comprehensive real-time analysis of all instrumentation used in surgery with the use of fluid data t

专利摘要:
The present invention relates to various systems and methods for tracking the costs of the surgical procedure. A computer system, such as a central surgical controller, is configured to be communicatively coupled to a plurality of surgical devices. The computer system can be programmed to identify the surgical devices that are being used during a surgical procedure using perioperative data received from the surgical devices and then calculate the total cost associated with the surgical devices used in the surgical procedure. The total cost may include an aggregation of the maintenance costs for each of the reusable surgical devices and the replacement costs for the reusable surgical devices consumed during the surgical procedure.
公开号:BR112020013112A2
申请号:R112020013112-1
申请日:2018-11-14
公开日:2020-11-24
发明作者:Frederick E. Shelton Iv；Jason L. Harris；Taylor W. Aronhalt
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] This application claims the benefit of non-provisional patent application serial number 16 / 182,242, entitled REAL-TIME ANALYSIS OF COMPREHENSIVE COST OF ALL INSTRUMENTATION USED IN SUR-
[0002] [0002] This application claims priority under code 35 USC § 119 (e) to US provisional patent application No. 62 / 729,191, entitled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASE- LINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION, filed on September 10, 2018, the description of which is incorporated herein.
[0003] [0003] This application claims priority under 35 USC§ 119 (e) to provisional patent application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE, filed on June 30, 2018, at US provisional patent application No. 62 / 692,748, entitled SMART ENERGY ARCHITEC-TURE, filed on June 30, 2018 and US provisional patent application No. 62 / 692,768, entitled SMART ENERGY DEVICES, filed on June 30 2018, the description of each of which is incorporated herein by reference, in its entirety.
[0004] [0004] The present application claims priority under 35 USC§ 119 (e) of US provisional patent application No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, the description of which is incorporated herein by way of reference, in its entirety.
[0005] [0005] This application also claims priority under 35 USC§ 119 (e) of US Provisional Patent Application No. 62 / 650,898 filed on March 30, 2018, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, US provisional patent application serial number 62 / 650,887, entitled SURGI-CAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES, filed on March 30, 2018, from US provisional patent application serial number 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, filed on March 30, 2018, and US provisional patent application serial number 62 / 650.877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTRROL, filed on March 30, 2018 2018, whose description of each is incorporated herein by reference, in its entirety.
[0006] [0006] This application also claims priority under 35 USC§ 119 (e) of US provisional patent application serial number 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018 , and US provisional patent application serial number 62 / 640,415, entitled ES-
[0007] [0007] This application also claims priority under 35 U.S.C.§ 119 (e) of US provisional patent application serial number
[0008] [0008] The present invention relates to various surgical systems. Surgical procedures are typically performed in theaters or surgical operating rooms in a health care facility, such as a hospital. A sterile field is typically created around the patient. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area. Various surgical devices and systems are used to perform a surgical procedure. SUMMARY
[0009] [0009] In a general aspect, a computer system configured to be communicatively coupled to a plurality of surgical devices. The computer system comprises a processor and a memory attached to the processor. The memory stores instructions that, when executed by the processor, make the computer system: determine which of the plurality of surgical devices is being used during a surgical procedure based, at least in part, on perioperative data received from one or more among the plurality of surgical devices; determine whether each of the plurality of surgical devices used during the surgical procedure is a reusable surgical device or a non-reusable surgical device; determine a maintenance cost for each reusable surgical device; determine a replacement cost for each non-reusable surgical device; and determining a total cost of the plurality of surgical devices for the surgical procedure according to the maintenance cost for each reusable surgical device and the replacement cost for each non-reusable surgical device.
[0010] [0010] In another general aspect, a computer system is provided that comprises a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, make the computer system: identify one or more surgical devices used during a surgical procedure according to perioperative data received from one or more surgical devices; and determining a total cost of one or more surgical devices for the surgical procedure according to a maintenance cost or a replacement cost associated with each of the one or more surgical devices.
[0011] [0011] In yet another general aspect, a computer-implemented method to determine a surgical device cost for a surgical procedure. The method comprises: determining, through a computer system, which of a plurality of surgical devices are used during the surgical procedure based at least in part on perioperative data received from one or more of the plurality of surgical devices; determine, through the computer system, whether each of the plurality of surgical devices used during the surgical procedure is a reusable surgical device or a non-reusable surgical device; determine, through the computer system, a maintenance cost for each reusable surgical device; determine, through the system of
[0012] [0012] The various aspects described here, both with regard to the organization and the methods of operation, together with objects and additional advantages of the same, can be better understood in reference to the description presented below, considered together with the attached drawings as follows.
[0013] [0013] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present description.
[0014] [0014] Figure 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 description.
[0015] [0015] Figure 3 is a central surgical controller paired with a visualization system, a robotic system, and an intelligent instrument, according to at least one aspect of the present description.
[0016] [0016] Figure 4 is a partial perspective view of a central surgical controller housing, and of a generator module in combination received slidingly in a central surgical controller housing, according to at least one aspect of this description.
[0017] [0017] Figure 5 is a perspective view of a generator module in combination with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present description.
[0018] [0018] Figure 6 illustrates different power bus connectors for a plurality of side coupling ports of a side modular cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present description.
[0019] [0019] Figure 7 illustrates a vertical modular housing configured to receive a plurality of modules, according to at least one aspect of the present description.
[0020] [0020] Figure 8 illustrates a surgical data network that comprises a modular communication center configured to connect modular devices located in one or more operating rooms of a health care facility, or any environment in a utility facility specially equipped for surgical operations, to the cloud, in accordance with at least one aspect of this description.
[0021] [0021] Figure 9 illustrates an interactive surgical system implemented by computer, in accordance with at least one aspect of the present description.
[0022] [0022] Figure 10 illustrates a central surgical controller that comprises a plurality of modules coupled to the modular control tower, according to at least one aspect of the present description.
[0023] [0023] Figure 11 illustrates an aspect of a universal serial bus (USB) central network controller device, in accordance with at least one aspect of the present description.
[0024] [0024] Figure 12 is a block diagram of a cloud computing system that comprises a plurality of intelligent surgical instruments coupled to central surgical controllers that can connect to the cloud component of the cloud computing system, according to at least one aspect of the present description.
[0025] [0025] Figure 13 is a functional module architecture of a cloud computing system, according to at least one aspect of the present description.
[0026] [0026] Figure 14 illustrates a diagram of a surgical system with situational recognition, according to at least one aspect of the present description.
[0027] [0027] Figure 15 is a timeline that represents the situational recognition of a central surgical controller, according to at least one aspect of the present description.
[0028] [0028] Figure 16 is a diagram of the database system illustrating the interoperability of data between the interrelated databases, in accordance with at least one aspect of the present description.
[0029] [0029] Figure 17 is a diagram of a database system illustrating the fluidity of data between the interrelated databases, in accordance with at least one aspect of the present description.
[0030] [0030] Figure 18 is a logic flow diagram of a process for sharing data between databases, according to at least one aspect of the present description.
[0031] [0031] Figure 19 is a diagram of a database system where specific data is shared between the central surgical controller, the electronic health record (EHR), and the hospital administration databases, according to at least one aspect of the present description.
[0032] [0032] Figure 20 is a diagram of a specific database system where specific data is shared between EHR and the hospital databases, in accordance with at least one aspect of the present description.
[0033] [0033] Figure 21 is a diagram illustrating a security and authorization system for a medical facility database system, in accordance with at least one aspect of the present description.
[0034] [0034] Figure 22 is a block diagram of a cost analysis algorithm that can be performed by the central surgical controller, according to at least one aspect of the present description.
[0035] [0035] Figure 23 is a block diagram illustrating a workflow for a surgical device through a medical installation, in accordance with at least one aspect of the present description.
[0036] [0036] Figure 24 is a logical flow diagram of a process to calculate the total cost associated with a surgical procedure, according to at least one aspect of the present description. DESCRIPTION
[0037] [0037] The applicant for this application holds the following US patent applications, filed on November 6, 2018, the description of which is incorporated herein by reference in its entirety: ● US patent application no. 16 / 182.224, entitled SURGI- CAL NETWORK, INSTRUMENT, AND CLOUD RESPONSES BASED
[0038] [0038] The applicant for this application holds the following US patent applications filed on September 10, 2018, the description of which is incorporated herein by reference in its entirety: ● ● US provisional patent application n ° 62 / 729,183, entitled A CONTROL FOR A SURGICAL NETWORK OR SURGICAL
[0039] [0039] The applicant for this application holds the following US patent applications, filed on August 28, 2018, the description of which is incorporated herein by reference in its entirety for reference: ● US patent application No. 16 /115,214, entitled ESTIMATING
[0040] [0040] The applicant for this application holds the following US patent applications, filed on August 23, 2018, the description of which is incorporated herein by reference in its entirety: ● Provisional patent application US No. 62 / 721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT AC- CORDING TO TISSUE LOCATION; ● US Provisional Patent Application No. 62 / 721,998, entitled SI- TUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS; ● US Provisional Patent Application No. 62 / 721,999, entitled IN-
[0041] [0041] The applicant for this application holds the following US patent applications, filed on June 30, 2018, the description of each of which is incorporated herein by way of reference in its entirety: ● Provisional patent application US No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE; ● US Provisional Patent Application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE; and ● US Provisional Patent Application No. 62 / 692,768, entitled SMART ENERGY DEVICES.
[0042] [0042] The applicant for the present application holds the following US patent applications, filed on June 29, 2018, the description of each of which is incorporated herein by reference in its entirety: ● US patent application serial number 16 / 024.090, entitled CA-
[0043] [0043] The applicant for this application holds the following provisional US patent applications, filed on June 28, 2018, with the description of each of which is incorporated herein by reference in its entirety: ● US provisional patent application n Serial number 62 / 691.228, entitled A Method of using reinforced flex circuits with multiple sensors with electrosurgical devices; ● US provisional patent application serial number 62 / 691.227, entitled controlling a surgical instrument according to sensed closure para- meters; ● US provisional patent application serial number 62 / 691.230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE; ● US provisional patent application serial number 62 / 691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL; ● US provisional patent application serial number 62 / 691,257, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PA-
[0044] [0044] The applicant for this application holds the following provisional US patent applications, filed on April 19, 2018, with the description of each of which is incorporated by reference in its entirety for reference in its entirety: ● US provisional patent application serial number 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[0045] [0045] The applicant for this application holds the following provisional US patent applications, filed on March 30, 2018, with the description of each of which is incorporated herein by reference in its entirety: ● US provisional patent application n Serial number 62 / 650,898, filed on March 30, 2018, entitled CAPACITIVE COU- PLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS; ● US provisional patent application serial number 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILI- TIES; ● US provisional patent application serial number 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and ● US provisional patent application serial number 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS.
[0046] [0046] The applicant for the present application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety: ● US patent application serial number 15 / 940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICA- TION CAPABILITIES;
[0047] [0047] The applicant for the present application holds the following provisional US patent applications, filed on March 28, 2018, with the description of each of which is incorporated herein by reference in its entirety: ● US provisional patent application n ° 62 / 649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICA- TION CAPABILITIES; ● US provisional patent application serial number 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RE- CORDS AND CREATE ANONYMIZED RECORD; ● US provisional patent application serial number 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS; ● US provisional patent application serial number 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVI- CES IN OPERATING THEATER; ● US Provisional Patent Application No. 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; ● US provisional patent application No. 62 / 649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT; ● US Provisional Patent Application No. 62 / 649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVI- CES;
[0048] [0048] The applicant for this application holds the following provisional US patent applications, filed on March 8, 2018, the description of each of which is incorporated herein by reference in its entirety for reference: ● US provisional patent application n Serial number 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and ● US provisional patent application serial number 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[0049] [0049] The applicant for this application holds the following provisional US patent applications, filed on December 28, 2017, the description of each of which is incorporated herein by reference in its entirety: ● Application for US provisional patent serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM; ● US provisional patent application serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and ● US provisional patent application serial number 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[0050] [0050] Before explaining in detail the various aspects of surgical instruments and generators, it should be noted that the illustrative examples are not limited, in terms of application or use, to the details of construction and arrangement of parts illustrated in the drawings and in the attached description. Illustrative examples can be implemented or incorporated into other aspects, variations and modifications, and can be practiced or executed in several ways. Furthermore, except where otherwise indicated, the terms and expressions used in the present invention were chosen for the purpose of describing illustrative examples for the convenience of the reader and not for the purpose of limiting it. In addition, it should be understood that one or more of the aspects, expressions of aspects, and / or examples described below can be combined with any one or more of the other aspects, expressions of aspects and / or examples described below. Central surgical controllers
[0051] [0051] With reference to Figure 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (for example, cloud 104 which may include a remote server 113 coupled to a device storage 105). Each surgical system 102 includes at least one central surgical controller 106 communicating with the cloud 104 which can include a remote server 113. In one example, as shown in Figure 1, surgical system 102 includes a display system 108 , a robotic system 110, a smart handheld surgical instrument 112, which are configured to communicate with each other and / or the central controller 106. In some respects, a surgical system 102 may include a number of M 106 central controllers , an N number of visualization systems 108, an O number of robotic systems 110, and a P number of smart, hand-held surgical instruments 112, where M, N, O, and P are integers greater than or equal the one.
[0052] [0052] Figure 2 represents an example of a surgical system 102 being used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in the procedure surgical procedure as a part of the surgical system 102. The robotic system 110 includes a surgeon console 118, a patient car 120 (surgical robot), and a robotic central surgical controller
[0053] [0053] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present description are described in provisional patent application no. 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLAT-FORM, filed on December 28, 2017, the description of which is incorporated herein by reference in its entirety for reference.
[0054] [0054] Several examples of cloud-based analysis that are performed by the cloud 104, and are suitable for use with the present description, are described in US provisional patent application serial number 62 / 611.340, entitled CLOUD -BASED MEDICAL ANALYTICS, deposited on December 28, 2017, the description of which is incorporated herein by reference, in its entirety.
[0055] [0055] In several 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, load-coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.
[0056] [0056] The optical components of the imaging device 124 may include one or more light sources and / or one or more lenses. One or more light sources can be directed to illuminate portions of the surgical field. The one or more image sensors can receive reflected or refracted light from the surgical field, including reflected or refracted light from the tissue and / or surgical instruments.
[0057] [0057] One or more light sources can be configured to radiate electromagnetic energy in the visible spectrum, as well as in the invisible spectrum. The visible spectrum, sometimes called the optical spectrum or light spectrum, is that portion of the electromagnetic spectrum that is visible to (that is, can be detected by) the human eye and can be called visible light or simply light. A typical human eye will respond to wavelengths in the air that are from about 380 nm to about 750 nm.
[0058] [0058] The invisible spectrum (that is, the non-luminous spectrum) is that portion of the electromagnetic spectrum located below and above the visible spectrum (that is, 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 visible red spectrum, and they become invisible infrared (IR), microwaves, radio and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and gamma-ray electromagnetic radiation.
[0059] [0059] In several aspects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present description include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledocoscope, colonoscope, cytoscope, duodenoscope, endo-roscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngoscope, sigmoidoscope, thoracoscope, and uteroscope.
[0060] [0060] In one aspect, the imaging device uses multiple spectrum monitoring to discriminate topography and underlying structures. A multispectral image is one that captures image data within wavelength bands across the electromagnetic spectrum. Wavelengths can be separated by filters or by using instruments that are sensitive to specific wavelengths, including light from frequencies beyond the visible light range, for example, IR and ultraviolet light. The spectral images can allow the extraction of additional information that the human eye cannot capture with its receivers for the colors red, green, and blue. The use of multispectral imaging is described in greater detail under the heading "Advanced Imaging Acquisition Model" in US provisional patent application serial number 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is incorporated herein by reference in its entirety. Multispectral monitoring can be a useful tool for relocating a surgical field after a surgical task is completed to perform one or more of the tests previously described on the treated tissue.
[0061] [0061] It is axiomatic that strict sterilization of the operating room and surgical equipment is necessary during any surgery. The strict hygiene and sterilization conditions required in an "operating room", that is, an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including imaging device 124 and its connectors and components. It will be understood that the sterile field can be considered a specified area, such as inside a tray or on a sterile towel, which is considered free of microorganisms, or the sterile field can be considered an area, immediately around a patient, who was prepared to perform a surgical procedure. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area.
[0062] [0062] In several aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage matrices and one or more screens that are strategically arranged in relation to the field sterile, as shown in Figure 2. In one aspect, the display system 108 includes an interface for HL7, PACS and EMR. Various components of the 108 display system are described under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLAT-FORM, filed on December 28, 2017, the description of which is hereby incorporated by reference in its entirety.
[0063] [0063] As shown in Figure 2, a primary screen 119 is positioned in the sterile field to be visible to the operator on the operating table 114. In addition, a viewing tower 111 is positioned outside the sterile field. The display tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. The visualization system 108, guided by the central controller 106, is configured to use screens 107, 109, and 119 to coordinate the flow of information to operators inside and outside the sterile field. For example, central controller 106 can have visualization system 108 display a snapshot of a surgical site, as recorded by an imaging device 124, on a non-sterile screen 107 or 109, while transmitting to the live from the surgical site on the main screen 119. The instant on the non-sterile screen 107 or 109 can allow a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.
[0064] [0064] In one aspect, the central controller 106 is also configured to route an entry or diagnostic feedback by a non-sterile operator in the display tower 111 to the primary screen 119 within the sterile field, where it can be seen by a sterile operator on the operating table. In one example, the entry may be in the form of a modification of the snapshot displayed on the non-sterile screen 107 or 109, which can be routed to main screen 119 by central controller 106.
[0065] [0065] With reference to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system 102. The central controller 106 is also configured to coordinate the flow of information to a screen of the surgical instrument 112. For For example, the flow of coordinated information is further described in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, deposited on December 28, 2017, the content of which is incorporated here for reference , in its entirety. An entry or diagnostic feedback inserted by a non-sterile operator in the viewing tower 111 can be routed by the central controller 106 to the surgical instrument screen 115 in the sterile field, where it can be seen by the operator of the surgical instrument 112. Instruments Exemplary surgical instruments that are suitable for use with surgical system 102 are described under the title "Hardware of Surgical Instruments" in US provisional patent application serial number 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on 28 December 2017, whose description is hereby incorporated by way of reference, in its entirety, for example.
[0066] [0066] Now with reference to Figure 3, a central controller 106 is shown in communication with a visualization system 108, a robotic system 110 and an intelligent handheld surgical instrument 112. Central controller 106 includes a central controller screen 135, an imaging module 138, a generator module 140 (which may include a monopolar generator 142, a bipolar generator 144 and / or an ultrasonic generator 143), a communication module 130, a processor module 132 and a storage matrix 134. In certain respects, as shown in Figure 3, the central controller 106 additionally includes a smoke evacuation module 126, a suction / irrigation module 128 and / or an OR 133 mapping module.
[0067] [0067] During a surgical procedure, the application of energy to the tissue, for sealing and / or cutting, is generally associated with the evacuation of smoke, suction of excess fluid and / or irrigation of the tissue. Fluid, power, and / or data lines from different sources are often intertwined during the surgical procedure. Valuable time can be wasted in addressing this issue during a surgical procedure. To untangle the lines, it may be necessary to disconnect the lines from their respective modules, which may require a restart of the modules. The modular housing of the central controller 136 offers a unified environment for managing power, data and fluid lines, which reduces the frequency of entanglement between such lines.
[0068] [0068] The aspects of the present description present a central surgical controller for use in a surgical procedure that involves the application of energy to the tissue at a surgical site. The central surgical controller includes a central controller housing and a combination generator module received slidingly at a central controller housing docking station. The docking station includes data and power contacts. The combined generator module includes two or more of an ultrasonic energy generating component, a bipolar RF energy generating component, and a monopolar RF energy generating component that are housed in a single unit. In one aspect, the combined generator module also includes a smoke evacuation component, at least one power application cable to connect the combined generator module to a surgical instrument, at least one smoke evacuation component. configured to evacuate smoke, fluid, and / or particulates generated by applying therapeutic energy to the tissue, and a fluid line that extends from the remote surgical site to the smoke evacuation component.
[0069] [0069] 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 central controller housing. In one aspect, the central controller housing comprises a fluid interface.
