data pairing to interconnect a measured parameter from a device with a result

专利摘要:
Several central surgical controllers are revealed. A central surgical controller is configured to communicate with a surgical instrument. The central surgical controller comprises a processor and a memory attached to the processor. The memory stores instructions executable by the processor to receive a first set of data associated with a surgical procedure. The first data set is generated at first. A second set of data, associated with the effectiveness of the surgical procedure, is also received. The second set of data is generated in a second moment. The second moment is separate and distinct from the first moment. The processor executes additional instructions to anonymize the first and second data sets by removing information that identifies a patient, surgery, or a scheduled surgery time; and stores the first and second anonymized data sets to generate a pair of data grouped by surgery.
公开号:BR112020013138A2
申请号:R112020013138-5
申请日:2018-07-30
公开日:2020-12-01
发明作者:Frederick E. Shelton Iv；David C. Yates；Jason L. Harris；Raymond E. Parfett
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] This application claims priority benefit under 35 U.S.C. 119 (e) to US provisional patent application serial number 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT. RECORDS AND CREATE ANONYMIZED RECORD, filed on March 28, 2018, the disclosure of which is hereby incorporated by reference, in its entirety.
[0002] [0002] This application claims priority under 35 USC 119 (e) of US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, with US provisional patent application serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, and US provisional patent application serial number 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the disclosure being each of which is incorporated herein by reference, in its entirety. BACKGROUND
[0003] [0003] The present disclosure relates to several surgical systems. Surgical procedures are typically performed in galleries or 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
[0004] [0004] In a general aspect, a central surgical controller is provided. The central surgical controller is configured to communicate with a surgical instrument. The central surgical controller comprises a processor and a memory attached to the processor. The memory stores instructions executable by the processor to receive a first set of data associated with a surgical procedure. The first data set is generated at first. A second set of data, associated with the effectiveness of the surgical procedure, is also received. The second set of data is generated in a second moment. The second moment is separate and distinct from the first moment. The processor executes additional instructions to anonymize the first and second data sets by removing information that identifies a patient, surgery, or a scheduled surgery time; and stores the first and second anonymized data sets to generate a pair of data grouped by surgery.
[0005] [0005] In another general aspect, another central surgical controller is provided. The central surgical controller is configured to communicate with a surgical instrument. The central surgical controller comprises a control circuit configured to receive a first set of data associated with a surgical procedure and receive a second set of data associated with the effectiveness of the surgical procedure. The first data set is generated at first. The second set of data is generated in a second moment. The second moment is separate and distinct from the first moment. The control circuit is also configured to anonymize the first and second data sets by removing information that identifies a patient, a surgery or a scheduled surgery time; and storing the first and second anonymized data sets to generate a pair of data grouped by surgery.
[0006] [0006] In yet another general aspect, computer-readable media is provided. Computer-readable media is non-transitory and stores computer-readable instructions that, when executed, cause a machine to receive a first set of data associated with a surgical procedure and receive a second set of data associated with the effectiveness of the surgical procedure. The first data set is generated at first. The second set of data is generated in a second moment. The second moment is separate and distinct from the first moment. The instructions executed also anonymize the first and second data sets by removing information that identifies a patient, surgery or a scheduled time for surgery; and store the first and second anonymized data sets to generate a pair of data grouped by surgery
[0007] [0007] In yet another general aspect, another central surgical controller is provided. The central surgical controller comprises a processor and a memory attached to the processor. The memory stores instructions executable by the processor to interrogate a surgical instrument and retrieve a first set of data from the surgical instrument. The surgical instrument is a first source of patient data and the first data set is associated with a patient and a surgical procedure. The executed instructions interrogate a medical imaging device. The medical imaging device is a second source of patient data. The executed instructions also retrieve a second set of data from the medical imaging device. The second set of data is associated with the patient and a result of the surgical procedure. The executed instructions associate the first and second data sets with a key, and transmit the first and second data sets associated with a remote network outside the central surgical controller. FIGURES
[0008] [0008] The appeals of various aspects are presented with particularity in the attached claims. The various aspects, however, with regard to both the organization and the methods of operation, together with additional objects and advantages of the same, can be better understood in reference to the description presented below, considered together with the attached drawings, as follows.
[0009] [0009] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present disclosure.
[0010] [0010] 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 disclosure.
[0011] [0011] 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 disclosure.
[0012] [0012] Figure 4 is a partial perspective view of a central surgical controller compartment, and of a generator module in combination received slidingly in a central surgical controller compartment, in accordance with at least one aspect of the present disclosure.
[0013] [0013] 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 disclosure.
[0014] [0014] 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 disclosure.
[0015] [0015] Figure 7 illustrates a vertical modular housing configured to receive a plurality of modules, according to at least one aspect of the present disclosure.
[0016] [0016] Figure 8 illustrates a surgical data network comprising a central modular communication controller 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 the cloud, according to at least one aspect of the present disclosure.
[0017] [0017] Figure 9 illustrates an interactive surgical system implemented by computer, according to at least one aspect of the present disclosure.
[0018] [0018] 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 disclosure.
[0019] [0019] Figure 11 illustrates an aspect of a central controller device of the universal serial bus (USB) network, in accordance with at least one aspect of the present disclosure.
[0020] [0020] Figure 12 illustrates a logical diagram of a control system for an instrument or surgical tool, according to at least one aspect of the present disclosure.
[0021] [0021] Figure 13 illustrates a control circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present disclosure.
[0022] [0022] Figure 14 illustrates a combinational logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present disclosure.
[0023] [0023] Figure 15 illustrates a sequential logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present disclosure.
[0024] [0024] Figure 16 illustrates an instrument or surgical tool that comprises a plurality of motors that can be activated to perform various functions, according to at least one aspect of the present disclosure.
[0025] [0025] Figure 17 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present disclosure.
[0026] [0026] Figure 18 illustrates a block diagram of a surgical instrument programmed to control the distal translation of the displacement member, according to an aspect of the present disclosure.
[0027] [0027] Figure 19 is a schematic diagram of a surgical instrument configured to control various functions, according to at least one aspect of the present disclosure.
[0028] [0028] Figure 20 is a simplified block diagram of a generator configured to provide adjustment without inductor, among other benefits, according to at least one aspect of the present disclosure.
[0029] [0029] Figure 21 illustrates an example of a generator, which is a form of the generator of Figure 20, according to at least one aspect of the present disclosure.
[0030] [0030] Figure 22 is a diagram that illustrates a technique for interacting with an electronic medical record (RME) database, in accordance with at least one aspect of the present disclosure.
[0031] [0031] Figure 23 illustrates a process of anonymizing a surgical procedure by replacing an artificial time measurement for a real time clock for all information stored internally within the instrument, robot, central surgical controller and / or hospital computerized equipment. , in accordance with at least one aspect of the present disclosure.
[0032] [0032] Figure 24 illustrates an ultrasonic sensor of an operating room wall to determine a distance between a central surgical controller and the operating room wall, in accordance with at least one aspect of the present disclosure.
[0033] [0033] Figure 25 illustrates a diagram representing the process of importing patient data stored in an electronic medical record (RME) database, the extraction of patient data and the identification of implications of the smart device, according to with at least one aspect of the present revelation.
[0034] [0034] Figure 26 illustrates the application of cloud-based analysis for edited and extracted patient data and independent data pairs, in accordance with at least one aspect of the present disclosure.
[0035] [0035] Figure 27 is a logic flow diagram of a process that represents a control program or a logical configuration for associating patient data sets from a first and a second data source, according to at least one aspect of the present revelation.
[0036] [0036] Figure 28 is a logic flow diagram of a process that represents a control program or a logical configuration to extract data in order to extract relevant portions of the data to configure and operate the central surgical controller and modules (for example , instruments) coupled to the central surgical controller, in accordance with at least one aspect of the present disclosure.
[0037] [0037] Figure 29 illustrates a self-describing data package comprising self-describing data, in accordance with at least one aspect of the present disclosure.
[0038] [0038] Figure 30 is a logic flow diagram of a process that represents a control program or a logical configuration for using data packages that comprise self-describing data, in accordance with at least one aspect of the present disclosure.
[0039] [0039] Figure 31 is a logic flow diagram of a process that represents a control program or a logical configuration for using data packages that comprise self-describing data, in accordance with at least one aspect of the present disclosure.
[0040] [0040] Figure 32 is a diagram of a tumor located in the upper right posterior lobe of the direct lung, according to at least one aspect of the present disclosure.
[0041] [0041] Figure 33 is a diagram of a surgical procedure for resection of a lung tumor that includes four separate shots of a surgical stapler to seal and cut exposed bronchial vessels in the fissure up to and from the upper and lower lobes of the right lung shown in Figure 32, according to at least one aspect of the present disclosure.
[0042] [0042] Figure 34 is a graphic illustration of a force to close (FTC) versus a time curve and a force to fire (FTF) versus a time curve that characterizes the first trigger of device 002 as shown in Figure 32, according to at least one aspect of the present disclosure.
[0043] [0043] Figure 35 is a diagram of a laser Doppler of the staple line visualization to assess the integrity of the staple line seals by monitoring the bleeding of a vessel after the triggering of a surgical stapler, according to least one aspect of the present disclosure.
[0044] [0044] Figure 36 illustrates a set of paired data grouped by surgery, according to at least one aspect of the present disclosure.
[0045] [0045] Figure 37 is a diagram of the right lung.
[0046] [0046] Figure 38 is a diagram of the bronchial tree that includes the trachea and the bronchi of the lung.
[0047] [0047] Figure 39 is a logical flow diagram of a process that represents a control program or a logical configuration for storing anonymous paired data sets grouped by surgery, in accordance with at least one aspect of the present disclosure.
[0048] [0048] Figure 40 is a logic flow diagram of a process that represents a control program or a logical configuration to determine the speed, frequency and type of data to be transferred to a remote cloud-based analytical network, from according to at least one aspect of the present disclosure.
[0049] [0049] Figure 41 is a timeline that represents the situational perception of a central surgical controller, according to at least one aspect of the present disclosure. DESCRIPTION
[0050] [0050] The applicant for this application holds the following provisional US patent applications, filed on March 28, 2018, each of which is incorporated herein by reference in its entirety: and US Provisional Patent Application serial number 62 /649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; and US Provisional Patent Application Serial No. 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; and US Provisional Patent Application serial number 62 / 649,300,
[0051] [0051] The applicant for the present application holds the following US patent applications, filed on March 29, 2018, each of which is hereby incorporated by reference in its entirety: and US Patent Application serial number; titled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; Attorney document number END8499USNP / 170766; and US Patent Application serial number; titled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES; Attorney document number END8499USNP1 / 170766-1; and US Patent Application serial number; titled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES; Attorney document number END8499USNP2 / 170766-2; and US Patent Application serial number; titled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS; Attorney document number END8499USNP3 / 170766-3; and US Patent Application serial number; titled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS; Attorney document number END8499USNP4 / 170766-4; and US Patent Application Serial No., entitled SURGICAL HUB CONTROL ARRANGEMENTS; Attorney document number END8499USNP5 / 170766-5; and US Patent Application serial number; titled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; Attorney document number END8500USNP / 170767; and US Patent Application serial number; titled COMMUNICATION HUB AND STORAGE DEVICE FOR
[0052] [0052] The applicant for this application holds the following US patent applications, filed on March 29, 2018, each of which is incorporated herein by reference in its entirety: and US Patent Application serial number; titled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; Attorney document number END8506USNP / 170773; and US Patent Application Serial No., entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR
[0053] [0053] The applicant for this application holds the following US patent applications, filed on March 29, 2018, each of which is incorporated herein by reference in its entirety:
[0054] [0054] 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 description attached. Illustrative examples can be implemented or incorporated into other aspects, variations and modifications, and can be practiced or performed in a variety of 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.
[0055] [0055] Referring 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 storage device 105). Each surgical system 102 includes at least one central surgical controller 106 in communication with the cloud 104 which can include a remote server 113. In one example, as illustrated in Figure 1, surgical system 102 includes a visualization system 108, a robotic system 110, a portable and intelligent 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 an M number of central controllers 106, an N number of visualization systems 108, an O number of robotic systems 110, and a P number of portable intelligent surgical instruments 112, where M, N, O, and P are integers greater than or equal to one.
[0056] [0056] Figure 3 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 surgical procedure as a part of surgical system 102. Robotic system 110 includes a surgeon console 118, a patient car 120 (surgical robot), and a robotic central surgical controller
[0057] [0057] 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 disclosure are described in provisional patent application serial number 62 / 611.339 , entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the disclosure of which is hereby incorporated by reference in its entirety for reference.
