EEPROM, magnetic or optical cards, flash memory, or tangible, machine-readable storage used in the transmission of information over the Internet via electrical, optical, acoustical, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals). Accordingly, the non-transitory computer-readable medium includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer). 
     As used in any aspect herein, the term “control circuit” may refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor comprising one or more individual instruction processing cores, processing unit, processor, microcontroller, microcontroller unit, controller, DSP, PLD, programmable logic array (PLA), or FPGA), state machine circuitry, firmware that stores instructions executed by programmable circuitry, and any combination thereof. The control circuit may, collectively or individually, be embodied as circuitry that forms part of a larger system, for example, an integrated circuit, an application-specific integrated circuit (ASIC), a system on-chip (SoC), desktop computers, laptop computers, tablet computers, servers, smart phones, etc. Accordingly, as used herein, “control circuit” includes, but is not limited to, electrical circuitry having at least one discrete electrical circuit, electrical circuitry having at least one integrated circuit, electrical circuitry having at least one application-specific integrated circuit, electrical circuitry forming a general-purpose computing device configured by a computer program (e.g., a general-purpose computer configured by a computer program which at least partially carries out processes and/or devices described herein, or a microprocessor configured by a computer program which at least partially carries out processes and/or devices described herein), electrical circuitry forming a memory device (e.g., forms of random access memory), and/or electrical circuitry forming a communications device (e.g., a modem, communications switch, or optical-electrical equipment). Those having skill in the art will recognize that the subject matter described herein may be implemented in an analog or digital fashion or some combination thereof. 
     As used in any aspect herein, the term “logic” may refer to an app, software, firmware, and/or circuitry configured to perform any of the aforementioned operations. Software may be embodied as a software package, code, instructions, instruction sets, and/or data recorded on non-transitory computer-readable storage medium. Firmware may be embodied as code, instructions, instruction sets, and/or data that are hard-coded (e.g., non-volatile) in memory devices. 
     As used in any aspect herein, the terms “component,” “system,” “module,” and the like can refer to a computer-related entity, either hardware, a combination of hardware and software, software, or software in execution. 
     As used in any aspect herein, an “algorithm” refers to a self-consistent sequence of steps leading to a desired result, where a “step” refers to a manipulation of physical quantities and/or logic states which may, though need not necessarily, take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It is common usage to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or states. 
     A network may include a packet-switched network. The communication devices may be capable of communicating with each other using a selected packet-switched network communications protocol. One example communications protocol may include an Ethernet communications protocol which may be capable permitting communication using a Transmission Control Protocol/IP. The Ethernet protocol may comply or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) titled “IEEE 802.3 Standard,” published in December 2008 and/or later versions of this standard. Alternatively or additionally, the communication devices may be capable of communicating with each other using an X.25 communications protocol. The X.25 communications protocol may comply or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be capable of communicating with each other using a frame relay communications protocol. The frame relay communications protocol may comply or be compatible with a standard promulgated by Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an Asynchronous Transfer Mode (ATM) communications protocol. The ATM communications protocol may comply or be compatible with an ATM standard published by the ATM Forum, titled “ATM-MPLS Network Interworking 2.0,” published August 2001, and/or later versions of this standard. Of course, different and/or after-developed connection-oriented network communication protocols are equally contemplated herein. 
     Unless specifically stated otherwise as apparent from the foregoing disclosure, it is appreciated that, throughout the foregoing disclosure, discussions using terms such as “processing,” “computing,” “calculating,” “determining,” “displaying,” or the like, refer to the action and processes of a computer system, or similar electronic computing device, that manipulates and transforms data represented as physical (electronic) quantities within the computer system’s registers and memories into other data similarly represented as physical quantities within the computer system memories or registers or other such information storage, transmission, or display devices. 
     One or more components may be referred to herein as “configured to,” “configurable to,” “operable/operative to,” “adapted/adaptable,” “able to,” “conformable/conformed to,” etc. Those skilled in the art will recognize that “configured to” can generally encompass active-state components, inactive-state components, and/or standby-state components, unless context requires otherwise. 
     With respect to the appended claims, those skilled in the art will appreciate that recited operations therein may generally be performed in any order. Also, although various operational flow diagrams are presented in a sequence(s), it should be understood that the various operations may be performed in other orders than those which are illustrated or may be performed concurrently. Examples of such alternate orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reverse, or other variant orderings, unless context dictates otherwise. Furthermore, terms like “responsive to,” “related to,” or other past-tense adjectives are generally not intended to exclude such variants, unless context dictates otherwise. 
     It is worthy to note that any reference to “one aspect,” “an aspect,” “an exemplification,” “one exemplification,” and the like means that a particular feature, structure, or characteristic described in connection with the aspect is included in at least one aspect. Thus, appearances of the phrases “in one aspect,” “in an aspect,” “in an exemplification,” and “in one exemplification” in various places throughout the specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more aspects. 
     While this invention has been described as having exemplary designs, the present invention may be further modified within the spirit and scope of the disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. 
     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 materials do 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.