[0070] [0070] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the tissue, while another type of different energy 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 description present a solution in which a modular housing of the central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the central modular housing 136 is that it allows the quick removal and / or replacement of several modules.
[0071] [0071] Aspects of the present description feature a modular surgical wrap for use in a surgical procedure that involves applying energy to the tissue. The modular surgical housing includes a first energy generator module, configured to generate a first energy for application to the tissue, and a first docking station that comprises a first docking port that includes first data and energy contacts, the first module being - the power generator module is movable in a sliding way in an electric coupling with the power and data contacts and the first power generator module is movable in a sliding way out of the electric coupling with the first power and data contacts.
[0072] [0072] In addition to the above, the modular surgical enclosure also includes a second energy generator module configured to generate a second energy, different from the first energy, for application to the tissue, and a second docking station that comprises it has a second coupling port that includes second data and power contacts, the second power generator module being slidably movable in an electrical coupling with the energy and data contacts, and the second module The power generator is slidably movable out of the electrical coupling with the second power and data contacts.
[0073] [0073] In addition, the modular surgical cabinet also includes a communication bus between the first coupling port and the second coupling port, configured to facilitate communication between the first power generator module and the second power generator module .
[0074] [0074] With reference to Figures 3 to 7, aspects of the present description are presented for a modular housing of the central controller 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126, and a suction module / irrigation 128. The central modular enclosure 136 further facilitates interactive communication between modules 140, 126, 128. As shown in Figure 5, generator module 140 can be a generator module with monopolar components , integrated bipolar and ultrasonic devices, supported in a single cabinet unit 139 slidably inserted into the central modular housing 136. As shown in Figure 5, generator module 140 can be configured to connect to a monopolar device 146, a device bipolar 147 and an ultrasonic device
[0075] [0075] In one aspect, the central modular housing 136 comprises a modular power and a back communication board 149 with external and wireless communication heads to allow removable securing of modules 140, 126, 128 and interactive communication between them.
[0076] [0076] In one aspect, the central modular housing 136 includes docking stations, or drawers, 151, here also called dowels, which are configured to slide modules 140, 126, 128. Figure 4 illustrates a partial perspective view of a central surgical controller housing 136, and a combined generating module 145 slidably received at a docking station 151 of the central surgical controller housing 136. A docking port 152 with power and data contacts on a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the central housing modular housing 136 according to the general module combined controller 145 is slid into position at the corresponding docking station 151 of the central controller modular housing
[0077] [0077] In several respects, the smoke evacuation module 126 includes a fluid line 154 that carries captured / collected fluid fluid away from a surgical site and to, for example, the smoke evacuation module 126. The vacuum suction that originates from the smoke evacuation module 126 can pull 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 that ends in the smoke evacuation module 126. The utility conduit and the fluid line define a fluid path that extends towards the smoke evacuation module 126 which is received in the central controller housing 136.
[0078] [0078] In several aspects, the suction / irrigation module 128 is coupled to a surgical tool comprising a fluid suction line and a fluid suction line. In one example, the suction and suction fluid lines are in the form of flexible tubes that extend from the surgical site towards the suction / irrigation module 128. One or more drive systems can be configured to make irrigation and aspiration of fluids to and from the surgical site.
[0079] [0079] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end of the same and at least an energy treatment associated with the end actuator, a suction tube, and a irrigation pipe. The suction tube can have an inlet port at a distal end and the suction tube extends through the drive shaft. Similarly, an irrigation pipe can extend through the drive shaft and may have an entrance port close to the power application implement. The power application implement is configured to supply ultrasonic and / or RF energy to the surgical site and is coupled to the generator module 140 by a cable that initially extends through the drive shaft.
[0080] [0080] The irrigation tube can be in fluid communication with a fluid source, and the suction 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 central controller housing 136 separately from the control module. suction / irrigation
[0081] [0081] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the central modular housing 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts in the docking stations of the central modular housing
[0082] [0082] In some respects, the drawers 151 of the central modular housing 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 respects, drawers 151 are different in size and are each designed to accommodate a specific module.
[0083] [0083] In addition, the contacts of a specific module can be switched to engage with the contacts of a specific drawer to avoid the insertion of a module in a drawer with unpaired contacts.
[0084] [0084] As shown in Figure 4, the coupling port 150 of one drawer 151 can be coupled to the coupling port 150 of another drawer 151 via a communication link 157 to facilitate interactive communication between the modules housed in the central modular housing 136. The coupling ports 150 of the central modular housing 136 can, alternatively or additionally, facilitate interactive wireless communication between the modules housed in the central modular housing 136. Any suitable wireless communication can be used, for example, Air Titan Bluetooth.
[0085] [0085] Figure 6 illustrates individual power bus connectors for a plurality of side coupling ports of a lateral modular compartment 160 configured to receive a plurality of modules from a central surgical controller 206. The modular compartment side 160 is configured to receive and later interconnect modules 161. The modules 161 are slidably inserted into the docking stations 162 of the side modular compartment 160, which includes a back plate for interconnecting the modules 161. As shown in Figure 6, modules 161 are arranged laterally in the side modular cabinet 160. Alternatively, modules 161 can be arranged vertically in a side modular cabinet.
[0086] [0086] Figure 7 illustrates a vertical modular cabinet 164 configured to receive a plurality of modules 165 from the central surgical controller 106. Modules 165 are slidably inserted into docking stations, or drawers, 167 of vertical modular cabinet 164, which includes a rear panel for interconnection of modules 165. Although drawers 167 of vertical modular cabinet 164 are arranged vertically, in certain cases, a vertical modular cabinet 164 may include drawers that are arranged laterally . In addition, modules 165 can interact with each other through the coupling ports of the vertical modular cabinet 164. In the example in Figure 7, a screen 177 is provided to show data relevant to the operation of modules 165. In addition, the vertical modular compartment 164 includes a master module 178 that houses a plurality of submodules that are received slidingly in the master module 178.
[0087] [0087] In several respects, 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 compartment that can be mounted with a light source module and a camera module. The compartment can be a disposable compartment. In at least one example, the disposable compartment 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 selected selectively 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 imaging the scanned beam. Similarly, the light source module can be configured to provide a white light or a different light, depending on the surgical procedure.
[0088] [0088] 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 other light source may be inefficient. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present description is configured to allow the replacement of a light source module or a "midstream" camera module during a surgical procedure, without the need to remove the imaging device from the surgical field.
[0089] [0089] In one aspect, the imaging device comprises a tubular compartment that includes a plurality of channels. A first channel is configured to receive the Camera module in a sliding way, which can be configured for a snap-fit fit (pressure fit) with the first channel. A second channel is configured to slide the camera module, which can be configured for a snap-fit fit (pressure fit) with the first channel. In another example, the camera module and / or the light source module can be rotated to an end position within their respective channels. A threaded coupling can be used instead of a pressure fitting.
[0090] [0090] In several examples, multiple imaging devices are placed in different positions in the surgical field to provide multiple views. Imaging module 138 can be configured to switch between imaging devices to provide an ideal view. In several respects, imaging module 138 can be configured to integrate images from different imaging devices.
[0091] [0091] Various image processors and imaging devices suitable for use with the present description are described in US patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIO-NAL IMAGE PROCESSOR, granted on August 9, 2011 which is here incorporated as a reference in its entirety. In addition, US patent No. 7,982,776, entitled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued on July 19, 2011, which is incorporated herein by reference in its entirety, describes various systems for removing motion artifacts from image data. Such systems can be integrated with imaging module 138. In addition to these, the publication of US patent application No. 2011/0306840, entitled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS, published on December 15, 2011, and the publication of the application US Patent No. 2014/0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published on August 28, 2014, which are each incorporated herein by reference in their entirety.
[0092] [0092] Figure 8 illustrates a surgical data network 201 that comprises a modular communication center 203 configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment. in a utility facility specially equipped for surgical operations, to a cloud-based system (for example, cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular communication center 203 comprises a central network controller 207 and / or a network key 209 in communication with a network router. The modular communication center 203 can also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 can be configured as a passive, intelligent, or switching network. A passive surgical data network serves as a conduit for data, allowing data to be transmitted from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network includes features to allow traffic to pass through the surgical data network to be monitored and to configure each port on the central network controller 207 or network key 209. An intelligent surgical data network
[0093] [0093] Modular devices 1a to 1n located in the operating room can be coupled to the modular communication center 203. The central network controller 207 and / or the network key 209 can be coupled to a network router 211 to connect devices 1a to 1n to the cloud 204 or to the local computer system 210. The data associated with devices 1a to 1n can be transferred to cloud-based computers via the router for remote data processing and manipulation. The data associated with devices 1a to 1n can also be transferred to the local computer system 210 for processing and manipulation of the local data. Modular devices 2a to 2m located in the same operating room can also be coupled to a network switch 209. The network switch 209 can be attached to the central network controller 207 and / or to the network router 211 to connect the devices. devices 2a to 2m to cloud 204. Data associated with devices 2a to 2n can be transferred to cloud 204 via network router 211 for data processing and manipulation. The data associated with devices 2a to 2m can also be transferred to the local computer system 210 for processing and manipulation of the local data.
[0094] [0094] It will be understood that the surgical data network 201 can be expanded by interconnecting multiple central network controllers 207 and / or multiple network keys 209 with multiple network routers 211. The modular communication center 203 may be contained in a modular control roaster configured to receive multiple devices 1a to 1n / 2a to 2m. The local computer system 210 can also be contained in a modular control tower. The modular communication center 203 is connected to a screen 212 to display the images obtained by some of the devices 1a to 1n / 2a to 2m, for example, during surgical procedures. In several respects, devices 1a to 1n / 2a to 2m may include, for example, several 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 matrix 134, a surgical device attached to a screen, and / or a non-contact sensor module, among other modular devices that can be connected to the modular communication center 203 of the surgical data network 201.
[0095] [0095] In one aspect, the surgical data network 201 can comprise a combination of central network controllers, network switches, and network routers that connect devices 1a to 1n / 2a to 2m to the cloud. Any or all of the devices 1a to 1n / 2a to 2m coupled to the central network controller or network key can collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be understood that cloud computing depends on sharing computing resources instead of having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "cloud computing" can be used here to refer to "a type of Internet-based computing", in which different services - such as servers, storage, and applications - are applied to the center modular communication system 203 and / or computer system 210 located in the operating room (for example, a fixed, mobile, temporary, or operating room or operating space) and devices connected to the modular communication center 203 and / or to computer system 210 through the
[0096] [0096] The application of cloud computer data processing techniques to the data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs, and better patient satisfaction. At least some of the devices 1a to 1n / 2a to 2m can be used to visualize the states of the tissue to assess the occurrence of leaks or perfusion of sealed tissue after a procedure of sealing and cutting the tissue. At least some of the devices 1a to 1n / 2a to 2m can be used to identify the pathology, such as the effects of disease, with the use of cloud-based computing to examine data including images of body tissue samples for diagnostic purposes . This includes confirmation of the location and margin of the tissue and phenotypes. At least some of the devices 1a to 1n / 2a to 2m can be used 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. Data collected by devices 1a to 1n / 2a to 2m, including image data, can be transferred to the cloud 204 or the local computer system 210 or both for data processing and manipulation including data processing and manipulation. Image. The data can be analyzed to improve the results of the surgical procedure by determining whether additional treatment, such as the application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention, precise robotics at specific sites and conditions of fabric, can be followed. This data analysis can additionally use analytical processing of the results, and with the use of standardized approaches they can provide beneficial standardized feedback both to confirm surgical treatments and the surgeon's behavior or to suggest modifications to surgical treatments and the behavior of the surgeon. surgeon.
[0097] [0097] In an implementation, devices from the operating room 1a to 1n can be connected to the modular communication center 203 via a wired channel or a wireless channel depending on the configuration of devices 1a to 1n on a controller. central network. The central network controller 207 can be implemented, in one aspect, as a local network transmission device that acts on the physical layer of the open system interconnection model ("OSI" - open system interconnection). The central network controller provides connectivity to devices 1a to 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends it to the router in half - duplex mode. The central network controller 207 does not store any media access control / Internet protocol (MAC / IP) to transfer data from the device. Only one of the devices 1a to 1n at a time can send data through the central network controller 207. The central network controller 207 does not have routing tables or intelligence about where to send information and transmits all data on the network through each connection and a remote server 213 (Figure 9) in the cloud 204. The central network controller 207 can detect basic network errors, such as collisions, but having all (admit that) the information transmitted to multiple input ports can be a risk security and cause bottlenecks.
[0098] [0098] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 through a wired or wireless channel. The network key 209 works in the data connection layer of the OSI model. The network key 209 is a multicast device for connecting devices 2a to 2m located in the same operation center to the network. The network key 209 sends data in frame form to the network router 211 and works in full duplex mode. Multiple devices 2a to 2m can send data at the same time via network key 209. Network key 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.
[0099] [0099] The central network controller 207 and / or the network key 209 are coupled to the network router 211 for a connection to the cloud
[0100] [0100] In one example, the central network controller 207 can be implemented as a central USB controller, which allows multiple USB devices to be connected to a host computer. The central USB controller can expand a single USB port on several levels so that more ports are available to connect the devices to the system's host computer. The central network controller 207 can include wired or wireless capabilities to receive information about a wired channel or a wireless channel. In one aspect, a wireless radio communication protocol for wireless, broadband and short-range USB wireless can be used for communication between devices 1a to 1n and devices 2a to 2m located in the room. operation.
[0101] [0101] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the modular communication center 203 via standard Bluetooth wireless technology for exchanging data over short distances (using short-wavelength UHF radio waves in the 2.4 to 2.485 GHz ISM band) from fixed and mobile devices and to build personal area networks ("PANs" - personal area networks). In other respects, operating room devices 1a to 1n / 2a to 2m can communicate with the modular communication center 203 through a number of wireless and wired communication standards or protocols, including, but not limited to, limiting to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution ("LTE" - long-term evolution), 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 can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Blue-
[0102] [0102] The modular communication center 203 can serve as a central connection for one or all devices in the operating room 1a to 1n / 2a to 2m and handles a data type known as frames. The tables carry the data generated by the devices 1a to 1n / 2a to 2m. When a frame is received by the modular communication center 203, it is amplified and transmitted to the network router 211, which transfers the data to the cloud computing resources using a series of wireless communication standards or protocols or with wire, as described in the present invention.
[0103] [0103] The modular communication center 203 can be used as a standalone device or be connected to compatible central network controllers and network switches to form a larger network. The modular communication center 203 is, in general, easy to install, configure and maintain, making it a good option for the network of devices 1a to 1n / 2a to 2m from the operating room.
[0104] [0104] Figure 9 illustrates an interactive surgical system, implemented by computer 200. The interactive surgical system implemented by computer 200 is similar in many ways to the interactive surgical system, implemented by computer 100. For example, the surgical system, interactive , implemented by computer 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one central surgical controller 206 in communication with a cloud 204 which 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 devices
[0105] [0105] Figure 10 illustrates a central surgical controller 206 comprising a plurality of modules coupled to the modular control tower 236. The modular control tower 236 comprises a modular communication center 203, for example, a network connectivity device, and a computer system 210 for providing local processing, visualization, and imaging, for example. As shown in Figure 10, the modular communication center 203 can be connected in a layered configuration to expand the number of modules (for example, devices) that can be connected to the modular communication center 203 and transfer data associated with modules to computer system 210, cloud computing resources, or both. As shown in Figure 10, each of the central controllers / network switches in the modular communication center 203 includes three downstream ports and one upstream port. The central controller / network switch upstream is connected to a processor to provide a communication connection with the cloud computing resources and a local display 217. Communication with the cloud 204 can be done through a communication channel wired or wireless.
[0106] [0106] The central surgical controller 206 uses a non-contact sensor module 242 to measure the dimensions of the operating room and generate a map of the operating room using non-contact measuring devices such as laser or ultrasonic. An ultrasound-based non-contact sensor module scans the operating room by transmitting an ultrasound explosion and receiving an echo when it bounces outside the perimeter of the walls of an operating room, as described under the heading “ Surgical Hub Spatial Awareness Within an Operating Room "in US Provisional Patent Application Serial No. 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, deposited on December 28, 2017, which is hereby incorporated by reference in its entirety, in which sensor module is configured to determine the size of the operating room and adjust the Bluetooth pairing distance limits A laser-based non-contact sensor module scans the operating room by transmitting pulses of laser light, receiving pulses of laser light that jump from the perimeter walls of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust Bluetooth pairing distance limits, for example.
[0107] [0107] Computer system 210 comprises a processor 244 and a network interface 245. Processor 244 is coupled to a communication module 247, storage 248, memory 249, non-volatile memory 250, and an input / output interface 251 via a system bus. The system bus can be any of several types of bus structures, including the memory bus or memory controller, a peripheral bus or external bus, and / or a local bus that uses any variety of architectures. available buses including, but not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charm Architecture (MSA), extended ISA (EISA), smart drive electronics (IDE), local VESA bus (VLB), interconnection of peripheral components (PCI), USB, accelerated graphics port (AGP), international memory card association bus for personal computers ("PCMCIA" - Personal Computer Memory Card International Association ), Small Computer Systems Interface (SCSI), or any other proprietary bus.
[0108] [0108] Processor 244 can be any single-core or multi-core processor, such as those known under the trade name of ARM Cortex available from Texas Instruments. In one aspect, the processor can be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises a 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a seek-ahead buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWare® program, memory 2 KB electrically erasable programmable read-only (EEPROM), one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more analog to digital converters ( 12-bit ADC) with 12 analog input channels, details of which are available for the product data sheet.
[0109] [0109] In one aspect, processor 244 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[0110] [0110] System memory includes volatile and non-volatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during startup, is stored in non-volatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EE-PROM or flash memory. Volatile memory includes random access memory (RAM), which acts as an external cache memory. In addition, 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 RAM Rambus RAM (DRRAM).
[0111] [0111] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, for example disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card or memory stick ( pen drive). In addition, the storage disc may 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 (CD-ROM) device recordable (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a versatile digital ROM drive (DVD-ROM). To facilitate the connection of disk storage devices to the system bus, a removable or non-removable interface can be used.
[0112] [0112] It is to be understood that computer system 210 includes software that acts as an intermediary between users and the basic resources of the computer described in an appropriate operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from the management capabilities of the operating system through program modules and program data stored in the system's memory or storage disk. It is to be understood that the various components described in the present invention can be implemented with various operating systems or combinations of operating systems.
[0113] [0113] A user enters commands or information into the computer system 210 through the input device (s) coupled to the I / O interface 251. Input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, keyboard, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like . These and other input devices connect to the processor via the system bus via the interface port (s). The interface ports include, for example, a serial port, a parallel port, a game port and a USB. Output devices use some of the same types of ports as input devices. In this way, for example, a USB port can be used to provide input to the computer system and to provide computer system information to an output device. An output adapter is provided to illustrate that there are some output devices such as monitors, screens, speakers, and printers, among other output devices, that need special adapters. 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 device systems, such as remote computers, provide input and output capabilities.
[0114] [0114] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. Remote cloud computers can be a personal computer, server, router, personal network computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include many or all elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system via a network interface and then physically connected via a communication connection. The network interface covers 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 such as digital integrated service networks (ISDN) and variations in them, packet switching networks and digital subscriber lines (DSL).
[0115] [0115] In several respects, computer system 210 of Figure 10, imaging module 238 and / or display system 208, and / or processor module 232 of Figures 9 to 10, may comprise a processor of image, image processing engine, media processor, or any specialized digital signal processor (DSP) used for processing digital images. The image processor can use parallel computing with multi-data instruction (SIMD) or multi-data instruction (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor can be a system in an integrated circuit with a multi-core processor architecture.