[0058] [0058] Several examples of cloud-based analysis that are performed by the cloud 104, and are suitable for use with the present disclosure, are described in US provisional patent application serial number 62 / 611.340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, the disclosure of which is hereby incorporated by reference, in its entirety.
[0059] [0059] In several respects, 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.
[0060] [0060] 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 tissue and / or surgical instruments.
[0061] [0061] The 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.
[0062] [0062] 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 electromagnetic gamma-ray radiation.
[0063] [0063] In several respects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present disclosure include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledocoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngoscope neproscope, sigmoidoscope, thoracoscope, and ureteroscope.
[0064] [0064] In one aspect, the imaging device employs multiple spectrum monitoring to discriminate topography and underlying structures. A multi-spectral image is one that captures image data within wavelength bands across the electromagnetic spectrum. Wavelengths can be separated by filters or using instruments that are sensitive to specific wavelengths, including light from frequencies beyond the visible light range, for example, IR and ultraviolet light. 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 more detail under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the disclosure of which is incorporated herein as a 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.
[0065] [0065] 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.
[0066] [0066] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays and one or more screens that are strategically arranged in relation to the sterile field, as illustrated in Figure 2. In one aspect, the display system 108 includes an interface for HL7, PACS and RME. Various components of the visualization system 108 are described under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the disclosure of which is incorporated herein reference title in its entirety.
[0067] [0067] 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, the central controller 106 can have the 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 maintaining a live transmission of the surgical site on main screen 119. Snapshot on non-sterile screen 107 or 109 can allow a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.
[0068] [0068] In one aspect, the central controller 106 is also configured to route a diagnostic input or 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.
[0069] [0069] With reference to Figure 2, a 112 surgical instrument is being used in the surgical procedure as part of the surgical system
[0070] [0070] Now with reference to Figure 3, a central controller 106 is shown in communication with a visualization system 108, a robotic system 110 and a portable intelligent surgical instrument 112. The central controller 106 includes a central controller screen 135, a imaging module 138, generator module 140, communication module 130, processor module 132 and storage array 134. In certain respects, as shown in Figure 3, central controller 106 additionally includes a smoke evacuation module 126 and / or a suction / irrigation module 128.
[0071] [0071] 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 central compartment 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.
[0072] [0072] Aspects of the present disclosure feature a central surgical controller for use in a surgical procedure that involves applying energy to tissue at a surgical site. The central surgical controller includes a central controller compartment and a combination generator module received slidingly at a central controller compartment 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 which 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.
[0073] [0073] 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 received slidingly in the central controller compartment. In one aspect, the central controller compartment comprises a fluid interface.
[0074] [0074] 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 fabric, while another type of energy may be more beneficial for sealing the fabric. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution in which a modular compartment of central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the central modular compartment 136 is that it allows quick removal and / or replacement of several modules.
[0075] [0075] Aspects of the present disclosure feature a modular surgical compartment for use in a surgical procedure that involves applying energy to the tissue. The modular surgical compartment 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 contacts and energy contacts, the the first power generator module is slidingly movable in an electrical coupling with the power and data contacts and the first power generator module is slidingly movable out of the electric coupling with the first power and data contacts.
[0076] [0076] In addition to the above, the modular surgical compartment 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 comprising a second docking port which includes second data and power contacts, the second power generating module being slidably movable in an electrical coupling with the power and data contacts, and the second power generating module being slidingly movable outwards electrical coupling with the second power and data contacts.
[0077] [0077] 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.
[0078] [0078] With reference to Figures 3 to 7, aspects of the present disclosure are presented for a modular compartment of the central controller 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126, and a suction / irrigation 128. The central modular compartment 136 further facilitates interactive communication between modules 140, 126, 128. As illustrated in Figure 5, generator module 140 can be a generator module with integrated monopolar, bipolar and ultrasonic components, supported on a single cabinet unit 139 slidably insertable in the central modular compartment 136. As shown in Figure 5, generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147 and an ultrasonic device 148. Alternatively, the generator module 140 can comprise a series of monopolar, bipolar and / or ultrasonic generator modules that interact through the comp central modular device 136. The central modular compartment 136 can be configured to facilitate the insertion of multiple generators and interactive communication between the generators anchored in the central modular compartment 136 so that the generators would act as a single generator.
[0079] [0079] In one aspect, the central modular compartment 136 comprises a modular power and a rear communication board 149 with external and wireless communication heads to allow removable fixing of modules 140, 126, 128 and interactive communication between them.
[0080] [0080] In one aspect, the central modular compartment 136 includes docking stations, or drawers, 151, here also called drawers, which are configured to receive modules 140, 126, 128 in a sliding manner. Figure 4 illustrates a view in partial perspective of a surgical central controller compartment 136, and a combined generator module 145 slidably received in a docking station 151 of the central surgical controller compartment 136. A docking port 152 with power and data contacts on one side rear 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 from the central controller modular compartment 136 as the combined generator module 145 is slid into position at the station matching coupling 151 of the modular compartment of the central controller 136. In one aspect, the generator module combined 145 includes a bipolar, ultrasonic and monopolar module and a smoke evacuation module integrated into a single compartment unit 139, as shown in Figure 5.
[0081] [0081] 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. Suction a vacuum 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 compartment
[0082] [0082] 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 cause irrigation and aspiration of fluids to and from the surgical site.
[0083] [0083] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end thereof and at least an energy treatment associated with the end actuator, a suction tube, and a suction tube. irrigation. The suction tube can have an inlet port at a distal end of it 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 deliver 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.
[0084] [0084] 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 compartment 136 separately from the control module. suction / irrigation 128. In such an example, a fluid interface can be configured to connect the suction / irrigation module 128 to the fluid source and / or the vacuum source.
[0085] [0085] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the central modular compartment 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts at the stations coupling module of the central modular compartment 136. For example, as shown in Figure 4, the combined generator module 145 includes side brackets 155 that are configured to slide the corresponding brackets 156 of the corresponding docking station 151 of the central modular compartment 136 slidably. The brackets cooperate to guide the coupling port contacts of the combined generator module 145 in an electrical coupling with the coupling port contacts of the central modular compartment 136.
[0086] [0086] In some respects, the drawers 151 of the central modular compartment 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.
[0087] [0087] 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.
[0088] [0088] 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 modular compartment central 136. The coupling ports 150 of the central modular compartment 136 can, alternatively or additionally, facilitate interactive wireless communication between modules housed in the central modular compartment 136. Any suitable wireless communication can be used, such as, for example, Air Titan Bluetooth.
[0089] [0089] 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 lateral modular compartment 160 is configured to receive and laterally interconnect modules 161. Modules 161 are slidably inserted into docking stations 162 of side modular compartment 160, which includes a back plate for interconnecting modules 161. As shown in Figure 6, modules 161 are arranged laterally in the side modular cabinet
[0090] [0090] Figure 7 illustrates a vertical modular cabinet 164 configured to receive a plurality of modules 165 from the surgical central controller 106. The modules 165 are slidably inserted into docking stations, or drawers, 167 of the vertical modular cabinet 164, the which includes a rear panel for interconnecting modules 165. Although the drawers 167 of the 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
[0091] [0091] In several respects, the imaging module 138 comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular 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.
[0092] [0092] 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 disclosure 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.
[0093] [0093] 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.
[0094] [0094] 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.
[0095] [0095] Various image processors and imaging devices suitable for use with the present disclosure are described in US patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, granted on August 9, 2011 which is incorporated herein by reference in its entirety. In addition, US patent No. 7,982,776, entitled SBIl 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 the data of image. Such systems can be integrated with the imaging module 138. In addition to these, the publication of US patent application No. 2011/0306840, entitled CONTROLLABLE
[0096] [0096] Figure 8 illustrates a surgical data network 201 comprising a central modular communication controller 203 configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a healthcare facility. audiences 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 central controller 203 comprises a central network controller 207 and / or a network key 209 in communication with a network router. The central modular communication controller 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 the data, allowing the 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 can be called a a central controller or controllable key. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.
[0097] [0097] The modular devices 1a to 1n located in the operating room can be coupled to the central controller of modular communication 203. The central network controller 207 and / or the network switch 209 can be coupled to a network router 211 to connect devices 1a through 1n to the 204 cloud or the local computer system
[0098] [0098] 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 central communication controller 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 central controller 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 can 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, an evacuation module smoke 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 others modular devices that can be connected to the modular communication central controller 203 of the surgical data network 201.
[0099] [0099] In one aspect, the surgical data network 201 may 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 modular central communication controller 203 and / or computer system 210 located in the operating room (for example, a fixed, mobile, temporary, or fixed room or space, or field of operation) and devices connected to the central modular communication controller 203 and / or computer system 210 over the Internet. The cloud infrastructure can be maintained by a cloud service provider. In this context, the service provider cloud computing can be the entity that coordinates the use and control of devices 1a to 1n / 2a to 2m located in one or more operating rooms. Cloud computing services can perform a large number of calculations those based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. The central controller hardware allows multiple devices or connections to be connected to a computer that communicates with cloud computing and storage resources.
[0100] [0100] The application of cloud computer data processing techniques to 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 view tissue status to assess leakage or perfusion of sealed tissue after a tissue sealing and cutting procedure. 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 1hn / 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. The data collected by devices 1a to 1n / 2a to 2m, including the image data, can be transferred to the cloud 204 or the local computer system 210 or both for data processing and manipulation including image processing and manipulation. The data can be analyzed to improve the results of the surgical procedure by determining whether additional treatment, such as application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention, accurate robotics at specific tissue sites and conditions, 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 changes to surgical treatments and the surgeon's behavior.
[0101] [0101] In an implementation, operating room devices 1a to 1n can be connected to the central modular communication controller 203 via a wired channel or a wireless channel depending on the configuration of devices 1a to 1n on a central controller of 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 OSI model ("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 / Internet protocol (MAC / IP) access control for transferring 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 has no routing tables or intelligence about where to send information and transmits all network data through each connection and to a remote server 213 (Figure 9) in 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 security risk and cause bottlenecks.
[0102] [0102] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 via a wired or wireless channel. The network key 209 works in the data connection layer of the OSI model. The network switch 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. The network key 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.
[0103] [0103] The central network controller 207 and / or the network key 209 are coupled to the network router 211 for a connection to the cloud
[0104] [0104] 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 wireless, broadband and short-range wireless USB communication protocol can be used for communication between devices 1a to 1n and devices 2a to 2m located in the operating room.
[0105] [0105] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the central modular communication controller 203 via standard Bluetooth wireless technology for exchanging data over short distances (with the use of short-wavelength UHF radio waves in the 2.4 to 2.485 GHz ISM band) from fixed and mobile devices and build personal area networks (PANs). In other respects, operating room devices 1a to 1n / 2a to 2m can communicate with the central modular communication controller 203 via a number of wireless and wired communication standards or protocols, including, but not limited to a, 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 Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , WiMAX, LTE, Ev-DO and others.
[0106] [0106] The modular communication central controller 203 can serve as a central connection for one or all operating room devices 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 central communication controller 203, it is amplified and transmitted to the network router 211, which transfers data to cloud computing resources using a series of wireless communication standards or protocols or wired, as described in the present invention.
[0107] [0107] The 203 modular communication central controller can be used as a standalone device or be connected to compatible central network controllers and network switches to form a larger network. The 203 modular communication central controller 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.
[0108] [0108] 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 per 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
[0109] [0109] Figure 10 illustrates a central surgical controller 206 that comprises a plurality of modules coupled to the modular control tower 236. The modular control tower 236 comprises a central controller for modular communication 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 central controller 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 central controller 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 central controller 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 to the cloud computing resources and a local display 217. Communication with the cloud 204 can be done via a wired communication channel or wireless.
[0110] [0110] The central surgical controller 206 employs 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 the echo when it bounces outside the perimeter of the operating room walls, as described under the heading "Surgical Hub Spatial Awareness Within an Operating Room "in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is incorporated herein by reference in its entirety, in which the 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 bounce off 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 the Bluetooth pairing distance limits, for example.
[0111] [0111] 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 through of 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 available bus architectures including, but not limited to, not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charmel Architecture (MSA), extended ISA (EISA), smart drive electronics (IDE), VESA local bus (VLB), component interconnection peripherals (PCI), USB, accelerated graphics port (AGP), PCMCIA bus (International Personal Computer Memory Card Association, "Personal Computer Memory Card International Association"), Small Computer Systems Interface (SCSI), or any another proprietary bus.
[0112] [0112] Processor 244 can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one respect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 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 StellarisWareO program, read-only memory programmable and electrically erasable (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more analog to digital converters (ADC) of 12 bits with 12 analog input channels, details of which are available for the product data sheet.
[0113] [0113] 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.
[0114] [0114] 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), EEPROM 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).
[0115] [0115] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, such as disk storage Disk storage includes, but is not limited to, devices such as a storage unit magnetic disk, 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.
[0116] [0116] It is to be understood that computer system 210 includes software that acts as an intermediary between users and basic computer resources described in an appropriate operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage,
[0117] [0117] A user enters commands or information into computer system 210 via the input device (s) coupled to the I / O interface 251. Input devices include, but are not limited to, a device pointer such as a mouse, trackball, stylus, touchpad, 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 information from the computer system 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.
[0118] [0118] 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 integrated service digital networks (ISDN) and variations in them, packet switching networks and digital subscriber lines (DSL).
[0119] [0119] 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 an image processor, a motor image processing, a media processor or any specialized digital signal processor (PSD) used for processing digital images. The image processor can employ parallel computing with single multi-data instruction (SIMD) or multiple 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 an integrated circuit system with a multi-core processor architecture.
[0120] [0120] The communication connection (s) refers 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 computer system 210. The hardware / software required for connection to the network interface includes, for illustrative purposes only, internal and external technologies such as modems, including regular telephone serial modems, cable modems and DSL modems, ISDN adapters, and Ethernet cards.
[0121] [0121] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 central network controller, in accordance with at least one aspect of the present disclosure. In the illustrated aspect, the USB 300 network central controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The central network controller USB 300 is a CMOS device that provides a 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" differential data input (DMO) paired with a "plus" differential data input (DPO). 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) .
[0122] [0122] 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 doors. The USB 300 network central controller device can be configured in bus powered or self powered mode and includes 312 central power logic to manage power.
[0123] [0123] 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, data encoding / decoding non-inverted zero (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 with a suspend / resume logic circuit and frame timer 316 and a central controller repeat circuit 318 to control communication between the upstream USB transceiver port 302 and the USB transceiver ports downstream 304, 306, 308 through the logic circuits of ports 320, 322, 324. The SIE 310 is coupled to a command decoder 326 through the logic interface to control the commands of a serial EEPROM via an EEPROM interface in 330 series.
[0124] [0124] 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 power management. individual port power or grouped port power management. In one aspect, using a USB cable, the USB 300 central network controller, the USB upstream transceiver port 302 is plugged into a USB host controller, and the downstream USB transceiver ports 304, 306, 308 are exposed to connect compatible USB devices, and so on. Surgical instrument hardware
[0125] [0125] Figure 12 illustrates a logic diagram of a module of a 470 control system of a surgical instrument or tool, according to one or more aspects of the present disclosure. The 470 system comprises a control circuit. The control circuit includes a microcontroller 461 comprising a processor 462 and a memory 468. One or more of the sensors 472, 474, 476, for example, provide real-time feedback to processor 462. A motor 482, driven by a driver motor 492, operationally couples a longitudinally movable displacement member to drive the beam cutting element with | A tracking system 480 is configured to determine the position of the longitudinally movable displacement member. Position information is provided to processor 462, which can be programmed or configured to determine the position of the longitudinally movable drive member as well as the position of a firing member, the firing bar and a beam cutting element with a profile in |. Additional motors can be provided at the instrument driver interface to control the firing of the beam with an i-profile, the displacement of the closing tube, the rotation of the drive shaft and the articulation. A 473 screen displays a variety of instrument operating conditions and can include touchscreen functionality for data entry. The information displayed on screen 473 can be overlaid with images captured using endoscopic imaging modules.
[0126] [0126] In one aspect, the 461 microcontroller can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one respect, the main microcontroller 461 can be an LM4F230H5QR ARM Cortex-M4F processor, available from Texas Instruments, for example, which comprises an integrated 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 series random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWare6 program, programmable memory and electrically erasable read-only (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analogs of quadrature encoder (QEI) inputs, and / or one or more analog converters for 12-bit digital (ADC) with 12 channels of analog input, details of which are available for the product data sheet.
[0127] [0127] In one aspect, the 461 microcontroller can comprise a safety controller that comprises two families based on controllers, such as TMS570 and RM4x known under the trade name Hercules ARM Cortex R4, also available from 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.
[0128] [0128] The 461 microcontroller can be programmed to perform various functions, such as precise control of the speed and position of the joint and knife systems. In one aspect, microcontroller 461 includes a processor 462 and a memory 468. The electric motor 482 can be a brushed direct current (DC) motor with a gearbox and mechanical connections with an articulation or scalpel system. In one aspect, a motor drive 492 can be an A3941 available from Allegro Microsystems, Inc. Other motor drives can be readily replaced for use in tracking system 480 which comprises an absolute positioning system. A detailed description of an absolute positioning system is given in US patent application publication 2017/0296213, entitled SYSTEMS AND METHODS FOR
[0129] [0129] The 461 microcontroller can be programmed to provide precise control of the speed and position of the displacement members and articulation systems. The 461 microcontroller can be configured to compute a response in the 461 microcontroller software. The computed response is compared to a measured response from the real system to obtain an "observed" response, which is used for actual feedback-based decisions. The observed response is a favorable and adjusted value, which balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences in the system.
[0130] [0130] In one aspect, motor 482 can be controlled by motor driver 492 and can be used by the instrument's trigger system or surgical tool. In many ways, the 482 motor can be a brushed direct current (DC) drive motor, with a maximum speed of approximately 25,000 RPM, for example. In other arrangements, the 482 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor or any other suitable type of electric motor. Motor starter 492 may comprise an H bridge starter comprising field effect transistors (FETs), for example. The 482 motor can be powered by a feed assembly releasably mounted on the handle assembly or tool compartment to provide control power for the instrument or surgical tool. The power pack may comprise a battery that may include several battery cells connected in series, which can be used as the power source to power the instrument or surgical tool. In certain circumstances, the battery cells in the power pack may be replaceable and / or rechargeable. In at least one example, the battery cells can be lithium-ion batteries that can be coupled and separable from the power pack.
[0131] [0131] The 492 motor driver can be an A3941, available from Allegro Microsystems, Inc. The 492 A3941 driver is an entire bridge controller for use with external power semiconductor metal oxide (MOSFET) field transistors. , of N channel, specifically designed for inductive loads, such as brushed DC motors. The 492 actuator comprises a single charge pump regulator that provides full door drive (> 10 V) for batteries with voltage up to 7 V and allows the A3941 to operate with a reduced door drive, up to 5.5 V. A capacitor input control can be used to supply the voltage surpassing that supplied by the battery required for the N channel MOSFETs. An internal charge pump for the upper side drive allows operation in direct current (100% duty cycle). The entire bridge can be triggered in fast or slow drop modes using diodes or synchronized rectification. In the slow drop mode, the current can be recirculated by means of FET from the top or from the bottom. The energy FETs are protected from the shoot-through effect through programmable dead-time resistors. Integrated diagnostics provide indication of undervoltage, overtemperature and faults in the power bridge, and can be configured to protect power MOSFETs in most short-circuit conditions. Other motor drives can be readily replaced for use in the tracking system 480 comprising an absolute positioning system.
[0132] [0132] Tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472 in accordance with an aspect of the present disclosure. The 4/2 position sensor for an absolute positioning system provides a unique position signal that corresponds to the location of a displacement member. In one aspect, the displacement member represents a longitudinally movable drive member * comprising a rack of drive teeth for engagement with a corresponding drive gear of a gear reduction assembly.
[0133] [0133] The 482 electric motor may include a rotary drive shaft, which interfaces operationally with a gear set, which is mounted on a coupling hitch with a set or rack of drive teeth on the drive member. A sensor element can be operationally coupled to a gear assembly so that a single revolution of the position sensor element 472 corresponds to some linear longitudinal translation of the displacement member. An array of gears and sensors can be connected to the linear actuator by means of a rack and pinion arrangement, or by a rotary actuator, by means of a sprocket or other connection. A power supply provides power to the absolute positioning system and an output indicator can display the output from the absolute positioning system. The drive member represents the longitudinally movable drive member comprising a rack of drive teeth formed thereon for engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member, the firing bar, the beam with | or combinations thereof.
[0134] [0134] A single revolution of the sensor element associated with the position sensor 472 is equivalent to a longitudinal linear displacement d1 of the displacement member, where di represents the longitudinal linear distance by which the displacement member moves from point "a" to the point "b" after a single revolution of the sensor element coupled to the displacement member. The sensor arrangement can be connected by means of a gear reduction which results in the position sensor 472 completing one or more revolutions for the complete travel of the displacement member. The 472 position sensor can complete multiple revolutions for the full travel of the displacement member.
[0135] [0135] A series of keys, where n is an integer greater than one, can be used alone or in combination with a gear reduction to provide a single position signal for more than one revolution of the 472 position sensor. of the switches is transmitted back to microcontroller 461 which applies logic to determine a single position signal corresponding to the longitudinal linear displacement d1 + d2 + ... dn of the displacement member. The output of the position sensor 472 is supplied to the microcontroller 461. In several embodiments, the position sensor 472 of the sensor arrangement may comprise a magnetic sensor, an analog rotary sensor, such as a potentiometer, or a series of analog Hall effect elements. , which emit a unique combination of position of signs or values.
[0136] [0136] The position sensor 472 can comprise any number of magnetic detection elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors cover many aspects of physics and electronics. Technologies used for magnetic field detection include flow meter, saturated flow, optical pumping, nuclear precession, SQUID, Hall effect, anisotropic magnetoresistance, giant magnesium resistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive / piesoelectric compounds, magnetodiode, magnetic transistor , optical fiber, magneto-optics and magnetic sensors based on microelectromechanical systems, among others.
[0137] [0137] In one aspect, position sensor 472 for tracking system 480 comprising an absolute positioning system comprises a magnetic rotating absolute positioning system. The 472 position sensor can be implemented as an ASSOSSEQFT single integrated rotating magnetic position sensor, available from Austria Microsystems, AG. The position sensor 472 interfaces with the 461 microcontroller to provide an absolute positioning system. The 472 position sensor is a low voltage, low power component and includes four effect elements in an area of the 472 position sensor located above a magnet. A high-resolution ADC and an intelligent power management controller are also provided on the integrated circuit. A CORDIC (digital computer for coordinate rotation) processor, also known as the digit-for-digit method and Volder algorithm, is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction, displacement operations bits and lookup table. The angle position, alarm bits and magnetic field information are transmitted via a standard serial communication interface, such as a serial peripheral interface (SPI), to the 461 microcontroller. The 472 position sensor provides 12 or 14 bits of resolution. The position sensor
[0138] [0138] The tracking system 480 comprising an absolute positioning system can comprise and / or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power supply converts the signal from the feedback controller to a physical input to the system, in this case the voltage. Other examples include a voltage, current and force PWM. Other sensors can be provided to measure the parameters of the physical system in addition to the position measured by the position sensor 472. In some respects, the other sensors may include sensor arrangements as described in US patent No. 9,345,481 entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, granted on May 24, 2016, which is incorporated by reference in its entirety into this document; US patent application serial number 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, published on September 18, 2014, is incorporated by reference in its entirety into this document; and US patent application serial number 15 / 628,175, entitled TECHNIQUES FOR ADAPTIVE
[0139] [0139] The absolute positioning system provides an absolute positioning of the displaced member on the activation of the instrument without having to retract or advance the longitudinally movable driving member to the restart position (zero or initial), as may be required by the encoders conventional rotating machines that merely count the number of progressive or regressive steps that the 482 motor has traveled to infer the position of a device actuator, actuation bar, scalpel, and the like.
[0140] [0140] A 474 sensor, such as a strain gauge or a micro strain gauge, is configured to measure one or more parameters of the end actuator, such as, for example, the amplitude of the strain exerted on the anvil during a gripping operation, which may be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor. Alternatively, or in addition to the 474 sensor, a 476 sensor, such as a load sensor, can measure the closing force applied by the drive system. anvil closure. The 476 sensor, such as a load sensor, can measure the firing force applied to a beam with a | in a course of firing the instrument or surgical tool. The i-profile beam is configured to engage a wedge slider, which is configured to move the clamp actuators upward to force the clamps to deform in contact with an anvil. The i-profile beam includes a sharp cutting edge that can be used to separate fabric, as the i-profile beam is advanced distally by the firing bar. Alternatively, a current sensor 478 can be used to measure the current drained by the 482 motor. The force required to advance the trigger member can correspond to the current drained by the 482 motor, for example. The measured force is converted into a digital signal and supplied to the 462 processor.