[0116] [0116] Communication connections refer to the hardware / software used to connect the network interface to the bus. Although the communication connection is shown for illustrative clarity within the computer system, it can also be external to the computer system 210. The hardware / software required for connection to the network interface includes, for purposes only illustrative, internal and external technologies such as modems, including regular telephone series modems, cable modems and DSL modems, ISDN adapters and Ethernet cards.
[0117] [0117] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 central network controller device, in accordance with at least one aspect of the present description. As illustrated, the USB 300 central network controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The USB 300 core network controller is a CMOS device that provides one USB transceiver port 302 and up to three USB transceiver ports downstream 304, 306, 308 in accordance with the USB 2.0 specification. Upstream USB transceiver port 302 is a differential data root port comprising a "minus" (DM0) differential data input paired with a "plus" (DP0) differential data input. The three ports of the downstream USB transceiver 304, 306, 308 are differential data ports, with each port including "more" differential data outputs (DP1-DP3) paired with "less" differential data outputs (DM1-DM3) .
[0118] [0118] The USB 300 central network controller device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compatible 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 as low speed automatically configuring the scan rate according to the speed of the device attached to the ports. The USB 300 central network controller device can be configured in bus-powered or self-powered mode and includes 312 central power logic to manage power.
[0119] [0119] The USB 300 central network controller device includes a 310 series interface engine (SIE). The SIE 310 is the front end of the USB 300 central network controller hardware and handles most of the protocol described in chapter 8 of the USB specification. SIE 310 typically comprises signaling down to the transaction level. The functions it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection / generation, clock / data separation, non-zero data encoding / decoding inverted (NRZI), generation and verification of CRC (token and data), generation and verification / decoding of packet ID (PID), and / or series-parallel / parallel-series conversion. The 310 receives a clock input 314 and is coupled to a suspend / resume logic circuit and frame timer 316 and a repeating circuit 318 of the central controller to control communication between the USB transceiver port 302 and the USB transceiver ports downstream 304, 306, 308 through the logic circuits of ports 320, 322,
[0120] [0120] In several aspects, the USB 300 central network controller can connect 127 functions configured in up to six logical layers (levels) to a single computer. In addition, the USB 300 central network controller can connect all peripherals using a standardized four-wire cable that provides both communication and power distribution. The power settings are bus-powered and self-powered modes. The USB 300 central network controller can be configured to support four power management modes: a bus-powered central controller, with individual port power management or grouped port power management, and the self-powered central controller, with individual door power management or grouped door power management. In one aspect, using a USB cable, the USB 300 central network controller, the USB transceiver port 302 is plugged into a USB host controller, and the USB transceiver ports downstream 304, 306, 308 are exposed to connect compatible USB devices, and so on.
[0121] [0121] Additional details regarding the structure and function of the central surgical controller and / or networks of central surgical controllers can be found in provisional US patent application 62/659,900, entitled METHOD OF HUB COMMUNICATION, deposited on April 19, 2018, which is incorporated herein by reference, in its entirety. Cloud system hardware and functional modules
[0122] [0122] Figure 12 is a block diagram of the interactive surgical system implemented by computer, according to at least one aspect of the present description. 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 central surgical controllers, surgical instruments, robotic devices, and operating rooms or healthcare facilities. The computer-implemented interactive surgical system comprises a cloud-based data analysis system. Although the cloud-based data analysis system is described as a surgical system, it is not necessarily limited with such and could be a cloud-based medical system in general. As shown in Figure 12, the cloud-based data analysis system comprises a plurality of surgical instruments 7012 (may be the same or similar to instruments 112), a plurality of central surgical controllers 7006 (may be the same or similar to controllers central 106) and a surgical data network 7001 (can be the same or similar to network 201) to couple central surgical controllers 7006 to cloud 7004 (can be the same or similar to cloud 204). Each of the plurality of central surgical controllers 7006 is communicatively coupled to one or more surgical instruments 7012. Central controllers 7006 are also connected in a communicable way to the cloud 7004 of the interactive surgical system implemented by computer over the network 7001. The 7004 cloud 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 Figure 12, access to the 7004 cloud is achieved through the 7001 network, which can be the Internet or some other suitable computer network. Central surgical controllers 7006 that are coupled to the 7004 cloud can be considered the client side of the cloud computing system (ie, cloud-based data analysis system). Surgical instruments 7012 are paired with central surgical controllers 7006 for control and implementation of various surgical operations or procedures as described here.
[0123] [0123] In addition, surgical instruments 7012 can comprise transceivers for transmitting data to and from their corresponding central surgical controllers 7006 (which can also comprise transceivers). Combinations of surgical instruments 7012 and corresponding central controllers 7006 can indicate specific locations, such as operating rooms in health posts (for example, hospitals), to provide medical operations. For example, the memory of a central surgical controller 7006 can store location data. As shown in Figure 12, cloud 7004 comprises central servers 7013 (which can be the same or similar to remote server 113 in Figure 1 and / or remote server 213 in Figure 9), application servers for central controllers 7002, analysis modules data 7034 and an input / output interface ("I / O") 7007. Central servers 7013 of the cloud 7004 collectively administer the cloud computing system, which includes monitoring requests by central client controllers 7006 and managing the capacity of 7004 cloud processing to execute requests. Each of the central servers 7013 comprises one or more processors 7008 coupled to suitable memory devices 7010 which may include volatile memory, such as random access memory (RAM), and non-volatile memory, such as memory devices. magnetic storage. The 7010 memory devices can comprise machine executable instructions that, when executed, cause the 7008 processors to run the 7034 data analysis modules for cloud-based data analysis, operations, recommendations and other operations described below. In addition, 7008 processors can run data analysis modules 7034 independently or in conjunction with applications for central controllers independently run by central controllers 7006. Central servers 7013 also comprise aggregated medical databases 2212, which may reside in memory 2210.
[0124] [0124] Based on connections to multiple 7006 surgical centers via the 7001 network, the 7004 cloud can aggregate data from specific data generated by various 7012 surgical instruments and their corresponding 7006 central controllers. Such aggregated data can be stored in the aggregated medical data databases 7011 of the cloud 7004. In particular, the cloud 7004 can advantageously perform data analysis and operations on the aggregated data to produce insights and / or perform functions that control them. 7006 individual central controllers could not reach on their own.
[0125] [0125] The configuration of the specific cloud computing system described in this description is specifically designed to address various issues raised in the context of medical operations and procedures performed using medical devices, such as the 7012 surgical instruments , 112. In particular, surgical instruments 7012 can be digital surgical devices configured to interact with the 7004 cloud to implement techniques to improve the performance of surgical operations. Various 7012 surgical instruments and / or 7006 central surgical controllers can comprise touch-controlled user interfaces, so that doctors can control aspects of interaction between the 7012 surgical instruments and the cloud
[0126] [0126] Figure 13 is a block diagram that illustrates the functional architecture of the interactive surgical system implemented by computer, in accordance with at least one aspect of the present description. The cloud-based data analysis system includes a plurality of 7034 data analysis modules that can be run by the 7008 cloud 7004 processors to provide analytical data solutions for problems that arise specifically in the medical field. As shown in Figure 13, the functions of the 7034 cloud-based data analysis modules can be aided by applications for central controllers 7014 hosted by the application servers for central controllers 7002 that can be accessed on central surgical controllers 7006 The 7008 cloud computing processors and the 7014 central controller applications can operate together to perform the 7034 data analysis modules. The 7016 application program interface ("API") interfaces define the set protocols and routines that correspond to the applications for central controllers 7014. In addition, APIs 7016 manage the storage and retrieval of data in / from the aggregated medical data databases 7011 for the operations of the 7014 applications. 7018 cache memories also store data (for example, temporarily) and are coupled to 7016 APIs for further retrieval and data used by 7014 applications. The data analysis modules 7034 in Figure 13 include modules for resource optimization 7020, data collection and aggregation 7022, authorization and security 7024, update of 7026 control programs, analysis of results - patient data 7028, recommendations 7030 and data classification and prioritization 7032. Other suitable data analysis modules could also be implemented by the 7004 cloud, according to some aspects. In one respect, data analysis modules are used for specific recommendations based on analysis of trends, results and other data.
[0127] [0127] For example, the 7022 data collection and aggregation module could be used to generate self-describing data (eg, metadata), including the identification of notable features or configuration (eg, trends), the management of sets of redundant data and the storage of data in paired data sets that can be grouped by surgery, but not necessarily linked to surgical dates and to real surgeons. In particular, paired data sets generated from the operations of the 7012 surgical instruments may comprise application of a binary classification, for example, a bleeding or non-bleeding event. More generally, the binary classification can be characterized as a desirable event (for example, a successful surgical procedure) or an undesirable event (for example, a surgical instrument with failure or misuse 7012). The aggregated self-describing data can correspond to individual data received from various groups or subgroups of central surgical controllers 7006. Consequently, the 7022 data collection and aggregation module can manage aggregated metadata or other organized data based on raw data received of the 7006 central surgical controllers. For this purpose, the 7008 processors can be operationally coupled to the 7014 central controller applications and the 7011 aggregate medical databases to perform the data analysis modules
[0128] [0128] The resource optimization module 7020 can be configured to analyze this aggregated data to determine an optimal use of resources for a specific group or group of health posts. For example, the resource optimization module 7020 can determine an ideal ordering point for surgical stapling instruments 7012 for a group of clinics based on the corresponding expected demand for such instruments 7012. The optimization module for 7020 resources could also assess resource use or other operational configurations of various health facilities to determine whether resource use could be improved. Similarly, the 7030 recommendation module can be configured to analyze aggregated data organized from the 7022 data collection and aggregation module to provide recommendations. For example, the 7030 recommendations module could recommend for health care providers (for example, medical service providers such as hospitals) that a specific surgical instrument 7012 should be upgraded to an improved version based on a higher than expected error rate. , for example. In addition, the 7030 recommendation module and / or the 7020 resource optimization module could recommend better supply chain parameters, such as product refill points, and provide suggestions for a different 7012 surgical instrument, uses of it or steps procedure to improve surgical results. Health clinics can receive such recommendations through corresponding 7006 central surgical controllers. More specific recommendations on parameters or configurations of various 7012 surgical instruments can also be provided. Central controllers 7006 and / or surgical instruments 7012 may each also have display screens that display data or recommendations provided by the 7004 cloud.
[0129] [0129] The 7028 patient results analysis module can analyze surgical results associated with currently used operating parameters of 7012 surgical instruments. The 7028 patient results analysis module can also analyze and evaluate other potential operating parameters. In this context, the 7030 recommendations module could recommend the use of these other potential operating parameters based on obtaining better surgical results, such as better sealing or less bleeding. For example, the 7030 recommendation module could transmit recommendations to a central surgical controller 7006 about when to use a particular cartridge for a corresponding 7012 stapling surgical instrument. In this way, the cloud-based data analysis system, while controlling common variables, can be configured to analyze the large collection of raw data and provide centralized recommendations on multiple health posts (advantageously determined based on data aggregates). For example, the cloud-based data analysis system could analyze, evaluate and / or aggregate data based on the type of medical practice, type of patient, number of patients, geographical similarity between medical providers, which providers / medical posts use types similar to instruments, etc., in a way that no health post alone would be able to analyze independently.
[0130] [0130] The 7026 control program update module can be configured to implement various 7012 surgical instrument recommendations when the corresponding control programs are updated. For example, the Patient Results Analysis Module 7028 could identify correlations that link specific control parameters with successful (or unsuccessful) results. These correlations can be addressed when updated control programs are transmitted to 7012 surgical instruments via the 7026 control program update module. Updates to 7012 instruments that are transmitted via a corresponding 7006 central controller can incorporate data performance aggregates that were gathered and analyzed by the 7022 cloud 7004 data collection and aggregation module. In addition, the 7028 patient outcome analysis module and the 7030 recommendations module could identify better methods of using 7012 instruments based on aggregated performance data.
[0131] [0131] The cloud-based data analysis system can include safety features implemented by the 7004 cloud. These safety features can be managed by the authorization and safety module 7024. Each central surgical controller 7006 can have unique credentials associated with username, password and other appropriate security credentials. These credentials could be stored in memory 7010 and associated with a level of access allowed to the cloud. For example, based on the provision of exact credentials, a central surgical controller 7006 can be granted access to communicate with the cloud up to a predetermined point (for example, only certain defined types of information can participate in transmitting or receiving information) ). For this purpose, the aggregated medical databases 7011 of the cloud 7004 may comprise a database of authorized credentials to verify the accuracy of the supplied credentials. Different credentials can be associated with varying levels of permission to interact with the 7004 cloud, such as a predetermined access level to receive data analyzes generated by the cloud
[0132] [0132] In addition, for security purposes, the cloud could maintain a database of 7006 central controllers, 7012 instruments and other devices that may comprise a "black list" of prohibited devices. In particular, a blacklisted central surgical controller 7006 may not be allowed to interact with the cloud, while blacklisted surgical instruments 7012 may not have functional access to a corresponding 7006 central controller and / or may be prevented from fully functioning when paired with its corresponding central controller 7006. Additionally or alternatively, the cloud 7004 can signal instruments 7012 based on incompatibility or other specified criteria. In this way, counterfeit medical devices and inappropriate reuse of such devices across the cloud-based data analysis system can be identified and addressed.
[0133] [0133] Surgical instruments 7012 can use wireless transceivers to transmit wireless signals that can represent, for example, authorization credentials for access to the corresponding central controllers 7006 and the 7004 cloud. Wired transceivers can also be used to transmit signals. These authorization credentials can be stored on the respective memory devices of the instruments.
[0134] [0134] The cloud-based data analysis system can allow the monitoring of multiple health posts (for example, medical posts like hospitals) to determine improved practices and recommend changes (through the 2030 recommendations module, for example). example) accordingly. In this way, cloud 7004 processors 7008 can analyze the data associated with an individual health center to identify the health center and aggregate the data with other data associated with other health centers in a group. Groups could be defined based on similar operating practices or geographic location, for example. In this way, the 7004 cloud can provide analysis and recommendations for the entire group of health posts. The cloud-based data analysis system could also be used to increase situational awareness. For example, 7008 processors can predictively model the effects of recommendations on cost and effectiveness for a specific post (in relation to general operations and / or various medical procedures). The cost and effectiveness associated with that specific post can also be compared to a local region corresponding to other posts or any other comparable posts.
[0135] [0135] The 7032 data classification and prioritization module can prioritize and classify data based on severity (for example, the severity of a medical event associated with the data, unpredictability, distrust). This classification and prioritization can be used in conjunction with the functions of the other 7034 data analysis modules described above to improve the operation and cloud-based data analysis described here. For example, the 7032 data classification and prioritization module can assign a priority to the data analysis performed by the 7022 data collection and aggregation module and the 7028 patient outcome analysis module. Different levels of prioritization can result in specific responses from the 7004 cloud (corresponding to a level of urgency), such as escalation to an accelerated response, special processing, deletion of aggregated medical databases 7011 or other appropriate responses. In addition, if necessary, the 7004 cloud can transmit a request (for example, a push message) through the application servers to central controllers for additional data from corresponding 7012 surgical instruments. The push message can result in a notification displayed on the corresponding 7006 central controllers to request support or additional data. This push message may be necessary in situations where the cloud detects an irregularity or results outside of significant limits and the cloud cannot determine the cause of the irregularity. 7013 central servers can be programmed to activate 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 that security has been compounded, for example .
[0136] [0136] Additional details related to the cloud data analysis system can be found in US provisional patent application 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, which is here incorporated by reference, in its entirety. Situational recognition
[0137] [0137] While a "smart" device, including control algorithms responsive to detected data, can be an improvement over a "stupid" device that operates without taking the detected data, some detected data can be incomplete or inconclusive when considered in isolation, that is, without the context of the type of surgical procedure being performed or the type of tissue that is undergoing the surgery. Without knowing the context of the procedure (for example, knowing the type of tissue that is undergoing surgery, or the type of procedure that is being performed), the control algorithm may control the modular device incorrectly or suboptimally, detected data without specific context is provided. For example, the ideal way for a control algorithm to control a surgical instrument in response to a certain detected parameter may vary according to the type of particular tissue being operated. This is due to the fact that different types of tissue have different properties (for example, tear resistance) and, thus, respond differently to actions performed by surgical instruments. Therefore, it may be desirable for a surgical instrument to perform different actions when the same measurement is detected for a specific parameter. As a specific example, the optimal way in which to control a stapling and surgical cutting instrument in response to the instrument detecting an unexpectedly high force to close its end actuator, will vary depending on whether the type of tissue is susceptible or resistant tearing. For tissues that are susceptible to tearing, such as lung tissue, the instrument control algorithm would optimally slow the engine in response to an unexpectedly high force to close to prevent tissue breakage. For tissues that are tear resistant, such as stomach tissue, the instrument's control algorithm would optimally accelerate the engine in response to an unexpectedly high force to close to ensure that the end actuator is properly attached to the tissue. Without knowing whether lung or stomach tissue has been trapped, the control algorithm can make a decision below what is considered ideal.
[0138] [0138] One solution uses a central surgical controller including a system configured to derive information about the surgical procedure being performed based on data received from various data sources, and then control, accordingly, the modular devices Paired. In other words, the central surgical controller is configured to infer information about the surgical procedure from received data and, then, to control the modular devices paired with the central surgical controller based on the inferred context of the surgical procedure. Figure 14 illustrates a diagram of a surgical system with 5100 situational recognition, according to at least one aspect of the present description. In some examples, data sources 5126 include, for example, modular devices 5102 (which may include sensors configured to detect parameters associated with the patient and / or the modular device itself), databases 5122 (for example, an EMR database containing the patient's record); and 5124 monitoring devices (for example, a blood pressure monitor (BP) and an electrocardiography monitor (ECG)).
[0139] [0139] A central surgical controller 5104 that can be similar to surgical controller 106 in many ways, can be configured to derive contextual information related to the surgical procedure from the data based, for example, on the combination (s) ( specific data (s) received or in the specific order in which data is received from data sources 5126. Contextual information inferred from data received may include, for example, the type of surgical procedure being performed, the specific stage of the surgical procedure that the surgeon is performing, the type of tissue being operated on, or the body cavity that is the object of the procedure. This ability for some aspects of the 5104 central surgical controller to derive or infer information related to the surgical procedure from received data, can be called "situational perception." In one example, the central surgical controller 5104 can incorporate a situational perception system, which is the hardware and / or programming associated with the central surgical controller 5104 that derives contextual information related to the surgical procedure based on the data received.
[0140] [0140] The situational perception system of the central surgical controller 5104 can be configured to derive contextual information from data received from data sources 5126 in various ways. In one example, the situational awareness system includes a pattern recognition system, or machine learning system (for example, an artificial neural network), that has been trained in training data to correlate various inputs (for example , 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 inputs provided. In another example, the situational perception system may include a lookup table that stores pre-characterized contextual information regarding a surgical procedure in association with one or more entries (or ranges of entries) corresponding to the contextual information. In response to a query with one or more inputs, the lookup table can return the corresponding contextual information to the situational perception system to control the 5102 Modular devices. In an example, the contextual information received by the system's situational perception system central surgical controller 5104, are associated with a specific control setting or set of control settings for one or more 5102 modular devices. In another example, the situational awareness system includes an additional machine learning system, table search engine or other such system, generating or retrieving one or more control settings for one or more 5102 modular devices, when contextual information is provided as input.
[0141] [0141] A 5104 central surgical controller, which incorporates a situational awareness system, provides several benefits to the 5100 surgical system. One benefit includes improving the interpretation of detected and captured data, which in turn improves the accuracy of termination and / or use of data during the course of a surgical procedure. To return to a previous example, a 5104 central surgical controller with situational awareness could determine what type of tissue was being operated on; therefore, when an unexpectedly high force is detected to close the end actuator of the surgical instrument, the central surgical controller with situational perception 5104 could correctly accelerate or decelerate the surgical instrument motor for the tissue type.
[0142] [0142] As another example, the type of fabric being operated can affect the adjustments that are made to the load and compression rate thresholds of a stapling and surgical cutting instrument for a specific span measurement. A central surgical controller with situational perception 5104 could infer whether a surgical procedure being performed is a thoracic or abdominal procedure, allowing the central surgical controller 5104 to determine whether tissue clamped by an instrument end actuator stapling and surgical cutting is lung tissue (for a thoracic procedure) or stomach tissue (for an abdominal procedure). The central surgical controller 5104 can then properly adjust the load and compression rate thresholds of the surgical stapling and cutting instrument for the tissue type.
[0143] [0143] As yet another example, the type of body cavity that is being operated during an insufflation procedure, can affect the function of a smoke evacuator. A central surgical controller with situational perception 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure is using insufflation) and determine the type of procedure. As a type of procedure is usually performed in a specific body cavity, the 5104 central surgical controller can then adequately control the speed of the smoke evacuator motor to the body cavity being operated. In this way, a central surgical controller with 5104 situational awareness can provide a consistent amount of smoke evacuation to both thoracic and abdominal procedures.