[0141] [0141] In one form, a 474 strain gauge sensor can be used to measure the force applied to the tissue by the end actuator. A strain gauge can be attached to the end actuator to measure the force applied to the tissue being treated by the end actuator. A system for measuring forces applied to the tissue attached by the end actuator comprises a 474 strain gauge sensor, such as, for example, a microstrain meter, which is configured to measure one or more parameters of the end actuator, for example. In one aspect, the strain gauge sensor 474 can measure the amplitude or magnitude of the strain exerted on a claw member of an end actuator during a gripping operation, which can be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor of a microcontroller
[0142] [0142] Measurements of tissue compression, tissue thickness and / or force required to close the end actuator on the tissue, as measured by sensors 474, 476,
[0143] [0143] The control system 470 of the instrument or surgical tool can also comprise wired or wireless communication circuits for communication with the modular central communication controller shown in Figures 8 to 11.
[0144] [0144] Figure 13 illustrates a control circuit 500 configured to control aspects of the instrument or surgical tool according to an aspect of the present disclosure. The control circuit 500 can be configured to implement various processes described herein. The control circuit 500 may comprise a microcontroller comprising one or more processors 502 (for example, microprocessor, microcontroller) coupled to at least one memory circuit 504. The memory circuit 504 stores instructions executable on a machine that, when executed by the processor 502, cause the 502 processor to execute machine instructions to implement several of the processes described here. The 502 processor can be any one of a number of single-core or multi-core processors known in the art. The memory circuit 504 can comprise volatile and non-volatile storage media The processor 502 can include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit can be configured to receive instructions from the memory circuit 504 of the present disclosure.
[0145] [0145] Figure 14 illustrates a combinational logic circuit 510 configured to control aspects of the instrument or surgical tool according to an aspect of the present disclosure. The combinational logic circuit 510 can be configured to implement various processes described herein. The combinational logic circuit 510 can comprise a finite state machine comprising a combinational logic 512 configured to receive data associated with the surgical instrument or tool at an input 514, process the data by combinational logic 512 and provide an output 516.
[0146] [0146] Figure 15 illustrates a sequential logic circuit 520 configured to control aspects of the instrument or surgical tool according to an aspect of the present disclosure. Sequential logic circuit 520 or combinational logic 522 can be configured to implement the process described herein. Sequential logic circuit 520 may comprise a finite state machine. Sequential logic circuit 520 may comprise combinational logic 522, at least one memory circuit 524, a clock 529 and, for example. The at least one memory circuit 524 can store a current state of the finite state machine. In certain cases, the sequential logic circuit 520 may be synchronous or asynchronous. Combinational logic 522 is configured to receive data associated with the surgical instrument or tool from an input 526, process the data by combinational logic 522, and provide an output 528. In other respects, the circuit may comprise a combination of a processor (for example , processor 502, Figure 13) and a finite state machine for implementing various processes of the present invention. In other respects, the finite state machine may comprise a combination of a combinational logic circuit (for example, a combinational logic circuit 510, Figure 14) and the sequential logic circuit 520.
[0147] [0147] Figure 16 illustrates an instrument or surgical tool that comprises a plurality of motors that can be activated to perform various functions. In certain cases, a first engine can be activated to perform a first function, a second engine can be activated to perform a second function, a third engine can be activated to perform a third function, a fourth engine can be activated to perform a fourth function, and so on. In certain cases, the plurality of motors of the robotic surgical instrument 600 can be individually activated to cause firing, closing, and / or articulation movements in the end actuator. The firing, closing and / or articulation movements can be transmitted to the end actuator through a drive shaft assembly, for example.
[0148] [0148] In certain cases, the instrument or surgical tool system may include a 602 firing motor. The 602 firing motor can be operationally coupled to a 604 firing motor drive assembly, which can be configured to transmit movements trigger points generated by the 602 motor to the end actuator, particularly to move the beam element with | profile. In certain cases, the firing movements generated by the firing motor 602 can cause the staples to be implanted from the staple cartridge in the fabric captured by the end actuator and / or by the cutting edge of the beam element with profile in | to be advanced in order to cut the captured tissue, for example. The beam element with profile in | can be retracted by reversing the direction of motor 602.
[0149] [0149] In certain cases, the surgical instrument or tool may include a closing motor 603. The closing motor 603 can be operationally coupled to a drive assembly of the closing motor 605 that can be configured to transmit closing movements generated by the motor 603 to the end actuator, particularly to move a closing tube to close the anvil and compress the fabric between the anvil and the staple cartridge. Closing movements can cause the end actuator to change from an open configuration to an approximate configuration to capture tissue, for example. The end actuator can be moved to an open position by reversing the direction of the 603 motor.
[0150] [0150] In certain cases, the surgical instrument or tool may include one or more articulation motors 606a, 606b, for example. The motors 606a, 606b can be operationally coupled to the drive assemblies of the articulation motor 608a, 608b, which can be configured to transmit articulation movements generated by the motors 606a, 606b to the end actuator. In certain cases, the articulation movements can cause the end actuator to be articulated in relation to the drive shaft assembly, for example.
[0151] [0151] As described above, the surgical instrument or tool can include a plurality of motors that can be configured to perform various independent functions. In certain cases, the plurality of motors of the instrument or surgical tool can be activated individually or separately to perform one or more functions, while other motors remain inactive. For example, the articulation motors 606a, 606b can be activated to cause the end actuator to be articulated, while the firing motor 602 remains inactive. Alternatively, the firing motor 602 can be activated to fire the plurality of clamps, and / or advance the cutting edge, while the hinge motor 606 remains inactive. In addition, the closing motor 603 can be activated simultaneously with the firing motor 602 to make the closing tube and the beam element with profile in | advance distally, as described in more detail later in this document.
[0152] [0152] In certain cases, the surgical instrument or tool may include a common 610 control module that can be used with a plurality of the instrument's instruments or surgical tool. In certain cases, the common control module 610 can accommodate one of the plurality of motors at a time. For example, the common control module 610 can be coupled to and separable from the plurality of motors of the robotic surgical instrument individually. In certain cases, a plurality of surgical instrument or tool motors may share one or more common control modules, such as the common control module 610. In certain cases, a plurality of surgical instrument or tool motors may be individually and selectively engaged to the common control module 610. In certain cases, the common control module 610 can be selectively switched between interfacing with one of a plurality of instrument motors or surgical tool to interface with another among the plurality of instrument motors or surgical tool.
[0153] [0153] In at least one example, the common control module 610 can be selectively switched between the operating coupling with the 606a, 606b articulation motors, and the operating coupling with the 602 firing motor or the 603 closing motor. at least one example, as shown in Figure 16, a key 614 can be moved or transitioned between a plurality of positions and / or states. In the first position 616, the switch 614 can electrically couple the common control module 610 to the trip motor 602; in a second position 617, the switch 614 can electrically couple the control module 610 to the closing motor 603; in a third position 618a, the switch 614 can electrically couple the common control module 610 to the first articulation motor 606a;
[0154] [0154] Each of the 602, 603, 606a, 606b motors can comprise a torque sensor to measure the output torque on the motor drive shaft. The force on an end actuator can be detected in any conventional manner, such as by means of force sensors on the outer sides of the jaws or by a motor torque sensor that drives the jaws.
[0155] [0155] In several cases, as shown in Figure 16, the common control module 610 may comprise a motor starter 626 that may comprise one or more H-Bridge FETs. The motor driver 626 can modulate the energy transmitted from a power source 628 to a motor coupled to the common control module 610, based on an input from a microcontroller 620 (the "controller"), for example. In certain cases, the microcontroller 620 can be used to determine the current drawn by the motor, for example, while the motor is coupled to the common control module 610, as described above.
[0156] [0156] In certain cases, the microcontroller 620 may include a microprocessor 622 (the "processor") and one or more non-transitory computer-readable media or 624 memory units (the "memory"). In certain cases, memory 624 can store various program instructions which, when executed, can cause processor 622 to perform a plurality of functions and / or calculations described herein. In certain cases, one or more of the memory units 624 can be coupled to the processor 622, for example.
[0157] [0157] In certain cases, the power supply 628 can be used to supply power to the microcontroller 620, for example. In certain cases, the 628 power source may comprise a battery (or "battery pack" or "power source"), such as a Li ion battery, for example. In certain cases, the battery pack can be configured to be releasably mounted to the handle to supply power to the surgical instrument 600. Several battery cells connected in series can be used as the 628 power source. In certain cases, the power source 628 power supply can be replaceable and / or rechargeable, for example.
[0158] [0158] In several cases, the 622 processor can control the motor drive 626 to control the position, direction of rotation and / or speed of a motor that is coupled to the common control module 610. In certain cases, the processor 622 can signal the motor driver 626 to stop and / or disable a motor that is coupled to the common control module 610. It should be understood that the term "processor", as used here, includes any microprocessor, microcontroller or other control device. adequate basic computing that incorporates the functions of a central computer processing unit (CPU) in an integrated circuit or, at most, some integrated circuits. The processor is a programmable multipurpose device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. This is an example of sequential digital logic, as it has internal memory. Processors operate on numbers and symbols represented in the binary numeral system.
[0159] [0159] In one example, the 622 processor can be any single-core or multi-core processor, such as those known by the Texas Instruments ARM Cortex trade name. In certain cases, the 620 microcontroller may be an LM 4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core that comprises a 256 KB single cycle flash integrated memory, or other non-volatile memory, up to 40 MHz, an early seek buffer for optimize performance above 40 MHz, a 32 KB single cycle SRAM, an internal ROM loaded with StellarisWareG software, 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, one or more ADCs of 12 bits with 12 channels of analog input, among other features that are readily available for the product data sheet. Other microcontrollers can be readily replaced for use with the 4410 module. Consequently, the present disclosure should not be limited in this context.
[0160] [0160] In certain cases, memory 624 may include program instructions for controlling each of the motors of the surgical instrument 600 that are attachable to the common control module 610. For example, memory 624 may include program instructions for controlling the motor trigger 602, closing motor 603 and hinge motors 606a, 606b. Such program instructions can cause the 622 processor to control the trigger, close, and link functions according to inputs from the instrument or surgical tool control algorithms or programs.
[0161] [0161] In certain cases, one or more mechanisms and / or sensors, such as 630 sensors, can be used to alert the 622 processor to program instructions that need to be used in a specific configuration. For example, sensors
[0162] [0162] Figure 17 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described in this document, in accordance with an aspect of that disclosure. The robotic surgical instrument 700 can be programmed or configured to control the distal / proximal translation of a displacement member, the distal / proximal displacement of a closing tube, the rotation of the drive and articulation axis, whether with a single or multiple connections articulation drive. In one aspect, the surgical instrument 700 can be programmed or configured to individually control a firing member, a closing member, a driving shaft member and / or one or more hinge members. The surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, closing members, driving shaft members and / or one or more hinge members.
[0163] [0163] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control an anvil 716 and a beam portion with profile in | 714 (including a sharp cutting edge) of an end actuator 702, a removable clamp cartridge 718, a drive shaft 740 and one or more hinge members 742a, 742b through a plurality of motors 704a to 704e. A 734 position sensor can be configured to provide feedback on the position of the beam with | 714 to control circuit 710. Other sensors 738 can be configured to provide feedback to control circuit 710. A timer / counter 731 provides timing and counting information to control circuit 710. A power source 712 can be provided to operate the motors 704a to 704e and a current sensor 736 provide motor current feedback to control circuit 710. Motors 704a to 704e can be operated individually by control circuit 710 in an open loop or closed loop feedback control.
[0164] [0164] In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors or other processors suitable for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer / counter 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the position of the beam with | 714, as determined by the position sensor 734, with the timer / counter output 731 so that the control circuit 710 can determine the position of the beam with profile in | 714 at a specific time (t) in relation to an initial position or the time (t) when the beam with profile in | 714 is in a specific position in relation to an initial position. Timer / counter 731 can be configured to measure elapsed time, count external events, or time external events.
[0165] [0165] In one aspect, control circuit 710 can be programmed to control functions of end actuator 702 based on one or more tissue conditions. Control circuit 710 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 710 can be programmed to select a trigger control program or closing control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to better treat different tissue conditions. For example, when thicker tissue is present, control circuit 710 can be programmed to translate the displacement member at a lower speed and / or with a lower power. When a thinner tissue is present, the control circuit 710 can be programmed to move the displacement member at a higher speed and / or with greater power. A closing control program can control the closing force applied to the tissue by the anvil 716. Other control programs control the rotation of the drive shaft 740 and the hinge members 742a, 742b.
[0166] [0166] In one aspect, the control circuit 710 can generate setpoint signals from the motor. Motor setpoint signals can be supplied to several motor controllers 708a through 708e. Motor controllers 708a to 708e can comprise one or more circuits configured to provide motor drive signals to motors 704a to 704e to drive motors 704a to 704e as described here. In some instances, motors 704a to 704e may be brushed DC motors. For example, the speed of motors 704a to 704e can be proportional to the respective motor start signals. In some examples, motors 704a to 704e may be brushless DC electric motors, and the respective motor drive signals may comprise a PWM signal provided for one or more stator windings of motors 704a to 704e. In addition, in some instances, motor controllers 708a through 708e can be omitted and control circuit 710 can directly generate motor drive signals.
[0167] [0167] In one aspect, the control circuit 710 can initially operate each of the motors 704a to 704e in an open circuit configuration for a first open circuit portion of a travel of the displacement member. Based on the response of the robotic surgical instrument 700 during the open circuit portion of the stroke, control circuit 710 can select a trigger control program in a closed circuit configuration. The response of the instrument may include a translation of the distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the energy supplied to one of the motors 704a to 704e during the open circuit portion, a sum pulse widths of a motor start signal, etc. After the open circuit portion, control circuit 710 can implement the selected trigger control program for a second portion of the travel member travel. For example, during a portion of the closed loop course, control circuit 710 can modulate one of the motors 704a to 704e based on the translation of data describing a position of the closed displacement member to translate the displacement member to a constant speed.
[0168] [0168] In one aspect, motors 704a to 704e can receive power from a 712 power source. Power supply 712 can be a DC power source powered by an alternating main power source, a battery, a supercapacitor , or any other suitable energy source. Motors 704a to 704e can be mechanically coupled to individual mobile mechanical elements such as the beam with profile in | 714, the anvil 716, the drive shaft 740, the hinge 742a and the hinge 742b, through the respective transmissions 706a to 706e. Transmissions 706a through 706e may include one or more gears or other connecting components for coupling motors 704a to 704e to moving mechanical elements. A position sensor 734 can detect a beam position with a profile in 1 714. The position sensor 734 can be or can include any type of sensor that is capable of generating position data that indicate a position of the beam with a profile in |
[0169] [0169] In one aspect, control circuit 710 is configured to drive a firing member as the beam portion with | 714 of end actuator 702. Control circuit 710 provides a motor setpoint for motor control 708a, which provides a drive signal for motor 704a. The output shaft of the motor 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to the beam with profile in | 714. The transmission 706a comprises moving mechanical elements, such as rotating elements and a firing member to control distal and proximally the movement of the beam with profile in | 714 along a longitudinal geometric axis of the end actuator 702. In one aspect, the motor 704a can be coupled to the knife gear assembly, which includes a knife gear reduction assembly that includes a first knife drive gear and a second knife drive gear. A torque sensor 744a provides a feedback signal from the firing force to the control circuit 710. The firing force signal represents the force required to fire or move the beam in profile | 714. A position sensor 734 can be configured to provide the position of the beam with 1 714 profile along the firing stroke or firing member position as a feedback signal to the 710 control circuit. The end actuator 702 can include additional sensors 738 configured to provide feedback signals to control circuit 710. When ready for use, control circuit 710 can provide a trip signal to the 708a motor control. In response to the trigger signal, motor 704a can drive the trigger member distally along the longitudinal geometry axis of end actuator 702 from an initial proximal position of the stroke to an end distal position of the stroke relative to the initial position of course. As the firing member moves distally, a beam with a | 714, with a cutting element positioned at a distal end, advances distally to cut the fabric between the staple cartridge 718 and the anvil 716.
[0170] [0170] In one aspect, control circuit 710 is configured to drive a closing member, such as anvil portion 716 of end actuator 702. Control circuit 710 provides a motor setpoint to a motor control 708b, which provides a drive signal to motor 704b. The output shaft of the 704b motor is coupled to a 744b torque sensor. The torque sensor 744b is coupled to a transmission 706b which is coupled to the anvil 716. The transmission 706b comprises moving mechanical elements, such as rotating elements and a closing member, to control the movement of the anvil 716 between the open and closed positions. In one aspect, the 704b motor is coupled to a closing gear assembly, which includes a closing reduction gear assembly that is supported in gear engaged with the closing sprocket. The torque sensor 744b provides a closing force feedback signal for control circuit 710. The closing force feedback signal represents the closing force applied to the anvil 716. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal to control circuit 710. Additional sensors 738 on end actuator 702 can provide the feedback signal of closing force to control circuit 710. The pivoting anvil 716 is positioned opposite the staple cartridge 718. When ready for use, control circuit 710 can provide a closing signal to the motor control
[0171] [0171] In one aspect, control circuit 710 is configured to rotate a drive shaft member, such as drive shaft 740, to rotate end actuator 702. Control circuit 710 provides a motor setpoint to a motor control 708c, which provides a drive signal to the motor 704c. The output shaft of the motor 704c is coupled to a torque sensor 744c. The torque sensor 744c is coupled to a transmission 706c which is coupled to the shaft 740. The transmission 706c comprises moving mechanical elements, such as rotary elements, to control the rotation of the drive shaft 740 clockwise or counterclockwise until and above 360º. In one aspect, the 704c engine is coupled to the rotary drive assembly, which includes a pipe gear segment that is formed over (or attached to) the proximal end of the proximal closing tube for operable engagement by a rotational gear assembly that is supported operationally on the tool mounting plate. The torque sensor 744c provides a rotation force feedback signal for control circuit 710. The rotation force feedback signal represents the rotation force applied to the drive shaft 740. The position sensor 734 can be configured to supply the position of the closing member as a feedback signal to the control circuit 710. Additional sensors 738, such as a drive shaft encoder, can supply the rotational position of the drive shaft 740 to the control circuit 710.
[0172] [0172] In one aspect, control circuit 710 is configured to link end actuator 702. Control circuit 710 provides a motor setpoint to a 708d motor control, which provides a drive signal to motor 704d . The output shaft of the 704d motor is coupled to a 744d torque sensor. The torque sensor 744d is coupled to a transmission 706d which is coupled to a pivot member 742a. The 706d transmission comprises moving mechanical elements, such as articulation elements, to control the articulation of the 702 + 65º end actuator. In one aspect, the 704d motor is coupled to a pivot nut, which is rotatably seated on the proximal end portion of the distal column portion and is pivotally driven thereon by a pivot gear assembly. The torque sensor 744d provides a hinge force feedback signal to control circuit 710. The hinge force feedback signal represents the hinge force applied to the end actuator 702. The 738 sensors, as a hinge encoder , can provide the pivoting position of end actuator 702 for control circuit 710.
[0173] [0173] In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members or connections, 742a, 742b. These hinge members 742a, 742b are driven by separate disks at the robot interface (the rack), which are driven by the two motors 708d, 708e. When the separate firing motor 704a is provided, each of the hinge connections 742a, 742b can be antagonistically driven with respect to the other connection to provide a resistive holding motion and a load to the head when it is not moving and to provide a articulation movement when the head is articulated. The hinge members 742a, 742b attach to the head in a fixed radius when the head is rotated. Consequently, the mechanical advantage of the push and pull link changes when the head is rotated. This change in mechanical advantage can be more pronounced with other drive systems for the articulation connection.
[0174] [0174] In one aspect, the one or more motors 704a to 704e may comprise a brushed DC motor with a gearbox and mechanical connections to a firing member, closing member or articulation member. Another example includes electric motors 704a to 704e that operate the moving mechanical elements such as the displacement member, the articulation connections, the closing tube and the drive shaft. An external influence is an excessive and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to one of the electric motors 704a to 704e. External influence, such as drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[0175] [0175] In one aspect, the position sensor 734 can be implemented as an absolute positioning system. In one aspect, the 734 position sensor may comprise an absolute rotary magnetic positioning system implemented as a single integrated circuit rotary magnetic position sensor ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 734 can interface with the control circuit 710 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions which only require addition, subtraction, bit shift and lookup table operations.
[0176] [0176] In one aspect, control circuit 710 can be in communication with one or more sensors 738. Sensors 738 can be positioned on end actuator 702 and adapted to work with the robotic surgical instrument 700 to measure various derived parameters such as span distance in relation to time, compression of the tissue in relation to time, and deformation of the anvil in relation to time. The 738 sensors can comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and / or any other sensor suitable for measuring one or more parameters of end actuator 702. Sensors 738 may include one or more sensors. Sensors 738 may be located on the staple cartridge platform 718 to determine the location of the tissue using segmented electrodes. The torque sensors 744a to 744e can be configured to detect force such as firing force, closing force, and / or articulation force, among others. Consequently, control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the trigger member on the rack and its position, (3) which portion of the staple cartridge 718 has tissue in it, and (4) the load and position on both articulation rods.
[0177] [0177] In one aspect, the one or more sensors 738 may comprise a stress meter, such as, for example, a microstrain meter, configured to measure the magnitude of the stress on the anvil 716 during a clamped condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. Sensors 738 can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 716 and the staple cartridge 718. Sensors 738 can be configured to detect the impedance of a section of tissue located between the anvil 716 and the staple cartridge 718 which is indicative of the thickness and / or completeness of the fabric located between them.
[0178] [0178] In one aspect, the 738 sensors can be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magneto-resistive devices (MR) giant magneto-resistive devices (GMR), magnetometers, among others. In other implementations, the 738 sensors can be implemented as solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar and the like). In other implementations, the 738 sensors can include driverless electric switches, ultrasonic switches, accelerometers and inertia sensors, among others.
[0179] [0179] In one aspect, sensors 738 can be configured to measure the forces exerted on the anvil 716 by the closing drive system. For example, one or more sensors 738 may be at a point of interaction between the closing tube and the anvil 716 to detect the closing forces applied by the closing tube on the anvil 716. The forces exerted on the anvil 716 may be representative of the tissue compression experienced by the tissue section captured between the anvil 716 and the staple cartridge 718. The one or more sensors 738 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied to the anvil 716 by the closing drive system. The one or more sensors 738 can be sampled in real time during a gripping operation by the processor of the control circuit 710. The control circuit 710 receives sample measurements in real time to provide and analyze information based on time and evaluate, in real time the closing forces applied to the anvil 716.
[0180] [0180] In one aspect, a current sensor 736 can be used to measure the current drawn by each of the 704a to 704e motors. The force required to advance any of the moving mechanical elements, such as the beam with a profile | 714, corresponds to the current drained by one of the motors 704a to 704e. The force is converted into a digital signal and supplied to control circuit 710. Control circuit 710 can be configured to simulate the response of the instrument's actual system in the controller software. A displacement member can be actuated to move a beam with a profile | 714 on end actuator 702 at or near a target speed. The robotic surgical instrument 700 may include a feedback controller, which may be one or any of the feedback controllers, including, but not limited to, a PID controller, state feedback, linear quadratic (LOR) and / or an adaptive controller , for example. The robotic surgical instrument 700 can include a power source to convert the signal from the feedback controller to a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example. Additional details are revealed in US patent application serial number 15 / 636,829, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed on June 29, 2017, which is hereby incorporated by reference in its entirety.
[0181] [0181] Figure 18 illustrates a block diagram of a surgical instrument 750 programmed to control the distal translation of a displacement member in accordance with an aspect of the present disclosure. In one aspect, the 750 surgical instrument is programmed to control the distal translation of a displacement member, such as the beam with a | 764. The surgical instrument 750 comprises an end actuator 752 which may comprise an anvil 766, a beam with a profile in | 764 (including a sharp cutting edge) and a removable staple cartridge 768.