[0144] [0144] As yet another example, the type of procedure being performed can affect the ideal energy level for an ultrasonic surgical instrument or radio frequency (RF) electrosurgical instrument to operate. Arthroscopic procedures, for example, require higher energy levels because the end actuator of the ultrasonic surgical instrument or RF electrosurgical instrument is immersed in fluid. A central surgical controller with situational perception 5104 can determine whether the surgical procedure is an arthroscopic procedure. The 5104 central surgical controller can then adjust the RF power level or the ultrasonic amplitude of the generator (ie, the "energy level") to compensate for the fluid-filled environment. Related to this, the type of tissue being operated on can affect the ideal energy level at which an ultrasonic surgical instrument or RF electrosurgical instrument operates. A central surgical controller with situational perception 5104 can 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 profile of tissue expected for the surgical procedure. In addition, a central surgical controller with 5104 situational awareness 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 central surgical controller
[0145] [0145] As yet another example, data can be extracted from additional data sources 5126 to improve the conclusions that the central surgical controller 5104 draws from a data source 5126. A central surgical controller with situational perception 5104 can increase ment the data he receives from modular devices 5102 with contextual information that he has accumulated, referring to the surgical procedure, from other data sources 5126. For example, a central surgical controller with situational perception 5104 can be configured to determine if hemostasis occurred (that is, if bleeding stopped at a surgical site), according to video or image data received from a medical imaging device. However, in some cases, video or image data may be inconclusive. Therefore, in one example, the 5104 central surgical controller can be additionally configured to compare a physiological measurement (for example, blood pressure detected by a BP monitor communicatively connected to the 5104 central surgical controller) with the visual or image data of hemostasis (for example, from a Medical Imaging device 124 (Figure 2) coupled in a communicable way to the central surgical controller 5104) to make a determination on the integrity of the staple line or tissue union. In other words, the situational perception system of the central surgical controller 5104 can consider the physiological measurement data to provide additional context in the analysis of the visualization data. The additional context can be useful when the visualization data can be inconclusive or incomplete in itself.
[0146] [0146] Another benefit includes proactively and automatically controlling paired modular devices 5102, according to the specific stage of the surgical procedure being performed to reduce the number of times medical personnel are required to interact com or control the 5100 surgical system during the course of a surgical procedure. For example, a central surgical controller with situational perception 5104 can proactively activate the generator to which an RF electrosurgical instrument is connected, if it is determined that a subsequent step in the procedure requires the use of the instrument. Proactively activating the power source allows the instrument to be ready for use as soon as the preceding step of the procedure is complete.
[0147] [0147] As another example, a central surgical controller with situational perception 5104 could determine whether the current or subsequent stage of the surgical procedure requires a different view or degree of magnification of the screen, according to the resource (s) (s) at the surgical site that the surgeon is expected to see. The central surgical controller 5104 could then proactively change the displayed view (provided, for example, by a medical imaging device to the visualization system 108), so that the screen automatically adjusts throughout the procedure surgical.
[0148] [0148] As yet another example, a central surgical controller with situational perception 5104 could determine which stage of the surgical procedure is being performed or will be performed subsequently and whether specific data or comparisons between the data will be required for that stage of the surgical procedure. The central surgical controller 5104 can be configured to call screens automatically based on data about the stage of the surgical procedure being performed, without waiting for the surgeon to request specific information.
[0149] [0149] Another benefit includes checking for errors during the configuration of the surgical procedure or during the course of the surgical procedure. For example, a central surgical controller with situational perception 5104 could determine whether the operating room is properly or ideally configured for the surgical procedure to be performed. The central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding checklists, product location, or configuration needs (for example, from a memory), and then compare the current operating room layout with the standard layout for the type of surgical procedure that the 5104 central surgical controller determines is being performed. In one example, the central surgical controller 5104 can be configured to compare the list of items for the procedure scanned by a suitable scanner 5132, for example and / or a list of devices paired with the central surgical controller 5104, with a manifest recommended or anticipated items and / or devices for the given surgical procedure. If there are any discontinuities between the lists, the central surgical controller 5104 can be configured to provide an alert indicating that a specific modular device 5102, patient monitoring device 5124 and / or another surgical item is missing. In one example, the central surgical controller 5104 can be configured to determine the position or relative distance of modular devices 5102 and patient monitoring devices 5124 using proximity sensors, for example. The 5104 central surgical controller can compare the relative positions of devices with a recommended or previous layout
[0150] [0150] As another example, the central surgical controller with situational awareness 5104 could determine whether the surgeon (or other medical personnel) was making a mistake or otherwise deviating from the expected course of action during the course of a surgical procedure. For example, the central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding list of steps or order of use of the equipment (for example, from a memory), and then compare the steps being performed or the equipment being used during the course of the surgical procedure with the steps or with the equipment expected for the type of surgical procedure that the central surgical controller 5104 determined is being used executed. In one example, the central surgical controller 5104 can be configured to provide an alert indicating that an unexpected action is being taken or an unexpected device is being used at the specific stage in the surgical procedure.
[0151] [0151] In general, the situational perception system for the 5104 central surgical controller improves the results of the surgical procedure by adjusting surgical instruments (and other 5102 modular devices) to the specific context of each surgical procedure. (such as adjustment to different types of tissue), and when validating actions during a surgical procedure. The situational perception system also improves the surgeon's efficiency in performing surgical procedures by automatically suggesting the next steps, providing data, and adjusting screens and other 5102 modular devices in the operating room, according to the specific context of the procedure.
[0152] [0152] With reference now to Figure 15, a time line 5200 is shown representing the situational recognition of a central controller, such as the central surgical controller 106 or 206 (Figures 1 to 11), for example. Timeline 5200 is an illustrative surgical procedure and the contextual information that the central surgical controller 106, 206 can derive from data received from data sources at each stage in the surgical procedure. Timeline 5200 represents typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a pulmonary segmentectomy procedure, starting with the setup of the operating room and ending with the transfer patient to a recovery room in the postoperative period.
[0153] [0153] Situational recognition of a central surgical controller 106, 206 receives data from data sources throughout the course of the surgical procedure, including data generated each time medical personnel use a modular device that is paired with the center surgical 106, 206. Central surgical controller 106, 206 can receive this data from paired modular devices and other data sources and continually derive inferences (ie 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 recognition system of the central surgical controller 106, 206 is, for example, able to record data referring to the procedure to generate reports, verify the steps being taken by medical personnel, provide data or warnings (for example, through a display screen) that may be relevant to the specific step of the procedure, adjust the modular devices based on the context (for example, activate monitors, adjust the field of view (FOV) of the medical imaging device, or change the energy level ultrasonic surgical instrument or RF electrosurgical instrument), and take any other action described above.
[0154] [0154] In the first step 5202, in this illustrative procedure, the members of the hospital team retrieve the electronic patient record (PEP) from the hospital's PEP database. Based on the patient selection data in the PEP, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.
[0155] [0155] In the second step 5204, the team members scan the incoming medical supplies for the procedure. The central surgical controller 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the mixing of the supplies corresponds to a thoracic procedure. In addition, the central surgical controller 106, 206 is also able to determine that the procedure is not a wedge procedure (because the inlet supplies have an absence of certain supplies that are necessary for a thoracic cuff procedure or, otherwise, that the inlet supplies do not correspond to a thoracic wedge procedure).
[0156] [0156] In the third step 5206, medical personnel scan the patient's band with a scanner that is communicably connected to the central surgical controller 106, 206. The central surgical controller 106, 206 can then confirm the patient's identity based on the scanned data .
[0157] [0157] In the fourth step 5208, the medical personnel turns on the auxiliary equipment. The auxiliary equipment being used may 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, an insufflator and a medical imaging device. When activated, auxiliary equipment that is a modular device can automatically pair with the central surgical controller 106, 206 which is located within a specific neighborhood of the modular devices as part of its initialization process. The central surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices that correspond with it during this preoperative or initialization phase. In this particular example, the central surgical controller 106, 206 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of paired modular devices. Based on the combination of data from the electronic patient record (PEP), the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the central controller, the central surgical controller 106, 206 can, in general, infer the specific procedure that the surgical team will perform. After the central surgical controller 106, 206 recognizes which specific procedure is being performed, the central surgical controller 106, 206 can then retrieve the steps of that process from a memory or from the cloud and then cross over the data that subsequently receives from connected data sources (for example, modular devices and patient monitoring devices) to infer which stage of the surgical procedure the surgical team is performing.
[0158] [0158] In the fifth step 5210, the team members fix the electrocardiogram (ECG) electrodes and other patient monitoring devices on the patient. ECG electrodes and other patient monitoring devices are able to pair with the central surgical controller 106, 206. As central surgical controller 106, 206 begins to receive data from the patient's monitoring devices, the central surgical controller 106, 206 thus confirms that the patient is in the operating room.
[0159] [0159] In the sixth step 5212, medical personnel induced anesthesia in the patient. Central surgical controller 106, 206 can infer that the patient is under anesthesia based on data from modular devices and / or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations thereof, for example. After the completion of the sixth step 5212, the preoperative portion of the lung segmentectomy procedure is completed and the operative portion begins.
[0160] [0160] In the seventh step 5214, the lung of the patient being operated on is retracted (while ventilation is switched to the contralateral lung). The central surgical controller 106, 206 can infer from the ventilator data that the patient's lung has been retracted, for example. The central surgical controller 106, 206 can infer that the operative portion of the procedure started when he could compare the detection of the patient's lung collapse in the expected steps of the procedure (which can be accessed or retrieved earlier) and thus determine that lung retraction is the first operative step in this specific procedure.
[0161] [0161] In the eighth step 5216, the medical imaging device (for example, a display device) is inserted and the video from the medical imaging device is started. Central surgical controller 106, 206 receives data from the medical imaging device (i.e., video or image data) through its connection to the medical imaging device. Upon receipt of data from the medical imaging device, the central surgical controller 106, 206 can determine that the portion of the laparoscopic surgical procedure has started. In addition, the central surgical controller 106, 206 can determine that the specific procedure being performed is a segmentectomy, rather than a lobectomy (note that a wedge procedure has already been discarded by the central surgical controller 106, 206 based on the data received in the second step 5204 of the procedure). The medical imaging device data 124 (Figure 2) can be used to determine contextual information about 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 in regarding the visualization of the patient's anatomy, monitor the number or medical imaging devices being used (that is, which are activated and paired with the operating room 106, 206), and monitor the types of visualization devices used.
[0162] [0162] In the ninth step 5218 of the procedure, the surgical team starts the dissection step. Central surgical controller 106, 206 can infer that the surgeon is in the process of dissecting to mobilize the patient's lung because he receives data from the RF or ultrasonic generator that indicate that an energy instrument is being triggered. Central surgical controller 106, 206 can cross-check the received data with the steps retrieved from the surgical procedure to determine that an energy instrument is being triggered at that point in the process (that is, after completing the previously discussed steps of the procedure) corresponds to the dissection stage. In certain cases, the energy instrument may be a power tool mounted on a robotic arm in a robotic surgical system.
[0163] [0163] In the tenth step 5220 of the procedure, the surgical team proceeds to the connection step. Central surgical controller 106, 206 can infer that the surgeon is ligating the arteries and veins because he receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similar to the previous step, the central surgical controller 106, 206 can derive this inference by crossing the reception data of the stapling and surgical cutting instrument with the steps recovered in the process. In certain cases, the surgical instrument can be a surgical tool mounted on a robotic arm of a robotic surgical system.
[0164] [0164] In the eleventh step 5222, the segmentectomy portion of the procedure is performed. Central surgical controller 106, 206 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 clamp being triggered by the instrument, for example. As different types of staples are used for different types of fabrics, the cartridge data can thus indicate the type of fabric being stapled and / or transected. In this case, the type of clamp that is fired is used for the parenchyma (or other similar types of tissue), which allows the central surgical controller 106, 206 to infer which segment of the procedure is being performed.
[0165] [0165] In the twelfth step 5224, the node dissection step is then performed. The central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on the data received from the generator that indicates which ultrasonic or RF instrument is being fired. For this specific procedure, an RF or ultrasonic instrument being used after the parenchyma has been transected corresponds to the node dissection step, which allows the central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly alternate between surgical stapling / cutting instruments and surgical energy instruments (ie, RF or ultrasonic) depending on the specific step in the procedure because different instruments are better adapted for specific tasks. - specific. Therefore, the specific sequence in which cutting / stapling instruments and surgical energy instruments are used can indicate which step of the procedure the surgeon is performing. In addition, in certain cases, robotic tools can be used for one or more steps in a surgical procedure and / or hand surgical instruments can be used for one or more steps in the surgical procedure. The surgeon can switch between robotic tools and hand-held surgical instruments and / or can use the devices simultaneously, for example. After the completion of the twelfth stage 5224, the incisions are closed and the post-operative portion of the process begins.
[0166] [0166] In the thirteenth stage 5226, the patient's anesthesia is reversed. The central surgical controller 106, 206 can infer that the patient is emerging from anesthesia based on ventilator data (that is, the patient's respiratory rate begins to increase), for example.
[0167] [0167] Finally, in the fourteenth step 5228 is that medical personnel remove the various patient monitoring devices from the patient. The central surgical controller 106, 206 can thus infer that the patient is being transferred to a recovery room when the central controller loses ECG, blood pressure and other data from patient monitoring devices. As can be seen from the description of this illustrative procedure, the central surgical controller 106, 206 can determine or infer when each step of a given surgical procedure is taking place according to the data received from the various data sources that are communicable. coupled to the central surgical controller 106, 206.
[0168] [0168] Situational recognition is further described in US provisional patent application serial number 62 / 659,900, entitled ME-THOD OF HUB COMMUNICATION, filed on April 19, 2018, which is hereby incorporated by reference in its entirety . In certain cases, the operation of a robotic surgical system, including the various robotic surgical systems disclosed here, for example, can be controlled by the central controller 106, 206 based on its situational recognition and / or feedback from its components and / or based on information from the cloud 104. Sharing structured data
[0169] [0169] A variety of computer systems have been described here,
[0170] [0170] A variety of paradigms or techniques can be used to share data efficiently between interrelated or connected databases, such as implementing relational database models or using consistent data formats so that data can be ported by different computer systems on a network. Two general paradigms of generic structured data sharing are called "data interoperability" and "data fluidity." These data sharing paradigms can be characterized as sets of rules executed by each of the computer systems within a computer network that define how and in what way data is shared by and between computer systems within of the computer network. The rule set can be incorporated as a set of computer executable instructions stored in a computer system memory (for example, memory 249 of the central surgical controller 206 illustrated in Figure 10) that, when executed by a processor (for example, processor 244), make the computer system perform the steps outlined to share data with other connected computer systems. In addition, all the databases described herein can be stored in a memory (e.g., memory 249) of a computer system, such as a central surgical controller 106, 206 or a database server. When it is said here that the databases communicate or share data with each other, what is meant is that the computer system that is storing the databases is creating, updating, retrieving and / or managing the data. data within the databases as described. In addition, database access and control can be managed by a database management system run by computer systems, which can include computer executable instructions stored in memory (eg 249 memory) of computer system that allows users to interact with the various databases and for data to be communicated by and between the various databases.
[0171] [0171] Data interoperability is defined as the ability of the computer or database systems to work cooperatively because they have a database automatically transmitting particular data to receiving databases according to predefined rules. For each type of data generated by or in a computer system, the rules of the data interoperability paradigm deign to which receiver database (s) the computer must transmit each type of data and, in some cases, the data format in which each type of data must be transmitted to each particular recipient database. In some ways, data interoperability can be characterized as a one-way communication of data between computer systems. Additionally, in some respects, the computer system that transmits data through the one-way communication channel may not be able to accept data of the same type from the receiver computer system. These aspects can be beneficial in order, for example, to have a database triggering or controlling the data that is stored or presented in another database.
[0172] [0172] As an illustration of these concepts, Figure 16 is a diagram of a 212000 database system that illustrates data interoperability between interrelated databases, in accordance with at least one aspect of the present description. In the aspect shown, the 212000 database system includes a first database 212002 communicatively connected to a second database
[0173] [0173] For example, the first database 212002 may include an EHR database, and the second database 212004 may include a pharmacy database. In this implementation, the set of data interoperability rules can dictate that when a patient's EHR is updated in the EH database to indicate that a new medication has been prescribed for the patient, the relevant data from the sale with a prescription they can be automatically transmitted to the pharmacy database, as a new sales order with a prescription for processing by the pharmacy department. Consequently, the first database 212002 can be programmed to transmit 212006 data representing a prescription order with a prescription to the second database 212004. The data in the prescription order may include, for example, data of drug interaction and a list of drugs updated based on the EHRs of the associated patient. In addition, the set of data interoperability rules may dictate that when a prescription sale is prepared in response to a prescription sale request received, a billing update can be automatically transmitted to the database of EHR. As a result, the second database 212004 can be programmed to transmit 212008 data representing a collection update to the first database 212002 in response to or when filling out the sales order with a prescription. The transmission of each of these types of data can be unidirectional with respect to the respective databases 212002, 212004.
[0174] [0174] As another example, the first database 212002 may include an OS scheduling database, and the second database 212004 may include a medical supply database. In this implementation, the set of data interoperability rules can dictate that when a new operation is scheduled or entered in the OS's scheduling database, data relevant to the scheduling operation can be automatically transmitted to the scheduling database. supply of medical supplies by the medical supplies supply department and at what time and date it should be prepared. As a result, the OS scheduling database can automatically transmit 212006 data that represents a procedure to the medical supplies supply database when a new procedure is scheduled. Consequently, employees who have access to the medical supplies supply database can automatically receive updates so that they can have the products and instruments necessary for the scheduled procedure prepared at the scheduled time.
[0175] [0175] As yet another example, the first database 212002 may include a laboratory database, and the second database 212004 may include an EHR database. In this implementation, the set of data interoperability rules can dictate that when a patient's laboratory results are sent to the laboratory database, the laboratory result data can be automatically transmitted to the laboratory database. EHR to be associated with the patient's EHR. Consequently, the laboratory database can automatically populate the EHR database with data representing test results and laboratories, when they are completed. Consequently, doctors and any other individuals with access to the patient's EHR can immediately access the results of any test and orderly laboratory without the need for any further action.
[0176] [0176] As yet another example, the first database 212002 can include an EHR or sales entry database with a prescription, and the second database 212004 can include a pharmacy or dispensing database medicine.
[0177] [0177] As yet another example, the first database 212002 can include a database of pathologies, and the second database 212004 can include an OS database (for example, stored in a central surgical controller 106 , 206). In this implementation, the set of data interoperability rules can dictate that when new pathology results are received for a patient, the relevant pathology data can be automatically transmitted to the OR database for review by the surgical team. . Consequently, data that includes updates or results stored in the pathology database, can be automatically transmitted 212006 to the SO through an update to the SO database. The data can be transmitted 212006 between the pathology database and the OS database in real time, as during the course of a surgical procedure to inform the subsequent steps of the procedure. As a specific illustration, during a wedge resection procedure to remove a small tumor in a patient's lung, the surgery team sends the resected specimen to the pathology department to check for malignancy while the patient is still is in the SO. If the pathology department confirms the malignancy, the surgical team often chooses to complete a lobectomy procedure on the lobe from which the wedge was taken. Consequently, this process of providing notifications from other departments to the surgical team during the course of a surgical procedure via the central surgical controller can be automated using a data interoperability paradigm between the pathology database and the central surgical controllers, as described above.
[0178] [0178] Data fluidity is defined as the ability of data to flow from one database to another database according to predefined rules that outline bidirectional relationships between databases for data sets stored there. In some ways, the data flow paradigm can define whether the data is transmitted to particular receiving databases and / or whether the data is linked to particular receiving databases. Data can be automatically shared or transferred to other databases using relational database techniques (ie, defined relationships between databases), for example. In one aspect, databases can execute a set of rules that define what types of data should be automatically transmitted to which particular receiving database. In addition, in one respect, databases can execute a set of rules that define the format of the data or the database to which the data is transmitted, according to the surgical contextual data (metadata) associated with the data. Dice. The set of rules can be incorporated as a set of executable instructions by computer stored in a memory of a computer system (for example, memory 249 of the central surgical controller 206 illustrated in Figure 10) that, when executed by a processor (for example, processor 244),