[0182] [0182] The position, movement, displacement and / or translation of a linear displacement member, such as the beam with a profile in 1764, can be measured by an absolute positioning system, a sensor arrangement and a position sensor 784. How the beam with profile in | 764 is coupled to a longitudinally movable drive member, the position of the beam with profile in | 764 can be determined by measuring the position of the longitudinally movable drive member that employs the position sensor 784. Consequently, in the description below, the position, displacement and / or translation of the beam with profile in | 764 can be obtained by the position sensor 784, as described in the present invention. A control circuit 760 can be programmed to control the translation of the displacement member, such as the beam with | 764. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors or other suitable processors to execute the instructions that cause the processor or processors to control the displacement member, for example, the profile beam in | 764, in the manner described In one aspect, a timer / counter 781 provides an output signal, such as elapsed time or a digital count, to control circuit 760 to correlate the beam position with | 764 as determined by position sensor 784 with timer / counter output 781 so that control circuit 760 can determine the position of the beam with profile in | 764 at a specific time (t) in relation to an initial position. The 781 timer / counter can be configured to measure elapsed time, count external events, or measure timeless events.
[0183] [0183] Control circuit 760 can generate a 772 engine setpoint signal. The 772 engine setpoint signal can be supplied to a 758 motor controller. The 758 motor controller can comprise one or more circuits configured to provide a motor 774 drive signal to motor 754 to drive motor 754, as described in the present invention. In some instances, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 can be proportional to the drive signal of motor 774. In some instances, motor 754 can be a brushless DC electric motor and the motor drive signal 774 can comprise a PWM signal provided for a or more motor stator windings 754. In addition, in some examples, motor controller 758 may be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[0184] [0184] The 754 motor can receive power from a power source
[0185] [0185] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure the various derived parameters, such as span distance in relation to time, compression of the tissue in relation to time and anvil effort in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors.
[0186] [0186] The one or more sensors 788 may comprise an effort meter, such as a microstrain meter, configured to measure the magnitude of the stress on the anvil 766 during a grip condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The 788 sensors can be configured to detect the impedance of a section of tissue located between the anvil 766 and the staple cartridge 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[0187] [0187] The 788 sensors can be configured to measure the forces exerted on the anvil 766 by a closing drive system. For example, one or more sensors 788 can be at a point of interaction between a closing tube and anvil 766 to detect the closing forces applied by a closing tube to anvil 766. The forces exerted on anvil 766 can be representative of the tissue compression experienced by the tissue section captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied anvil 766 by the closing drive system. The one or more 788 sensors can be sampled in real time during a gripping operation by a processor of the control circuit 760. The control circuit 760 receives sample measurements in real time to provide and analyze information based on time and evaluate, in real time, the closing forces applied to the anvil 766.
[0188] [0188] A current sensor 786 can be used to measure the current drained by the 754 motor. The force necessary to advance the beam with profile in | 764 corresponds to the current drained by the motor
[0189] [0189] Control circuit 760 can be configured to simulate the actual system response of the instrument in the controller software. A displacement member can be actuated to move a beam with a profile | 764 on end actuator 752 at or near a target speed. The surgical instrument 750 can include a feedback controller, which can be one or any of the feedback controllers, including, but not limited to, a PID controller, state feedback, LOR, and / or an adaptive controller, for example. The surgical instrument 750 can include a power source to convert the signal from the feedback controller to a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example.
[0190] [0190] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, the cutting member or the beam with profile in | 764 by a brushed DC motor with gearbox and mechanical connections to a hinge and / or knife system. Another example is the 754 electric motor that operates the displacement member and the articulation drive, for example, from an interchangeable drive shaft assembly. An external influence is an excessive and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, like drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[0191] [0191] Several exemplifying aspects are directed to a 750 surgical instrument that comprises a 752 end actuator with motor-driven surgical stapling and cutting implements. For example, a motor 754 can drive a displacement member distally and proximally along a longitudinal geometry axis of end actuator 752. End actuator 752 may comprise a pivot anvil 766 and, when configured for use, an ultrasonic blade 768 positioned opposite the anvil 766. A doctor can hold the tissue between the anvil 766 and the staple cartridge 768, as described in the present invention. When ready to use the 750 instrument, the physician can provide a trigger signal, for example, by pressing a trigger on the 750 instrument. In response to the trigger signal, motor 754 can drive the displacement member distally along the longitudinal geometric axis of the end actuator 752 from a proximal start position to an end position distal from the start position. As the displacement member moves distally, a beam with a | 764 with a cutting element positioned at a distal end can cut the fabric between the staple cartridge 768 and the anvil 766.
[0192] [0192] In several examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the beam with profile in | 764, for example, based on one or more tissue conditions. The control circuit 760 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 760 can be programmed to select a trigger control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to better treat different tissue conditions. For example, when a thicker tissue is present, control circuit 760 can be programmed to translate the displacement member at a lower speed and / or with a lower power. When a thinner tissue is present, the control circuit 760 can be programmed to move the displacement member at a higher speed and / or with greater power.
[0193] [0193] In some examples, control circuit 760 may initially operate motor 754 in an open circuit configuration for a first open circuit portion of a travel member travel. Based on an instrument response 750 during the open circuit portion of the course, control circuit 760 can select a trip control program. The response of the instrument may include a travel distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the power supplied to the motor 754 during the open circuit portion, a sum of pulse widths a motor start signal, etc. After the open circuit portion, control circuit 760 can implement the selected trigger control program for a second portion of the travel member travel. For example, during the closed loop portion of the stroke, control circuit 760 can modulate motor 754 based on translation data that describes a position of the displacement member in a closed circuit manner to translate the displacement member into a constant speed. Additional details are revealed in US patent application serial number 15 / 720,852, entitled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, filed on September 29, 2017, which is hereby incorporated by reference in its entirety.
[0194] [0194] Figure 19 is a schematic diagram of a 790 surgical instrument configured to control various functions in accordance with an aspect of the present disclosure. In one aspect, the 790 surgical instrument is programmed to control the distal translation of a displacement member, such as the beam with a | 764. The surgical instrument 790 comprises an end actuator 792 which may comprise an anvil 766, a beam with a profile | 764 and a removable staple cartridge 768 that can be interchanged with an RF cartridge 796 (shown in dashed line).
[0195] [0195] In one aspect, the 788 sensors can be implemented as a limit switch, electromechanical device, solid state switches, Hall effect devices, MRI devices, GMR devices, magnetometers, among others. In other implementations, 638 sensors can be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar and the like). In other implementations, 788 sensors can include driverless electric switches, ultrasonic switches, accelerometers, inertia sensors, and more.
[0196] [0196] In one aspect, the position sensor 784 can be implemented as an absolute positioning system, which comprises a rotating magnetic absolute positioning system implemented as a single integrated circuit rotary magnetic position sensor ASSOSSEQFT, available from Austria Microsystems , AG. The position sensor 784 can interface with the control circuit 760 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions which only require addition, subtraction, bit shift and lookup table operations.
[0197] [0197] In one aspect, the beam with | 764 can be implemented as a knife member comprising a knife body which operationally supports a tissue cutting blade therein and can additionally include anvil engagement tabs or features and channel engagement or a base. In one aspect, the staple cartridge 768 can be implemented as a standard (mechanical) surgical clamp cartridge. In one aspect, the RF cartridge 796 can be implemented as an RF cartridge. These and other sensor provisions are described in Commonly Owned US Patent Application Serial No. 15 / 628,175, entitled TECHNIQUES
[0198] [0198] The position, movement, displacement and / or translation of a member of linear displacement, such as the beam with profile in | 764, can be measured by an absolute positioning system, a sensor arrangement and a position sensor represented as the position sensor 784. As the beam with profile in | 764 is coupled to the longitudinally movable drive member, the position of the beam with profile in | 764 can be determined by measuring the position of the longitudinally movable drive member that employs the position sensor 784. Consequently, in the description below, the position, displacement and / or translation of the beam with profile in | 764 can be obtained by the position sensor 784, as described in the present invention. A control circuit 760 can be programmed to control the translation of the displacement member, such as the beam with | 764, as described here. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors or other suitable processors to execute the instructions that cause the processor or processors to control the displacement member, for example, the beam with profile in | 764, as described. In one aspect, a timer / counter 781 provides an output signal, such as elapsed time or a digital count, to the control circuit 760 to correlate the position of the beam with | 764 as determined by position sensor 784 with timer / counter output 781 so that control circuit 760 can determine the position of the beam with profile in | 764 at a specific time (t) in relation to an initial position. The 781 timer / counter can be configured to measure elapsed time, count external events, or measure timeless events.
[0199] [0199] Control circuit 760 can generate a 772 engine setpoint signal. The 772 engine setpoint signal can be supplied to a 758 motor controller. The 758 motor controller can comprise one or more circuits configured to provide a motor 774 drive signal to motor 754 to drive motor 754, as described in the present invention. In some instances, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 can be proportional to the drive signal of motor 774. In some instances, motor 754 can be a brushless DC electric motor and the motor drive signal 774 can comprise a PWM signal provided for a or more motor stator windings 754. In addition, in some examples, motor controller 758 may be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[0200] [0200] The 754 motor can receive power from a power source
[0201] [0201] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 792 and adapted to work with the surgical instrument 790 to measure the various derived parameters, such as span distance in relation to time, compression of the tissue in relation to time and anvil effort in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the end actuator 792. The 788 sensors may include one or more sensors.
[0202] [0202] The one or more sensors 788 may comprise an effort meter, such as a microstrain meter, configured to measure the magnitude of the stress on the anvil 766 during a grip condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The 788 sensors can be configured to detect the impedance of a section of tissue located between the anvil 766 and the staple cartridge 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[0203] [0203] The 788 sensors can be configured to measure the forces exerted on the anvil 766 by the closing drive system. For example, one or more sensors 788 can be at a point of interaction between a closing tube and anvil 766 to detect the closing forces applied by a closing tube to anvil 766. The forces exerted on anvil 766 can be representative of the tissue compression experienced by the tissue section captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied anvil 766 by the closing drive system. The one or more 788 sensors can be sampled in real time during a hold operation by a processor portion of the control circuit 760. The control circuit 760 receives sample measurements in real time to provide and analyze time-based information and evaluate , in real time, the closing forces applied to the anvil
[0204] [0204] A current sensor 786 can be used to measure the current drained by the 754 motor. The force necessary to advance the beam with profile in | 764 corresponds to the current drained by the motor
[0205] [0205] An RF power source 794 is coupled to the end actuator 792 and is applied to the RF 796 cartridge when the RF 796 cartridge is loaded on the end actuator 792 in place of the clamp cartridge 768. The control circuit 760 controls the supply of RF energy to the 796 RF cartridge.
[0206] [0206] Additional details are disclosed in US patent application serial number 15 / 636,096, entitled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed on June 28, 2017, which is hereby incorporated into reference title in its entirety. Generator hardware
[0207] [0207] Figure 20 is a simplified block diagram of a generator 800 configured to provide tuning without an inductor, among other benefits. Additional details of generator 800 are described in US patent 9,060,775, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, granted on June 23, 2015, which is incorporated herein by reference, in its entirety. The generator 800 may comprise a patient isolated stage 802 in communication with a non-isolated stage 804 by means of a power transformer 806. A secondary winding 808 of the power transformer 806 is contained in the isolated stage
[0208] [0208] In certain forms, ultrasonic and electrosurgical trigger signals can be supplied simultaneously to different surgical instruments and / or to a single surgical instrument, such as the multifunctional surgical instrument, with the ability to supply both ultrasonic and electrosurgical energy to the tissue. It will be noted that the electrosurgical signal provided by both the electrosurgical instrument - dedicated - and by the “combined electrosurgical / ultrasonic multifunctional instrument can be both a therapeutic and subtherapeutic level signal, where the subtherapeutic signal can be used, for example, to monitor tissue or instrument conditions and provide feedback to the generator. For example, RF and ultrasonic signals can be provided separately or simultaneously from a generator with a single output port in order to provide the desired output signal to the surgical instrument,
[0209] [0209] The non-isolated stage 804 may comprise a power amplifier 812 having an output connected to a primary winding 814 of the power transformer 806. In certain forms, the power amplifier 812 may comprise a push and pull type amplifier. For example, the non-isolated stage 804 may additionally contain a logic device 816 to provide a digital output to a digital-to-analog converter ("DAC" - digital-to-analog converter) 818 which, in turn, provides a corresponding analog signal to an input of the power amplifier 812. In certain forms, the logic device 816 may comprise a programmable gate array ("PGA '"), an FPGA, a programmable logic device ("PLD") ), among other logic circuits, for example. The logic device 816, because it controls the input of the power amplifier 812 through the DAC circuit 818, can therefore control any one of several parameters (for example, frequency, waveform shape, amplitude of the waveform) trigger signals that appear at the trigger signal outputs 810a, 810b and 810c. In certain ways and as discussed below, logic device 816, in conjunction with a processor (for example, a PSD discussed below),
[0210] [0210] Power can be supplied to a power rail of the power amplifier 812 by a key mode regulator 820, for example, a power converter. In certain forms, the key mode regulator 820 may comprise an adjustable antagonistic regulator, for example. The non-isolated stage 804 may further comprise a first processor 822 which, in one form, may comprise a PSD processor as an analog device ADSP-21469 SHARC DSP, available from Analog Devices, Norwood, MA, USA, for example , although in various forms, any suitable processor can be used. In certain ways, the PSD processor 822 can control the operation of the key mode regulator 820 responsive to voltage feedback data received from the power amplifier 812 by the PSD processor 822 via an ADC 824 circuit. For example, the PSD 822 processor can receive the waveform envelope of a signal (for example, an RF signal) as input, which is amplified by the power amplifier 812, via the ADC 824 circuit. The PSD 822 processor you can then control the key mode regulator 820 (for example, via a pulse width modulation output) so that the rail voltage supplied to the power amplifier 812 follows the waveform envelope of the amplified signal . By dynamically modulating the rail voltage of the 812 power amplifier based on the waveform envelope, the efficiency of the 812 power amplifier can be significantly improved over fixed rail voltage amplifier schemes.
[0211] [0211] In certain forms, the logic device 816, in conjunction with the PSD 822 processor, can implement a digital synthesis circuit as a control scheme with direct digital synthesizer to control the shape of the waveform, frequency and / or the amplitude of the trigger signals emitted by the generator 800. In one way, for example, the logic device 816 can implement a DDS control algorithm by retrieving waveform samples stored in a lookup table ("LUT" - look-up table) dynamically updated, like a RAM LUT that can be integrated into an FPGA.
[0212] [0212] The non-isolated stage 804 may additionally comprise a first ADC 826 circuit and a second ADC 828 circuit coupled to the output of the power transformer 806 by means of the respective isolation transformers, 830 and 832, to sample the voltage and current respectively. of trigger signals emitted by the generator 800. In certain ways, the ADC 826 and 828 circuits can be configured for sampling at high speeds (for example, samples of 80 mega per second ("MSPS" - mega samples per second)) to allow oversampling of the trigger signals. In one way, for example, the sampling speed of the ADC 826 and 828 circuits can allow an oversampling of approximately 200x (depending on the frequency) of the drive signals. In certain ways, the sampling operations of the ADC 826 and 828 circuit can be performed by a single ADC circuit that receives voltage and current input signals through a bidirectional multiplexer. The use of high-speed sampling in the forms of the generator 800 can allow, among other things, the calculation of the complex current flowing through the branch of motion (which can be used in certain forms to implement waveform-based shape control in DDS described above), the accurate digital filtering of the sampled signals and the calculation of the actual energy consumption with a high degree of precision. The feedback data about voltage and current emitted by the ADC 826 and 828 circuits can be received and processed (for example, first-in-first-out (FIFO), multiplexer) temporary storage by the 816 logic device and stored in memory of data for subsequent recovery, for example, through the 822 processor. As noted above, the feedback data on voltage and current can be used as input to an algorithm for pre-distortion or modification of waveform samples in the LUT, dynamic and continuous way. In certain ways, this may require that each stored voltage and current feedback data pair be indexed based on, or otherwise associated with, a sample of the corresponding LUT that was provided by logic device 816 when the data pair of feedback on voltage and current was captured. The synchronization of the LUT samples with the feedback data about voltage and current in this way contributes to the correct timing and stability of the pre-distortion algorithm.
[0213] [0213] In certain forms, voltage and current feedback data can be used to control the frequency and / or amplitude (for example, current amplitude) of the trigger signals. In one way, for example, feedback data about voltage and current can be used to determine the impedance phase. The frequency of the trigger signal can then be controlled to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (for example, 0º), thereby minimizing or reducing the effects of distortion harmonic and correspondingly accentuating the accuracy of the impedance phase measurement. The determination of the phase impedance and a frequency control signal can be implemented in the PSD 822 processor, for example, with the frequency control signal being supplied as input to a DDS control algorithm implemented by the programmable logic device 816.
[0214] [0214] In another form, for example, the current feedback data can be monitored in order to maintain the current amplitude of the drive signal at a current amplitude setpoint. The current amplitude set point can be specified directly or indirectly determined based on the specified set points for voltage and power amplitude. In certain ways, current amplitude control can be implemented by the control algorithm, such as a proportional-integral-derivative control algorithm ("PID" - proportional-integral— derivative), in the PSD 822 processor. The variables controlled by the control algorithm to properly control the current amplitude of the drive signal may include, for example, scaling the LUT waveform samples stored in logic device 816 and / or the full-scale output voltage of the DAC circuit 818 (which provides input to the power amplifier 812) via a DAC 834 circuit.
[0215] [0215] The non-isolated stage 804 may additionally comprise a second processor 836 to provide, among other things, user interface (UI) functionality. In one form, the UI 836 processor can comprise an Atmel AT91SAM9263 processor with an ARM 926EJ-S core, available from Atmel Corporation, of San Jose, CA, USA, for example. Examples of UI functionality supported by the 836 processor may include audible and visual feedback from the user, communication with peripheral devices (for example, via a USB interface), communication with the foot switch, communication with an input device (for example , a touchscreen) and communication with an output device (for example, a speaker). The UI processor 836 can communicate with the PSD processor 822 and the logical device 816 (for example, via SPI buses). Although the UIl 836 processor can primarily support UI functionality, it can also coordinate with the PSD 822 processor to implement risk mitigation in certain ways. For example, the UI 836 processor can be programmed to monitor various aspects of information entered by the user and / or other inputs (for example, touchscreen inputs, foot switch inputs, temperature sensor inputs) and can disable the generator 800 output when an error condition is detected.
[0216] [0216] In certain ways, both the PSD 822 processor and the UI 836 processor can, for example, determine and monitor the operational status of generator 800. For the PSD 822 processor, the operational state of generator 800 can determine, for example, which control and / or diagnostic processes are implemented by the PSD 822 processor. For the UI 836 processor, the operational state of generator 800 can determine, for example, which elements of a UI (for example, display screens , sounds) are presented to a user. The respective Ul and PSD processors 822 and 836 can independently maintain the current operational state of generator 800, as well as recognize and evaluate possible transitions out of the current operational state. The PSD 822 processor can act as the master in this relationship and can determine when transitions between operational states should occur. The UI 836 processor can be aware of valid transitions between operational states and can confirm that a particular transition is adequate. For example, when the PSD 822 processor instructs the UI 836 processor to transition to a specific state, the UI 836 processor can verify that the requested transition is valid. If a requested transition between states is determined to be invalid by the UI 836 processor, the UIl 836 processor can cause generator 800 to enter a fault mode.
[0217] [0217] The non-isolated stage 804 can also comprise a controller 838 for monitoring input devices (for example, a capacitive touch sensor used to turn generator 800 on and off, a capacitive touch screen). In certain forms, controller 838 may comprise at least one processor and / or other controller device in communication with the UI processor
[0218] [0218] In certain forms, when generator 800 is in an "off" state, controller 838 can continue to receive operational power (for example, through a line from a generator 800 power supply, such as the power supply 854 discussed below). In this way, controller 838 can continue to monitor an input device (for example, a capacitive touch sensor located on a front panel of generator 800) to turn generator 800 on and off. When generator 800 is in the off state, the controller 838 can wake up the power supply (for example, enable one or more DC / DC voltage converters 856 from the power supply 854 to operate) if activation of the "on / off" input device by a user is detected. Controller 838 can therefore initiate a sequence to transition the generator 800 to an "on" state. On the other hand, controller 838 can initiate a sequence to transition the generator 800 to the off state if activation of the "on / off" input device is detected when the generator 800 is in the on state. In certain ways, for example, controller 838 can report the activation of the "on / off" input device to the UI 836 processor, which in turn implements the process sequence necessary to transition the generator 800 to the state off. In such forms, controller 838 may not have any independent capacity to cause the removal of power from generator 800 after its on state has been established.
[0219] [0219] In certain forms, controller 838 may cause generator 800 to provide audible feedback or other sensory feedback to alert the user that an on or off sequence has been initiated. This type of alert can be provided at the beginning of an on or off sequence, and before the start of other processes associated with the sequence.
[0220] [0220] In certain forms, the isolated stage 802 may comprise an instrument interface circuit 840 to, for example, provide a communication interface between a control circuit of a surgical instrument (for example, a control circuit comprising switches handle) and non-isolated stage components 804, such as logic device 816, PSD processor 822 and / or UI processor 836. Instrument interface circuit 840 can exchange information with non-stage components isolated 804 by means of a communication link that maintains an adequate degree of electrical isolation between the isolated and non-isolated stages 802 and 804 such as, for example, an IR-based communication link. Power can be supplied to the instrument interface circuit 840 using, for example, a low-drop voltage regulator powered by an isolation transformer driven from the non-isolated stage 804.
[0221] [0221] In one form, the instrument interface circuit 840 may comprise a logic circuit 842 (for example, a logic circuit, a programmable logic circuit, PGA, FPGA, PLD) in communication with a signal conditioning circuit 844. Signal conditioning circuit 844 can be configured to receive a periodic signal from logic circuit 842 (e.g., a 2 kHz square wave) to generate a bipolar interrogation signal that has an identical frequency. The question mark can be generated, for example, using a bipolar current source powered by a differential amplifier. The question mark can be communicated to a surgical instrument control circuit (for example, using a conductive pair on a cable that connects the generator 800 to the surgical instrument) and monitored to determine a state or configuration of the control circuit. control. The control circuit may comprise numerous switches, resistors and / or diodes to modify one or more characteristics (for example, amplitude, rectification) of the question mark so that a state or configuration of the control circuit is unambiguously discernible with based on that one or more characteristics. In one form, for example, signal conditioning circuit 844 may comprise an ADC circuit for generating samples of a voltage signal appearing over control circuit inputs that result from passing the interrogation signal through them. The logic instrument 842 (or a non-isolated stage component 804) can then determine the status or configuration of the control circuit based on samples from the ADC circuit.
[0222] [0222] In one form, the instrument interface circuit 840 may comprise a first data circuit interface 846 to enable the exchange of information between logic circuit 842 (or another element of the instrument interface circuit 840) and a first data circuit disposed in a surgical instrument or otherwise associated with it. In certain ways, for example, a first data circuit may be arranged on a wire integrally attached to a handle or on a surgical instrument adapter to interface between a specific type or model of surgical instrument and the 800 generator. The data circuit can be deployed in any suitable manner and can communicate with the generator in accordance with any suitable protocol, including, for example, as described here with respect to the first data circuit. In certain forms, the first data circuit may comprise a non-volatile storage device, such as an EEPROM device. In certain ways, the first data circuit interface 846 can be implemented separately from logic circuit 842 and comprises a suitable circuitry (for example, separate logic devices, a processor) to enable communication between logic circuit 842 and the first data circuit. In other forms, the first data circuit interface 846 can be integral with logic circuit 842.
[0223] [0223] In certain forms, the first data circuit can store information related to the specific surgical instrument with which it is associated. This information may include, for example, a model number, a serial number, a number of operations in which the surgical instrument was used, and / or any other types of information. This information can be read by the instrument interface circuit 840 (for example, logic circuit 842), transferred to a non-isolated stage component 804 (for example, to logic device 816, PSD 822 processor and / or UI processor 836) for presentation to a user by means of an output device and / or to control a function or operation of the generator 800. In addition, any type of information can be communicated to the first data circuit for storage through the first interface of the generator. data circuit 846 (for example, using logic circuit 842). This information may include, for example, an updated number of operations in which the surgical instrument was used and / or the dates and / or times of its use.
[0224] [0224] As discussed earlier, a surgical instrument can be removable from a handle (for example, the multifunctional surgical instrument can be removable from the handle) to promote interchangeability and / or disposability of the instrument. In such cases, conventional generators may be limited in their ability to recognize specific instrument configurations being used, as well as to optimize the control and diagnostic processes as needed. The addition of readable data circuits to surgical instruments to address this issue is problematic from a compatibility point of view, however. For example, design a surgical instrument so that it remains backward compatible '! with generators lacking the indispensable data reading functionality, it can be impractical due, for example, to different signaling schemes, design complexity and cost. The forms of instruments discussed here address these concerns through the use of data circuits that can be implemented in existing surgical instruments, economically and with minimal design changes to preserve the compatibility of surgical instruments with current generator platforms.