[0179] [0179] For example, a central surgical controller can use situational recognition (described above under the heading SITUATIONAL RECOGNITION) to determine the surgical context (for example, the type of surgical procedure or the stage of the surgical procedure being performed) based on the perioperative data received from the surgical instrument, patient monitors, and other surgical devices or databases, and then associate the surgical context with the data being generated (for example, storing the surgical context as metadata for the generated data). The determined surgical context can influence which specific database (s) receives specific data, how much of the data is transmitted to the receiving database (s), the data format where data is transmitted, and so on. Consequently, the computer system (for example, a central surgical controller) can then transmit the collected data (with or without its associated surgical metadata) to specific receiving databases or in specific data formats, according to according to the determined surgical context. In many respects, the surgical context can influence the bit size, quantity, resolution and / or the time range around the transmitted data (for example, the number of samples of the data captured at a specific sample rate ). Consequently, the data flow paradigm allows interrelated databases to share relevant data with each database, according to the needs of each receiving database. In other words, computer systems that share data, according to a data fluidity paradigm, can anticipate potential uses and needs for data received by computer systems and then automatically route data for receiving databases or computer systems. In addition, the surgical context can dictate the format in which a computer system transmits data, the scope of data transmitted by the computer system, and so on.
[0180] [0180] As an illustration of these concepts, Figure 17 is a diagram of a database system that illustrates the fluidity of data between interrelated databases, in accordance with at least one aspect of the present description. In the aspect shown, the database system 212020 includes a first database 212022, a second database 212024, and a third database 212026, which are each connected to each other in a communicative manner. In one aspect, each of the databases 212022, 212024, 212026 is programmed to communicate data in a bidirectional manner. In other words, when a specific data set in one of the databases 212022, 212024, 212026 is updated and the updated data is relevant to another among the databases 212022, 212024, 212026 (as dictated by the rules of fluidity of specific data that define the relationships between databases 212022, 212024, 212026), the database 212022, 212024, 212026 in which the data was updated, can automatically transmit or share those updates to the database ( corresponding data (s) 212022, 212024, 212026.
[0181] [0181] The sets of data fluidity rules that dictate the data flow between the different databases can be defined (for example, by administrators of the 212020 database system) according to the relationships between the departments represented by the databases 212022, 212024, 212026. For example, some departments (for example, OR and pathology or OR and supply) routinely collaborate or consult with each other about medical problems that occur with patients in the medical facility. Consequently, data fluidity rules may dictate that when an update is made to a specific data type (or a set of data types) in one of these collaborating databases, a substantial portion of or all updated data can be transmitted or linked to another collaborating database. In addition, transmitted data may include contextual metadata determined through surgical situational recognition and other additional or associated data, for example. Alternatively, some departments (for example, collection), need only a small portion of certain types of data. Consequently, data fluidity rules may dictate that when an update is made to a specific data type (or set of data types) in a database, only a small portion of the updated data is relevant. forward to the receiving database, and transmitted or linked to the receiving database. For example, if the receiving database is a collection department database, the data shared with the collection database may include only procedure codes, time, and what was consumed during a medical procedure. , because only that data is what the collection department needs. As can be seen, only data that is relevant to the receiving database is actually transmitted or linked to the receiving database, which limits access to sensitive patient data, prevents the receiver from being overloaded with unnecessary data, and minimizes the necessary data transmission bandwidths, while allowing all databases to be perfectly updated according to each other.
[0182] [0182] In one implementation, the first database 212022 can include a laboratory database, the second database 212024 can include an EHR database, and the third database
[0183] [0183] In another implementation, a computer system and / or network of linked databases, can be configured to automatically collect and compile surgical results resulting from specific treatment regimens by connecting databases from various departments through a data fluidity paradigm, allowing all data relevant to a patient's treatment to be aggregated and perfectly integrated together. By automatically compiling patient outcome data with patient treatment data, it is possible to track patient care more accurately and improvements in treatment regimens, surgical procedures, and other care can be developed. patient. In some aspects, by automatically sharing relevant data across departments in a format specific to that department, data can be more easily communicated, which in turn can allow data to be presented to the patient at conferences , in medical articles, in an easier way, and so on. In some respects, data can be recorded in each database and transmitted to the other connected databases in a standard format, allowing data from any database to be integrated seamlessly into another database. compatible data.
[0184] [0184] In one aspect, collaboration between multiple departments could be increased by allowing or allowing data collected in any database to flow easily from one group of experts to another. The data fluidity paradigm allows data to flow easily between departments in a medical facility by establishing a standard set of rules that all computer systems within the medical facility use to transmit or link data that dictates destination for any type of data, the format in which the data should be transmitted to the receiving database, and so on. The structured data sharing paradigms described here are beneficial in this and other contexts because they ensure that the correct data is being collected for medical uses. By allowing a computer system to automatically retrieve the necessary data from the relevant database (s) and allowing the databases to be updated synchronously between them when data is added or altered, human errors in the transmission and transcription of data, errors due to the receipt of partial incomplete information and other errors of this type are avoided.
[0185] [0185] In one aspect, some or all of the data in specific databases can respond fluidly to requests made by users, instead of being automatically transmitted or linked to another database. Consequently, a first computer system can be programmed to receive data requests from a second computer or database system (which can be initiated by a user, for example) and then transmit the requested data and / or defining a relationship between the database stored by the first computer system and the second computer system, depending on the identity or type of request sent by the second computer system. For example, doctors can make data requests from the computer system, which then proceeds to automatically collect and compile the requested data from the relevant databases to which the computer system is connected. Such aspects can be used in a variety of applications, such as personalized cancer medicine. For example, the computer system can connect the oncologist, the surgeon and the histologist who collaborate to treat a patient, allowing any of them to retrieve all treatment data related to the given patient. This, in turn, allows medical personnel to track the patient's treatment and allows the individual associated with a patient's care to easily recover and analyze patient-related data, such as tumor location, margins, nodal dissection, and chemical treatment. By giving each individual associated with the treatment
[0186] [0186] Figure 18 illustrates an example of a 212100 process, according to the structured data sharing paradigms discussed here, where data is shared according to the surgical context associated with the data. As described above under the heading "CENTRAL SURGICAL CONTROLLERS", computer systems, such as central surgical controllers 106, 206 (Figures 1 to 11), can be connected to or paired with a variety of surgical devices, such as surgical instruments , generators, smoke evacuators, screens and so on. Through their connections to these surgical devices, central surgical controllers 106, 206 can receive an array of perioperative data from these paired surgical devices while the devices are in use during a surgical procedure. Additionally, as described above under the heading SITUATIONAL RECOGNITION, the central surgical controllers 106, 206 can determine the context of the surgical procedure being performed (for example, the type of procedure or the stage of the procedure being performed) based, at least in part, on perioperative data received from these connected surgical devices. The surgical context determined by the central surgical controller 106, 206 through situational recognition, can be used to dictate what types of collected data are transmitted to the specific databases, the format in which the collected data are transmitted and so on. onwards. Consequently, Figure 18 illustrates a logic flow diagram of a 212100 process for sharing data between databases, in accordance with at least one aspect of the present description. Process 212100 can be performed by a processor or control circuit of a computer system, such as processor 244 of the central surgical controller 206 illustrated in Figure 10. Consequently, process 212100 can be incorporated as a set of instructions executable by computer. stored in memory 249 which, when executed by processor 244, cause the computer system (for example, a central surgical controller 206) to perform the steps described.
[0187] [0187] Consequently, processor 244 that runs the 212100 process receives 212102 perioperative data from the connected surgical devices and determines 212104 the surgical context based, at least in part, on the perioperative data received, as discussed above, under the title SITUATIONAL RECOGNITION.
[0188] [0188] What the central surgical controller 206 does with the collected data is dictated by the set of structured data rules implemented by the central surgical controller 206. Depending on the surgical context and the type of data, the central surgical controller 206 can transmit the data (or a subset of it) to another database, define a relationship between the database stored in the memory 249 of the central surgical controller 206 and another database (that is, connect the data fields relevant databases), or perform other such actions. In the illustrated aspect, processor 244 transmits 212106 at least a portion of the surgical data collected to one or more recipient databases based on the determined surgical context and the identities of the receiving databases.
[0189] [0189] Another illustrative implementation of the 212100 process is shown in Figure 19. Figure 19 is a diagram of a 212020 database system where specific data is shared between a 212130 central surgical controller database, a database EHR 212132 database, and a hospital administration database 212134, in accordance with at least one aspect of the present description. The central surgical controller database 212130 can collect various data generated by the central surgical controller 206 and / or any surgical device paired with the central surgical controller 206. For example, the central surgical controller database 212130 can store the name of the patient (or other biographical or identification information), the surgical procedure the patient underwent, the inventory of surgical devices and other products used during the surgical procedure and / or the extension of the surgical procedure. In addition, the EHR 212132 database can store medications, diagnostics, vital signs and tests associated with the patient. In addition, the 212134 hospital administration database can store data that includes hospital staff, scheduling, medical supplies, inventory and inventory information. Each of the computer systems can be executing the 212100 process and, consequently, it can transmit the data stored in its respective database or define relationships between its databases and other databases, as dictated by the set of structured data sharing rules that govern the interactions between each of the 212130, 212132,
[0190] [0190] As discussed above, databases can share only a subset of the data they store with other connected databases. In addition, different subsets of the data stored by each database can be shared with different databases, depending on the data that each receiving database needs. For example, the data stored in each database can be organized into data categories and the set of structured data sharing rules can dictate, for example, which categories of data are shared with which other databases. For example, Figure 20 shows several categories of illustrative data 212056 that the EHR database 212052 and the hospital administration database 212054 of the 212020 database system can store. In the implementation depicted, the commercial office data category, which includes payer and billing data as subcategories, is shared (that is, transmitted to or linked to) with the hospital's administration database 212054. The others data categories 212056 of the EHR database and the hospital administration database 212054, are not shared with the other database or are shared with other databases, as defined by the set of specific structured data sharing.
[0191] [0191] Computer systems that store databases 212130, 212132, 212134, which define a database system
[0192] [0192] In one aspect, users can also define the types of data they would like the medical systems of the medical facility, such as central surgical controllers 106, 206 (Figures 1 to 11), to collect through, for example, a user interface provided by a computer system on the medical facility's network. For example, a user could indicate that they want the central surgical controllers 206 at the medical facility to collect a specific type of data for a certain type of surgical instrument. Consequently, the order can be pushed to the central surgical controllers 206 within the network of the medical facility, and the central surgical controllers 206 will thereafter collect that type of surgical instrument, if they are not already doing so. Central surgical controllers 206 can collect intraoperative or postoperative data as requested by the user. Once the order has been placed, the collected data can be shared, for example, with a user-defined database, according to a set of structured data sharing rules, as described above. Then, the data desired by the user can be transmitted, linked or otherwise supplied to the user. These aspects can be used to conduct research on the performance of the surgical instrument, the correlations between the patient's results and surgical techniques, and so on. In some respects, the requested data can be forwarded to other users inside or outside the network of medical facilities. In some ways, the data request can be saved and repeated, as desired by the user. In some respects, the data request can proceed for a predefined period of time or indefinitely (until completed by the user). In some aspects, the user can follow the requested data when retrieving the metadata associated with the requested data or, otherwise, request other data that are associated with the requested data. For example, a user can enter a request to be delivered with the surgical device success rates. Consequently, each central surgical controller 206 or other computer system can monitor the progress of each surgical procedure and the success rates of the device associated with it. In addition, the user can have the central surgical controller 206 or other computer systems route the success rate data of the surgical device to be transmitted to the new orders department (for example, so that they know they are not is to re-order surgical devices that have low success rates) and any other desired department.
[0193] [0193] In several respects, database systems that execute a structured data sharing paradigm can monitor the activities that occur in an OS through a central surgical controller 206 in them and automatically route the relevant data to the relevant departments of in order to improve the efficiency and function of the medical facility. In one aspect, a central surgical controller 206 can be configured to monitor the progress of a surgical procedure, surgical device success rate, and other OS data through, for example, situational recognition. The ability of the central surgical controller 206 to seamlessly share and communicate data with other databases in the medical facility can have a substantial number of benefits.
[0194] [0194] In one aspect, a computer system (for example, a central surgical controller 206) can be programmed to track the use of surgical devices and their movement through a medical facility, for example, to collect data on the surgical instruments throughout their life cycle. These data can include the number of times a surgical device has been sterilized, repaired and / or kept in the inventory or the number of times a surgical device has been maintained in each of the respective departments. A computer system can track surgical devices in this way by sharing structured data by receiving location data for a surgical device from the databases of each relevant department (for example, when a surgical device is brought to a hospital). department, it can be scanned to enter that department, which generates a record of the location of the surgical device), repair and maintenance records for the surgical device, and so on. Such data can be used to assess the values, costs, and efficiencies of all medical products that are used in the medical facility.
[0195] [0195] In one aspect, a computer system can be programmed to allow patients to contribute self-registration data. In many ways, self-registration data can be directly entered into a medical facility computer system database via a computer terminal or the patient can make a personal electronic device (or other electronic device). personal data collection) automatically transmit the collected information to a designated recipient database. Self-registration data could include, for example, reports from blood sugar testing equipment, such as a continuous blood glucose monitor, insulin pumps, artificial pancreas data, and so on. Self-registration data can also include, for example, data from activity monitors (for example, Fitbit or Apple Watch) that are configured to collect activity data, location data, and other types of data. Activity monitors can provide, for example, activity level data (for example, distance traveled, active minutes, number of steps taken, number of stairs), data on sleep (for example, sleep cycles , duration and stages of sleep), heart rate monitoring data (for example, resting heart rate, percentage of time in specific heart rate zones, which can be determined by age, and heart rate variability), nutritional information, water intake, calories burned, and so on. When loaded into a receiving database, the receiving database can then, in some respects, automatically share relevant patient self-registration data with other connected devices, according to a set of sharing rules. structured data.
[0196] [0196] With the sharing of structured data, a concern is that access to data is guaranteed only for suitable beneficiaries. Consequently, all data requests and all requests to connect databases, need to be verified and authorized to prevent unauthorized beneficiaries from accessing the data. Figure 21 is a diagram illustrating a 212200 security and authorization system for a 212203 medical facility computer network, in accordance with at least one aspect of this description. The security and authorization system 212200 may include, for example, a firewall 212202 to regulate the communication of incoming and outgoing data, such as communication requests 212201 from a computer system that seeks to connect to the computer network of the medical facility 212203. Communication requests 212201 may include, for example, requests for specific data or types of data to be transmitted from the computer network at medical facility 212203, requests to establish a relationship or link between a database in computer network of the medical facility 212203 and an external database, and so on. In one respect, communication requests 212201 may require a security key to guarantee access to the computer network of medical facility 212203. In an implementation, when the computer network of medical facility 212203 receives a communication request 212201, the 212202 firewall can only allow access to the computer network of the medical facility 212203 if the security key corresponds to a valid guarantee stored in an authorization database 212208, for example. Consequently, authorized requests 212204 that have a valid security key will be guaranteed access to the computer network of the medical facility 212203 and unauthorized requests 212206, which do not have a valid security key, will be denied access through the 212202 firewall.
[0197] [0197] Consequently, the structured data sharing paradigms described here, that is, data fluidity and data interoperability, can facilitate data movement across an entire medical facility (or a network of interconnected medical facilities) . By perfectly sharing data, so that each interconnected database always has access to all the data generated in the medical facility, which are relevant to its department, structured data sharing paradigms allow medical facilities to operate more efficiently and provide better patient outcomes. Cost analysis of surgical procedure
[0198] [0198] In some respects, the computer systems described here are programmed to provide a clear and holistic analysis of the total costs associated with any given treatment or surgical procedure, such as by calculating the total cost associated with all items that are used during a treatment or surgical procedure. This functionality can provide a number of benefits, including allowing administrators to understand precisely where and how money is being spent in a medical facility, providing suggestions on low-cost product mixes for specific types of surgical procedures. , identify when reusable items should be replaced, determine the degree of wear of surgical instruments and other items used during a procedure, and so on. In addition, these economic data can be integrated with data on treatment or surgical results so that users can provide additional analysis or so that systems can provide recommendations to users. Data on treatment or surgical results can be determined, for example, by a cloud computing system, described in conjunction with Figures 12 to 13, or can be sent to computer systems from the medical literature . For example, Daniel L. Miller et al., Impact of Powered and Tissue-Specific Endoscopic Stapling Technology on Clinical and Economic Outcomes of Video-Assisted Thoracic Surgery Lobectomy Procedures: A Retrospective, Observational Study, Advances in Therapy, May 2018 (35), pages 707 to 23, demonstrates several ways in which results and economic data can be considered together. For example, Miller et al., Demonstrates that energized staplers are associated with fewer complications related to hemostasis and lower procedure costs, specific types of instruments (eg energized staplers) are associated with fewer complications related to hemostasis. than other types of instruments (for example, manual staplers), and the effect size is greater in patients with chronic obstructive pulmonary disease (COPD). As a result, a computer system could be programmed to present economic data illustrating the cost associated with specific product mixes for a given procedure and the result data associated with different product mixes, allowing surgeons and system administrators hospital to make informed decisions about which surgical instruments and other surgical devices should be used for a surgical procedure given the results associated with the different devices and the patient's medical history.
[0199] [0199] Consequently, systems and methods for analyzing the total costs of surgical instruments and devices for surgical procedures are described here, including both internal costs and maintenance costs. In one aspect, a computer system (for example, a central surgical controller) can be programmed to provide real-time analysis of the comprehensive costs of all instruments and devices used in a surgical procedure, including costs associated with both reusable devices (for example, maintenance, cleaning and re-sterilization costs), and non-reusable (ie replacement costs). In some respects, the computer system may use the data sharing paradigms described above under the heading STRUCTURED DATA SHARING to determine the costs of replacing non-reusable surgical devices, for example, receiving or sharing data between a database of shopping data. In some respects, the computer system can use the data sharing paradigms described above under the heading STRUCTURED DATA SHARING to determine the real costs of maintaining reusable surgical devices by, for example, receiving or data sharing across a variety of medical facility databases to track devices across the medical facility. By tracking devices as they are transported throughout the medical facility for stock, sterilization and other internal maintenance processes, the computer system can calculate maintenance costs according to the time and resources actually spent on maintaining the devices. surgical devices.
[0200] [0200] In one respect, the various computer systems (for example, central surgical controllers) throughout a medical facility can generate, store and share metadata that indicates when and how each surgical device interacted with each of the various computer systems. For example, when a surgical device is brought to an OS and connects to the central surgical controller located within that OS, the central surgical controller can generate metadata associated with the surgical instrument that indicates the date, time and location of the surgical instrument. and then store and share that metadata with other computer systems within the network. Consequently, the computer systems described here can track surgical instruments according to their associated metadata. In one aspect, a computer system (for example, a central surgical controller) can be programmed to retrieve or otherwise receive metadata for all surgical devices used during the course of a surgical procedure to track them across all devices. pre and post-operative processes, including locations, states, installed replacement parts, repairs applied and cleaning times. Consequently, the computer system can track the cost and use of surgical devices as they circulate through the medical facility.
[0201] [0201] In one aspect, a computer system (for example, a central surgical controller) can be programmed to track the number of uses for a re-sterilized or otherwise reused device. The computer system can be additionally programmed to determine when the device has reached the end of its useful life according to whether the number of uses can satisfy or exceed a usage limit. In another aspect, a computer system (for example, a central surgical controller) can be programmed to determine maintenance costs for a surgical device, determine the cost of replacing the surgical device (for example, recovering the cost of replacing a purchasing database), and then determining whether the surgical device should be replaced according to the possibility that maintenance costs will exceed replacement costs. Consequently, the computer system can run cost analysis algorithms to track surgical devices in all medical facilities, analyze costs associated with surgical devices, and provide recommendations to users.
[0202] [0202] Figure 22 is a 210500 block diagram of a cost analysis algorithm executable by a computer system, such as a central surgical controller 210504, in accordance with at least one aspect of the present description. In one aspect, a 210504 central surgical controller (or other computer system) can run a 210502 cost analysis module. The 210502 cost analysis module can include, for example, an embedded algorithm as a set of operating instructions. computer stored in a memory 249 (Figure 10) of the central surgical controller 210504 that are executable by a 244 processor (Figure 10) or control circuit to perform the described process. The 210502 cost analysis module can be configured to track reusable devices (for example, surgical instruments) during cleaning, repair and re-sterilization processes at the medical facility by accessing or receiving data from various sources. data, as through data sharing paradigms discussed above under the heading STRUCTURED DATA SHARING.
[0203] [0203] Tracking all the various costs associated with the total care and maintenance associated with each surgical device allows the 210502 cost analysis module to provide true one-to-one comparisons between different mixtures of surgical products. As a result, users can use the cost analysis module 210502 to perform cost analyzes, or the cost analysis module 210502 can automatically perform such analyzes and make recommendations to users to use hospital resources more efficiently, identify bottlenecks in the medical facility systems and provide suggestions on how to improve them, identify when there is too little or too much specific products that are consuming time or money, and so on.
[0204] [0204] As mentioned above, the various computer systems (eg, central surgical controllers) within a medical facility can track each individual surgical device as it is processed through the medical facility's workflow through generation, storage and sharing metadata that indicates when and how each surgical device interacted with each of the various computer systems. For example, Figure 23 is a block diagram illustrating a workflow for a 210702 surgical device through a 210700 medical facility, in accordance with at least one aspect of the present description. The illustrative medical facility 210700 includes several departments, including surgery 210706, sterilization 210708, maintenance 210710, and inventory or storage 210712. The workflow for the specific surgical device 210702 (which can be a reusable surgical device, for example) determines that the surgical device
[0205] [0205] Additional algorithms or processes can then use these surgical device location metadata. For example, a 210704 computer system can determine when a particular 210702 surgical device is in an earlier department in the workflow for the 210702 surgical device and then automatically provide a message or notification to personnel to prepare to receive surgical device 210702 (for example, preparing sterilization when surgical device 210702 is in surgical area 210706 and is expected to be sent for sterilization 210708). As another example, a 210704 computer system can determine when a 210702 surgical device has been used in a surgical or clean procedure a limited number of times and then provide a notification to staff to order replacement parts for the 210702 surgical device or discard the 210702 surgical device. Alternatively, the 210704 computer system can automatically order replacement parts for the 210702 surgical device after a limited number of uses. Such processes reduce or eliminate the need for the 210700 medical facility to excessively stock replacement parts, cleaning products, and other such products on site.
[0206] [0206] In another aspect, 210704 computer systems can be programmed to compare and analyze actual post-operative results with predicted post-operative results, incorporating the economic data generated by the 210502 cost analysis module. For example, the expected reoperation costs can be calculated based on expected surgical results. More particularly, computer systems 210704 can be programmed to retrieve data (for example, surgical results from medical literature data that are sent to a database accessible by computer systems 210704) or to determine (for example, by the cloud computing system described in conjunction with Figures 12 to 13) expected results from a surgical procedure and then calculate the costs associated with the range of results based on the costs he tracked for each of the potential results . The range of costs associated with the results of the surgical procedure can then be presented to users when asked to assist in the analysis of the total costs associated with a given surgical procedure. As another example, computer systems 210704 can be additionally programmed for surgical procedures and / or surgical device 210702 to reduce the likelihood of reoperation and therefore additional costs. As yet another example, computer systems 210704 can be programmed to assess the costs associated with the treatment of expected postoperative results by tracking the average postoperative patient's stay following each given type of procedure and the costs associated with this, the average number of types of drugs administered to a patient following each given type of procedure, the total costs associated with the processing and delivery of those drugs, and so on.
[0207] [0207] Figure 24 is a logic flow diagram of a process
[0208] [0208] As described above under the title CENTRAL CI-RURGICAL CONTROLLERS, central surgical controllers 206 can be connected to a variety of surgical devices, such as surgical instruments, generators, smoke evacuators, screens, and so on. Through their connections to these surgical devices, central surgical controllers 206 can receive an array of perioperative data from these paired surgical devices while the devices are in use during a surgical procedure. Additionally, as described above under the heading SITUATIONAL RECOGNITION, central surgical controllers 206 can determine the context of the surgical procedure being performed (for example, the type of procedure or the stage of the procedure being performed ) based on perioperative data received, at least in part, from these connected surgical devices. Consequently, processor 244, which executes process 210600, determines 210602 whether a surgical procedure is being performed, for example, through a situational recognition system performed by central surgical controller 206. Consequently, processor 244 determines
[0209] [0209] Consequently, for each surgical device that is or has been used during the surgical procedure, processor 244 determines 210606 whether the surgical device is reusable or non-reusable. Processor 244 can determine 210606 whether a surgical device is reusable by consulting a database that lists whether each specific item is reusable, retrieving the manufacturer's specifications for the surgical device, or retrieving the metadata associated with the surgical device to verify that the item was used previously or if it is intended to be used multiple times, for example. If the given surgical device is reusable, then the process proceeds along the SIM branch and processor 244 determines 210608 the maintenance cost for the device. Maintenance costs can include repair costs, re-sterilization costs, cleaning costs and so on. The 244 processor can determine 210608 the maintenance cost using the techniques discussed above, that is, tracking the metadata associated with the given surgical device to determine how often and by what types of maintenance steps the surgical device goes during its workflow. If the given surgical device is not reusable, then the process proceeds along the NO branch and processor 244 determines 20610 the replacement cost for the device. Processor 244 can determine 210610 the replacement cost by consulting a purchasing database associated with medical installation 210700, to recover the purchase price of the given surgical device, for example.
[0210] [0210] In several respects, process 210600 calculates the costs associated with each surgical device used during the surgical procedure to calculate a complete cost associated with the surgical procedure. Consequently, processor 244 determines 210612 whether the surgical procedure is completed through, for example, a situational recognition system, as discussed above. If the procedure is not completed, then process 210600 proceeds along the NO branch and processor 244 continues a monitoring circuit of which surgical devices are being used or consumed until the procedure is complete. If the procedure is finished, then process 210600 proceeds along the YES branch and processor 244 determines 210614 the total cost for the surgical procedure based on the aggregate maintenance and replacement costs of the surgical devices used during the procedure. surgical procedure. Examples
[0211] [0211] Various aspects of the subject described in this document are defined in the following numbered examples:
[0212] [0212] Example 1. A computer system configured to be communicatively coupled to a plurality of surgical devices. The computer system comprises a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, make the computer system: determine which of the plurality of surgical devices is being used during a surgical procedure based, at least in part, on perioperative data received from one or more among the plurality of surgical devices; determine whether each of the plurality of surgical devices used during the surgical procedure is a reusable surgical device or a non-reusable surgical device; determine a maintenance cost for each reusable surgical device; determine a replacement cost for each non-reusable surgical device; and determining a total cost of the plurality of surgical devices for the surgical procedure according to the maintenance cost for each reusable surgical device and the replacement cost for each non-reusable surgical device.
[0213] [0213] Example 2. The computer system of Example 1, the maintenance cost comprising at least one of a cleaning cost, a re-sterilization cost, a repair cost, or any combination thereof.
[0214] [0214] Example 3. The computer system of Example 1 or Example 2, and the memory additionally stores instructions that, when executed by the processor, make the computer system: determine whether the maintenance cost exceeds the cost of replacement for each reusable surgical device; provide a replacement recommendation for each reusable surgical device when the maintenance cost exceeds the replacement cost.
[0215] [0215] Example 4. The computer system of any of Examples 1 to 3, the memory additionally storing instructions that, when executed by the processor, make the computer system: determine a number of uses for each surgical device reusable; and provide a replacement recommendation for each reusable surgical device when the number of uses exceeds a limit.
[0216] [0216] Example 5. The computer system of any of examples 1 to 4, and the memory additionally stores instructions that, when executed by the processor, make the computer system: retrieve metadata associated with each surgical device reusable, metadata storing at least one of the locations of the reusable surgical device, time extensions for the locations, a number of uses of the reusable surgical device, or any combination thereof; and determine the maintenance cost for each reusable surgical device according to the metadata.
[0217] [0217] Example 6. The computer system of any of Examples 1 to 5, the memory additionally stores instructions that, when executed by the processor, cause the computer system to recover a purchase price associated with each device. non-reusable surgical positive from a purchasing database, the replacement cost corresponding to the purchase price.
[0218] [0218] Example 7. The computer system of any of Examples 1 to 6, the computer system comprising a central surgical controller.
[0219] [0219] Example 8. A computer system comprising a processor and memory attached to the processor. The memory stores instructions that, when executed by the processor, make the computer system: identify one or more surgical devices used during a surgical procedure according to perioperative data received from one or more surgical devices; and determining a total cost of one or more surgical devices for the surgical procedure according to a maintenance cost or a replacement cost associated with each of the one or more surgical devices.
[0220] [0220] Example 9. The computer system of Example 8, the maintenance cost comprising at least one of a cleaning cost, a re-sterilization cost, a repair cost, or any combination thereof.
[0221] [0221] Example 10. The computer system of Example 8 or Example 9, the memory additionally storing instructions that, when executed by the processor, make the computer system: determine if the maintenance cost exceeds the cost of replacement for each reusable surgical device; provide a replacement recommendation for each reusable surgical device when the maintenance cost exceeds the replacement cost.
[0222] [0222] Example 11. The computer system of any of Examples 8 to 10, the memory additionally stores instructions that, when executed by the processor, make the computer system: determine a number of uses for each surgical device reusable; and provide a replacement recommendation for each reusable surgical device when the number of uses exceeds a limit.
[0223] [0223] Example 12. The computer system of any of Examples 8 to 11, and the memory additionally stores instructions that, when executed by the processor, make the computer system: recover metadata associated with each reusable surgical device, metadata storing at least one of the locations of the reusable surgical device, time extensions for the locations, a number of uses of the reusable surgical device, or any combination thereof; and determine the maintenance cost for each reusable surgical device according to the metadata.
[0224] [0224] Example 13. The computer system of any of Examples 8 to 12, the memory additionally stores instructions that, when executed by the processor, cause the computer system to recover a purchase price associated with each device. non-reusable surgical positive from a purchasing database, the replacement cost corresponding to the purchase price.
[0225] [0225] Example 14. The computer system of any of Examples 8 to 13, the computer system comprising a central surgical controller.
[0226] [0226] Example 15. A computer-implemented method to determine a surgical device cost for a surgical procedure. The method comprises: determining, through a computer system, which of a plurality of surgical devices are used during the surgical procedure based at least in part on perioperative data received from one or more of the plurality of surgical devices; determine, through the computer system, whether each of the plurality of surgical devices used during the surgical procedure is a reusable surgical device or a non-reusable surgical device; determine, through the computer system, a maintenance cost for each reusable surgical device; determine, through the computer system, a replacement cost for each non-reusable surgical device; and determining, through the computer system, a total cost of the plurality of surgical devices for the surgical procedure according to the maintenance cost for each reusable surgical device and the replacement cost for each non-reusable surgical device.
[0227] [0227] Example 16. The computer-implemented method of Example 15, with the maintenance cost comprising at least one of a cleaning cost, a re-sterilization cost, a repair cost, or any combination thereof .
[0228] [0228] Example 17. The computer implemented method of Examples 15 or 16, which further comprises: determining, by the computer system, whether the maintenance cost exceeds the replacement cost for each reusable surgical device; and provide, through the computer system, a replacement recommendation for each reusable surgical device when the maintenance cost exceeds the replacement cost.
[0229] [0229] Example 18. The computer-implemented method of any of Examples 15 to 17, which further comprises: determining, by the computer system, various uses for each reusable surgical device; and provide, through the computer system, a replacement recommendation for each reusable surgical device when the number of uses exceeds a limit.
[0230] [0230] Example 19. The computer-implemented method of any of Examples 15 to 18, which further comprises: retrieving, via the computer system, metadata associated with each reusable surgical device, the metadata being stored by me - in one of the locations of the reusable surgical device, time periods for the locations, a number of uses of the reusable surgical device, or any combination thereof; and determine, through the computer system, the maintenance cost for each reusable surgical device according to the metadata.
[0231] [0231] Example 20. The computer-implemented method of any of Examples 15 to 19, which further comprises recovering, by the computer system, a purchase price associated with each non-reusable surgical device from a purchasing database , the replacement cost being the purchase price.
[0232] [0232] Example 21. The computer-implemented method of any of Examples 15 to 20, the computer system comprising a central surgical controller.
[0233] [0233] Although several forms have been illustrated and described,
[0234] [0234] The previous detailed description presented various forms of devices and / or processes through the use of block diagrams, flowcharts and / or examples. Although these block diagrams, flowcharts and / or examples contain one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation within these block diagrams, flowcharts and / or examples can be implemented , individually and / or collectively, through a wide range of hardware, software, firmware or almost any combination thereof. Those skilled in the art will recognize, however, that some aspects of the aspects disclosed here, in whole or in part, can be implemented in an equivalent way in integrated circuits, such as one or more computer programs run on one or more computers ( for example, as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (for example, as one or more programs running on one or more microprocessors), as firmware , or virtually as any combination thereof, and that designing the circuitry and / or writing the code for the software and firmware would be within the scope of practice of those skilled in the art, in light of this description. In addition, those skilled in the art will understand that the mechanisms of the subject described herein can be distributed as one or more program products in a variety of ways and that an illustrative form of the subject described here is applicable regardless of the specific type of transmission medium. signals used to effectively carry out the distribution.
[0235] [0235] The instructions used to program the logic to execute various revealed aspects can be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory or other storage. In addition, instructions can be distributed over a network or via other computer-readable media. In this way, a machine-readable media can include any mechanism to store or transmit information in a machine-readable form (for example, a computer), but is not limited to, floppy disks, optical discs, compact memory disc read-only (CD-ROMs), and optical-dynamo discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), read-only memory pro- electrically erasable (EEPROM), magnetic or optical cards, flash memory, or machine-readable tangible storage media used to transmit information over the Internet via an electrical, optical, acoustic cable or other forms of signal processing. paid (for example, carrier waves, infrared signal, digital signals, etc.). Consequently, computer-readable non-transitory media includes any type of machine-readable media suitable for storing or transmitting instructions or electronic information in a machine-readable form (for example, a computer).
[0236] [0236] As used in any aspect of the present invention, the term "control circuit" can refer to, for example, a set of wired circuits, programmable circuits (for example, a computer processor that includes one or more cores individual instruction processing units, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic matrix (PLA), or arrangement field programmable ports (FPGA)), state machine circuits, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuit can, collectively or individually, be incorporated as an electrical circuit that is part of a larger system, for example, an integrated circuit (IC), an application specific integrated circuit (ASIC), an on-line system. -chip (SoC), desktop computers, laptop computers, tablet computers, servers, smart headsets, etc. Accordingly, as used in the present invention, "control circuit" includes, but is not limited to, electrical circuits that have at least one discrete electrical circuit, electrical circuits that have at least one integrated circuit, electrical circuits that have at least one circuit integrated circuit for specific application, electrical circuits that form a general-purpose computing device configured by a computer program (for example, a general-purpose computer configured by a computer program that at least partially runs processes and / or devices described herein, or a microprocessor configured by a computer program that at least partially performs the processes and / or devices described herein), electrical circuits that form a memory device (for example, forms of random access memory), and / or electrical circuits that form a communications device (for example, a modem, communication, or optical-electrical equipment). Those skilled in the art will recognize that the subject described here can be implemented in an analog or digital way, or in some combination of these.
[0237] [0237] As used in any aspect of the present invention, the term "logical" can refer to an application, software, firmware and / or circuit configured to perform any of the aforementioned operations. The software can be incorporated as a software package, code, instructions, instruction sets and / or data recorded on the computer-readable non-transitory storage media. The firmware can be embedded as code, instructions or instruction sets and / or data that are hard-coded (for example, non-volatile) in memory devices.
[0238] [0238] As used in any aspect of the present invention, the terms "component", "system", "module" and the like may refer to a computer-related entity, be it hardware, a combination of hardware and software, software or software running.
[0239] [0239] As used here in one aspect of the present invention, an "algorithm" refers to the self-consistent sequence of steps that lead to the desired result, where a "step" refers to the manipulation of physical quantities and / or logical states that can, although they do not necessarily need to, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is common use to call these signs bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may be associated with adequate physical quantities and are merely convenient identifications applied to these quantities and / or states.
[0240] [0240] A network can include a packet switched network. Communication devices may be able to communicate with each other using a selected packet switched network communications protocol.
[0241] [0241] Unless otherwise stated, as is evident from the preceding description, it is understood that, throughout the preceding description, discussions that use terms such as "processing", or "computation", or "calculation", or " determination ", or" display ", or similar, refer to the action and processes of a computer, or similar electronic computing device, that manipulate and transform the data represented in the form of physical (electronic) quantities in the records and in the computer's memories in other data represented in a similar way in the form of physical quantities in the memories or records of the computer, or in other similar information storage, transmission or display devices.
[0242] [0242] One or more components in the present invention may be called "configured for", "configurable for", "operable / operational for", "adapted / adaptable for", "capable of", "according to movable / conformed to ", etc. Those skilled in the art will recognize that "configured for" can, in general, encompass components in an active state and / or components in an inactive state and / or components in a standby state, except when the context dictates otherwise.
[0243] [0243] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located opposite the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[0244] [0244] Persons skilled in the art will recognize that, in general, the terms used here, and especially in the appended claims (eg, bodies of the appended claims) are generally intended as "open" terms (eg, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having at least", the term "includes" should be interpreted as "includes, but not limits to ", etc.). It will also be understood by those skilled in the art that, when a specific number of a claim statement entered is intended, that intention will be expressly mentioned in the claim and, in the absence of such mention, no intention will be present. For example, as an aid to understanding, the following appended claims may contain the use of the introductory phrases "at least one" and "one or more" to introduce claim statements. However, the use of such phrases should not be interpreted as implying that the introduction of a claim statement by the indefinite articles "one, ones" or "one, ones" limits any specific claim containing the mention of the claim introduced to claims containing only one such mention, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles, such as "one, ones" or "one, ones" (for example, "one, ones" and / or "one, ones" should typically be interpreted as meaning "at least one" or "one or more"); the same goes for the use of defined articles used to introduce claims.
[0245] [0245] Furthermore, even if a specific number of an introduced claim statement is explicitly mentioned, those skilled in the art will recognize that that statement must typically be interpreted as meaning at least the number mentioned (for example, example, the mere mention of "two mentions", without other modifiers, typically means at least two mentions, or two or more mentions). In addition, in cases where a convention analogous to "at least one of A, B and C, etc." is used, in general this construction is intended to have the meaning in which the convention would be understood by (for example, "a system that has at least one of A, B and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). In cases in which a convention analogous to "at least one among A, B or C, etc." is used, in general this construction is intended to have the meaning in which the convention would be understood by (for example, "a system that has at least one of A, B and C "would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). It will be further understood by those skilled in the art that typically a disjunctive word and / or phrase presenting two or more alternative terms, whether in the description, in the claims or in the drawings, should be understood as contemplating the possibility of including one of the terms - mos, either term or both terms, except when the context determines to indicate something different. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B".
[0246] [0246] With respect to the appended claims, those skilled in the art will understand that the operations mentioned in the same can, in general, be performed in any order. In addition, although several operational flow diagrams are presented in one or more sequences, it must be understood that the various operations can be performed in other orders than those shown, or can be performed simultaneously. Examples of these alternative sorts may include overlapping, merged, interrupted, reordered, incremental,
[0247] [0247] It is worth noting that any reference to "one (1) aspect", "one aspect", "an exemplification" or "one (1) exemplification", and the like means that a particular resource, structure or characteristic described in connection with the aspect is included in at least one aspect. Thus, the use of expressions such as "in one (1) aspect", "in one aspect", "in an exemplification", "in one (1) exemplification", in several places throughout this specification necessarily refers to the same aspect. In addition, specific resources, structures or characteristics can be combined in any appropriate way in one or more aspects.
[0248] [0248] Any patent application, patent, non-patent publication or other description material mentioned in this specification and / or mentioned in any order data sheet is hereby incorporated by reference, up to the point in that the embedded materials are not inconsistent with this. Thus, and as necessary, the description as explicitly presented herein replaces any conflicting material incorporated into the present invention as a reference. Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other description materials contained herein, will be incorporated here only to the extent that that there is no conflict between the embedded material and the existing description material.
[0249] [0249] In summary, numerous benefits have been described that result from the use of the concepts described in this document. The previously mentioned description of one or more modalities has been presented for purposes of illustration and description.
This description is not intended to be exhaustive or to limit the invention to the precise form disclosed.
Modifications or variations are possible in light of the above teachings.
One or more modalities were chosen and described in order to illustrate the principles and practical application to, thus, allow those skilled in the art to use the various modalities and with various modifications, as they are convenient to the specific use contemplated.
It is intended that the claims presented in the annex define the global scope.

权利要求:
Claims (21)
[1]
1. Computer system configured to connect communicatively to a plurality of surgical devices, characterized by the computer system comprising: a processor; and a memory attached to the processor, and the memory stores instructions that, when executed by the processor, make up the computer system: determine which of the plurality of surgical devices are used during a surgical procedure based on at least partly in perioperative data received from one or more of the plurality of surgical devices; determining whether each of the plurality of surgical devices used during the surgical procedure is a reusable surgical device or a non-reusable surgical device; determine a maintenance cost for each reusable surgical device; determine a replacement cost for each non-reusable surgical device; and determining a total cost of the plurality of surgical devices for the surgical procedure according to the maintenance cost for each reusable surgical device and the replacement cost for each non-reusable surgical device.
[2]
2. Computer system, according to claim 1, characterized in that the maintenance cost comprises at least one of a cleaning cost, a re-sterilization cost, a repair cost, or any combination thereof.
[3]
3. Computer system, according to claim 1, characterized in that the memory also stores instructions that,
when performed by the processor, make the computer system: determine whether the maintenance cost exceeds the replacement cost for each reusable surgical device; and provide a replacement recommendation for each reusable surgical device when the maintenance cost exceeds the replacement cost.
[4]
4. Computer system, according to claim 1, characterized in that the memory also stores instructions that, when executed by the processor, make the computer system: determine a number of uses for each reusable surgical device; and provide a replacement recommendation for each reusable surgical device when the number of uses exceeds a limit.
[5]
5. Computer system, according to claim 1, characterized in that the memory also stores instructions that, when executed by the processor, make the computer system: retrieve metadata associated with each reusable surgical device, and the metadata store by minus one of the locations of the reusable surgical device, time periods for the locations, a number of uses of the reusable surgical device, or any combination thereof; and determine the maintenance cost for each reusable surgical device according to the metadata.
[6]
6. Computer system, according to claim 1, characterized in that the memory still stores instructions that, when executed by the processor, make the computer system:
retrieve a purchase price associated with each non-reusable surgical device from a purchasing database; where the replacement cost corresponds to the purchase price.
[7]
7. Computer system according to claim 1, characterized in that the computer system comprises a central surgical controller.
[8]
8. Computer system, characterized by comprising: a processor; and a memory coupled to the processor, and the memory stores instructions that, when executed by the processor, make the computer system: identify one or more surgical devices used during a surgical procedure, according to perioperative data received one or more surgical devices; and determining a total cost of one or more surgical devices for the surgical procedure according to a maintenance cost or a replacement cost associated with each of the one or more surgical devices.
[9]
9. Computer system according to claim 8, characterized in that the maintenance cost comprises at least one of a cleaning cost, a re-sterilization cost, a repair cost, or any combination thereof.
[10]
10. Computer system, according to claim 8, characterized in that the memory still stores instructions that, when executed by the processor, make the computer system: determine if the maintenance cost exceeds the replacement cost for each surgical device reusable; and provide a replacement recommendation for each reusable surgical device when the maintenance cost exceeds the replacement cost.
[11]
11. Computer system, according to claim 8, characterized in that the memory also stores instructions that, when executed by the processor, make the computer system: determine a number of uses for each reusable surgical device; and provide a replacement recommendation for each reusable surgical device when the number of uses exceeds a limit.
[12]
12. Computer system, according to claim 8, characterized in that the memory also stores instructions that, when executed by the processor, make the computer system: retrieve metadata associated with each reusable surgical device, and the metadata store by minus one of the locations of the reusable surgical device, time periods for the locations, a number of uses of the reusable surgical device, or any combination thereof; and determine the maintenance cost for each reusable surgical device according to the metadata.
[13]
13. Computer system, according to claim 8, characterized in that the memory also stores instructions that, when executed by the processor, make the computer system: recover a purchase price associated with each non-reusable surgical device from a purchasing database; where the replacement cost corresponds to the purchase price.
[14]
14. Computer system according to claim 8, characterized in that the computer system comprises a central surgical controller.
[15]
15. Method implemented by computer to determine a cost of the surgical device for a surgical procedure, characterized by the method comprising: determining, through a computer system, which among a plurality of surgical devices are used during the surgical procedure based on at least in part in perioperative data received from one or more of the plurality of surgical devices; determine, through the computer system, whether each of the plurality of surgical devices used during the surgical procedure is a reusable surgical device or a non-reusable surgical device; determine, through the computer system, a maintenance cost for each reusable surgical device; determine, through the computer system, a replacement cost for each non-reusable surgical device; and determining, through the computer system, a total cost of the plurality of surgical devices for the surgical procedure according to the maintenance cost for each reusable surgical device and the replacement cost for each non-reusable surgical device.
[16]
16. Computer-implemented method according to claim 15, characterized in that the maintenance cost comprises at least one of a cleaning cost, a re-sterilization cost, a repair cost, or any combination of themselves.
[17]
17. Method implemented by computer, according to claim 15, characterized by further comprising:
determine, through the computer system, whether the maintenance cost exceeds the replacement cost for each reusable surgical device; and provide, through the computer system, a replacement recommendation for each reusable surgical device when the maintenance cost exceeds the replacement cost.
[18]
18. Method implemented by computer, according to claim 15, characterized by further comprising: determining, through the computer system, a number of uses for each reusable surgical device; and provide, through the computer system, a replacement recommendation for each reusable surgical device when the number of uses exceeds a limit.
[19]
19. Method implemented by computer, according to claim 15, characterized by further comprising: recovering, through the computer system, metadata associated with each reusable surgical device, with the data storing at least one of the device's locations reusable surgical, time periods for sites, a number of uses of the reusable surgical device, or any combination thereof; and determine, through the computer system, the maintenance cost for each reusable surgical device according to the metadata.
[20]
20. Method implemented by computer, according to claim 15, characterized by further comprising: recovering, through the computer system, a purchase price associated with each non-reusable surgical device from a purchasing database; where the replacement cost corresponds to the purchase price.
[21]
21. A computer-implemented method according to claim 15, characterized in that the computer system comprises a central surgical controller.

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US20210205021A1|2021-07-08|Surgical network recommendations from real time analysis of procedure variables against a baseline highlighting differences from the optimal solution

---

US20190200980A1|2019-07-04|Surgical system for presenting information interpreted from external data

---

BR112020013175A2|2020-12-01|imaging of areas outside the abdomen to improve placement and control of an in-use surgical device

---

BR112020013169A2|2020-12-01|surgical tool equipped with motor with predefined adjustable control algorithm to control end actuator parameters

---

BR112020013196A2|2020-12-01|position detection and patient contact with the use of the monopolar return block electrode to provide situational recognition to the central controller

---

BR112020013013A2|2020-11-24|surgical systems with autonomously adjustable control programs

---

BR112020013241A2|2020-12-01|control of a surgical system through a surgical barrier

---

BR112020013199A2|2020-12-01|change of scale, alignment and self-organization of data based on predefined parameters within surgical networks

---

US11278281B2|2022-03-22|Interactive surgical system

---

BR112020013087A2|2020-12-01|detection and escalation of surgical instrument safety responses to threats of increasing severity

---

BR112020013162A2|2020-12-01|interactive surgical system

---

BR112020012957A2|2020-12-01|surgical system to present information interpreted from external data

---

BR112020013031A2|2020-11-24|response adjustment of modular device and central surgical controller based on situational recognition

同族专利:

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公开号 | 公开日

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US11257589B2|2022-02-22|

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US20190206556A1|2019-07-04|

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EP3506311A1|2019-07-03|

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CN111699532A|2020-09-22|

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JP2021509329A|2021-03-25|

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WO2019133127A1|2019-07-04|

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法律状态:
2021-12-07| B350| Update of information on the portal [chapter 15.35 patent gazette]|

优先权:

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申请号 | 申请日 | 专利标题

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US201762611341P| true| 2017-12-28|2017-12-28|

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US201762611340P| true| 2017-12-28|2017-12-28|

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US201762611339P| true| 2017-12-28|2017-12-28|

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US62/611,340|2017-12-28|

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US62/611,341|2017-12-28|

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US62/611,339|2017-12-28|

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US201862640417P| true| 2018-03-08|2018-03-08|

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US201862640415P| true| 2018-03-08|2018-03-08|

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US62/640,417|2018-03-08|

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US62/640,415|2018-03-08|

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US201862650882P| true| 2018-03-30|2018-03-30|

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US201862650877P| true| 2018-03-30|2018-03-30|

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US201862650898P| true| 2018-03-30|2018-03-30|

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US201862650887P| true| 2018-03-30|2018-03-30|

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US62/650,877|2018-03-30|

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US62/650,882|2018-03-30|

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US62/650,898|2018-03-30|

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US62/650,887|2018-03-30|

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US201862659900P| true| 2018-04-19|2018-04-19|

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US62/659,900|2018-04-19|

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US201862692747P| true| 2018-06-30|2018-06-30|

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US201862692748P| true| 2018-06-30|2018-06-30|

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US201862692768P| true| 2018-06-30|2018-06-30|

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US62/692,768|2018-06-30|

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US62/692,747|2018-06-30|

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US62/692,748|2018-06-30|

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US201862729191P| true| 2018-09-10|2018-09-10|

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US62/729,191|2018-09-10|

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US16/182,242|2018-11-06|

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