[0225] [0225] Additionally, the shapes of the generator 800 can enable communication with instrument-based data circuits. For example, generator 800 can be configured to communicate with a second data circuit contained in an instrument (for example, the multifunctional surgical instrument). In some ways, the second data circuit can be implemented in a manner similar to that of the first data circuit described here. The instrument interface circuit 840 may comprise a second data circuit interface 848 to enable such communication. In one form, the second data circuit interface 848 can comprise a three-state digital interface, although other interfaces can also be used. In certain ways, the second data circuit can generally be any circuit for transmitting and / or receiving data. In one form, for example, the second data circuit can store information related to the specific surgical instrument with which it is associated. This information may include, for example, a model number, a serial number, a number of operations in which the surgical instrument was used, and / or any other types of information.
[0226] [0226] In some ways, the second data circuit can store information about the ultrasonic and / or electronic properties of an associated ultrasonic transducer, end actuator or ultrasonic drive system. For example, the first data circuit can indicate an initialization frequency slope, as described here. In addition or alternatively, any type of information can be communicated to the second data circuit for storage in it via the second data circuit interface 848 (for example, using logic circuit 842). This information may include, for example, an updated number of operations in which the instrument was used and / or the dates and / or times of its use. In certain ways, the second data circuit can transmit data captured by one or more sensors (for example, an instrument-based temperature sensor). In certain ways, the second data circuit can receive data from generator 800 and provide an indication to a user (for example, a light-emitting indication or other visible indication) based on the received data.
[0227] [0227] In certain ways, the second data circuit and the second data circuit interface 848 can be configured so that communication between logic circuit 842 and the second data circuit can be carried out without the need to supply conductors for this purpose (for example, dedicated conductors on a cable that connects a handle to the 800 generator). In one form, for example, information can be communicated to and from the second data circuit using a wire bus communication scheme implemented in existing wiring, as one of the conductors used that transmit interrogation signals from from signal conditioning circuit 844 to a control circuit on a cable. In this way, changes or modifications to the design of the surgical device that may otherwise be necessary are minimized or reduced. In addition, due to the fact that different types of communications implemented on a common physical channel can be separated based on frequency, the presence of a second data circuit can be "invisible" to generators that do not have the essential functionality of reading data, which, therefore, allows the backward compatibility of the surgical instrument.
[0228] [0228] In certain forms, the isolated stage 802 may comprise at least one blocking capacitor 850-1 connected to the output of the drive signal 810b to prevent the passage of direct current to a patient. A single blocking capacitor may be required to comply with medical regulations and standards, for example. Although failures in single-capacitor designs are relatively uncommon, such failures can still have negative consequences. In one form, a second blocking capacitor 850-2 can be supplied in series with the blocking capacitor 850-1, with current dispersion of one point between the blocking capacitors 850-1 and 850-2 being monitored, for example , by an ADC 852 circuit for sampling a voltage induced by leakage current. Samples can be received, for example, via logic circuit 842. Changes based on the leakage current (as indicated by the voltage samples), generator 800 can determine when at least one of the blocking capacitors 850-1, 850- 2 failed, thus offering a benefit over single capacitor designs that have a single point of failure.
[0229] [0229] In certain forms, the non-isolated stage 804 may comprise a power supply 854 to provide DC power with adequate voltage and current. The power supply may comprise, for example, a 400 W power supply to deliver a system voltage of 48 VDC. The power supply 854 can additionally comprise one or more DC / DC voltage converters 856 to receive the output from the power supply to generate DC outputs at the voltages and currents required by the various components of generator 800. As discussed above in relation to the controller 838, one or more of the 856 DC / DC voltage converters can receive an input from the 838 controller when the activation of the "on / off" input device by a user is detected by the 838 controller to enable operation, or wake up, 856 DC / DC voltage converters.
[0230] [0230] Figure 21 illustrates an example of generator 900, which is a form of generator 800 (Figure 20). The 900 generator is configured to supply multiple types of energy to a surgical instrument. The 900 generator provides ultrasonic and RF signals to power a surgical instrument, independently or simultaneously. Ultrasonic and RF signals can be provided alone or in combination and can be provided simultaneously. As indicated above, at least one generator output can provide multiple types of energy (for example, ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others) through a single port, and these signals can be supplied separately or simultaneously to the end actuator to treat tissue.
[0231] [0231] Generator 900 comprises a processor 902 coupled to a waveform generator 904. Processor 902 and waveform generator 904 are configured to generate various signal waveforms based on information stored in a coupled memory to processor 902, not shown for clarity of disclosure. The digital information associated with a waveform is provided to the waveform generator 904 that includes one or more DAC circuits to convert the digital input to an analog output. The analog output is powered by an amplifier 1106 for signal conditioning and amplification. The conditioned and amplified output of the amplifier 906 is coupled to a power transformer 908. The signals are coupled by the power transformer 908 to the secondary side, which is on the patient isolation side. A first signal of a first energy modality is supplied to the surgical instrument between the terminals identified as ENERGIAI and RETORNO. A second signal from a second energy modality is coupled by a 910 capacitor and is supplied to the surgical instrument between the terminals identified as
[0232] [0232] A first voltage detection circuit 912 is coupled through the terminals identified as ENERGY1 and the RETURN path to measure the output voltage between them. A second voltage detection circuit 924 is connected via the terminals identified as ENERGY and the RETURN path to measure the output voltage between them. A current detection circuit 914 is arranged in series with the RETURN leg on the secondary side of the power transformer 908 as shown to measure the output current for any energy modality. If different return paths are provided for each energy modality, then a separate current detection circuit would be provided on each return leg. The outputs of the first and second voltage detection circuits 912, 924 are supplied to the respective isolation transformers 916, 922, and the output of the current detection circuit 914 is supplied to another isolation transformer 918. The outputs of the voltage transformers Isolation 916, 928, 922 on the primary side of the power transformer 908 (non-isolated side of the patient) are supplied to one or more ADC 926 circuits. The digitized output from the ADC 926 circuit is supplied to processor 902 for further processing and computing. The output voltages and the output current feedback information can be used to adjust the output voltage and the current supplied to the surgical instrument, and to compute the output impedance, among other parameters. Input / output communications between the 902 processor and the patient's isolated circuits are provided via a 920 interface circuit. The sensors may also be in electrical communication with the 902 processor via the 920 interface circuit.
[0233] [0233] In one aspect, impedance can be determined by processor 902 by dividing the output of the first voltage detection circuit 912 coupled to the terminals identified as ENERGY1 / RETURN or the second voltage detection circuit 924 coupled to the terminals identified as ENERGY2 / RETURN through the output of the current detection circuit 914 arranged in series with the RETURN leg on the secondary side of the power transformer 908. The outputs of the first and second voltage detection circuits 912, 924 are provided to separate the transformers insulation 916, 922 and the current detection circuit 914 output is provided to another isolation transformer 916. Digitized current and voltage detection measurements from the ADC 926 circuit are provided to processor 902 to compute the impedance. As an example, the first ENERGIA1 energy modality can be ultrasonic energy and the second ENERGIA2 energy modality can be RF energy. However, in addition to the ultrasonic and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and / or reversible electroporation and / or microwave energy, among others. In addition, although the example illustrated in Figure 21 shows a single RETURN return path that can be provided for two or more energy modes, in other respects, multiple RETORNOnN return paths can be provided for each ENERGY energy mode. Thus, as described here, the impedance of the ultrasonic transducer can be measured by dividing the output of the first voltage detection circuit 912 by the current detection circuit 914 and the fabric impedance can be measured by dividing the output of the second circuit detection voltage 924 by current detection circuit 914.
[0234] [0234] As shown in Figure 21, generator 900 comprising at least one output port may include a single-output, multiple-lead 908 power transformer to provide power in the form of one or more energy modalities, such as ultrasonic , Bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others, for example, to the end actuator depending on the type of tissue treatment that is performed. For example, the 900 generator can supply higher voltage and lower current power to drive an ultrasonic transducer, lower voltage and higher current to drive RF electrodes to seal the tissue or with a coagulation waveform for point clotting using electrosurgical electrodes Monopolar or bipolar RF. The output waveform of generator 900 can be oriented, switched or filtered to provide frequency to the end actuator of the surgical instrument. The connection of an ultrasonic transducer to the output of generator 900 would preferably be located between the output identified as ENERGY1 and RETURN, as shown in Figure 21. In one example, a connection of bipolar RF electrodes to the output of generator 900 would be , preferably located between the exit identified as ENERGY and RETURN. In the case of a monopolar output, would the preferred connections be an active electrode (for example, a light beam or another probe) for the ENERGY output and a suitable return block connected to the RETURN output.
[0235] [0235] Additional details are revealed in US patent application publication 2017/0086914 entitled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING
[0236] [0236] As used throughout this description, the term "wireless" and its derivatives can be used to describe circuits, devices, systems, methods, techniques, communication channels, etc., which can communicate data through the use of electromagnetic radiation modulated using a non-solid medium. The term does not imply that the associated devices do not contain any wires, although in some ways they may not. The communication module can implement any of a number of wireless and wired communication standards or protocols, including, but not limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, evolution long-term evolution (LTE), Ev-DO, HSPA +, HSDPA +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as any other protocols without wired and wired which 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 Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , WiMAX, LTE, Ev-DO and others.
[0237] [0237] As used here, a processor or processing unit is an electronic circuit that performs operations on some external data source, usually memory or some other data stream. The term is used in the present invention to refer to the central processor (central processing unit) in a computer system or systems (specifically systems on a chip (SoCs)) that combine several specialized "processors".
[0238] [0238] As used here, a system on a chip or system on the chip (SoC or SOC) is an integrated circuit (also known as an "IC" or "chip") that integrates all components of a computer or other electronic systems . It can contain digital, analog, mixed and often radio frequency functions - all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as a graphics processing unit (GPU), Wi-Fi module, or coprocessor. An SoC may or may not contain internal memory.
[0239] [0239] As used here, a microcontroller or controller is a system that integrates a microprocessor with peripheral circuits and memory. A microcontroller (or MCU for microcontroller unit) can be implemented as a small computer on a single integrated circuit. It can be similar to a SoC; a SoC can include a microcontroller as one of its components. A microcontroller can contain one or more core processing units (CPUs) along with memory and programmable input / output peripherals. Program memory in the form of ferroelectric RAM, NOR flash or OTP ROM is also often included on the chip, as well as a small amount of RAM. Microcontrollers can be used for integrated applications, in contrast to microprocessors used in personal computers or other general purpose applications that consist of several separate integrated circuits.
[0240] [0240] As used here, the term controller or microcontroller can be an independent chip or IC (integrated circuit) device that interfaces with a peripheral device. This can be a connection between two parts of a computer or a controller on an external device that manages the operation of (and connection to) that device.
[0241] [0241] Any of the processors or microcontrollers described in the present invention can be implemented by any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one respect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 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 StellarisWareO program, read-only memory programmable and electrically erasable (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more analog to digital converters (ADC) of 12 bits with 12 analog input channels, details of which are available for the product data sheet.
[0242] [0242] In one aspect, the processor may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller 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.
[0243] [0243] The modular devices include the modules (as described in connection with Figures 3 and 9, for example) that are receivable within a central surgical controller and the devices or surgical instruments that can be connected to the various modules in order to connect or pair with the corresponding central surgical controller. Modular devices include, for example, smart surgical instruments, medical imaging devices, suction / irrigation devices, smoke evacuators, power generators, fans, insufflators and displays. The modular devices described here can be controlled by control algorithms. The control algorithms can be executed on the modular device itself, on the central surgical controller to which the specific modular device is paired, or on both the modular device and the central surgical controller (for example, through a distributed computing architecture). In some examples, the control algorithms of the modular devices control the devices based on the data detected by the modular device itself (that is, by sensors on, over or connected to the modular device). This data can be related to the patient being operated on (for example, tissue properties or insufflation pressure) or to the modular device itself (for example, the rate at which a knife is being advanced, the motor current, or the levels of energy). For example, a control algorithm for a surgical stapling and cutting instrument can control the rate at which the instrument's motor drives its knife through the fabric according to the resistance encountered by the knife as it progresses.
[0244] [0244] In one aspect, the central surgical controller provides data storage capabilities. Data storage includes the creation and use of self-describing data including identification features, management of redundant data sets and storage of data in a manner of paired data sets that can be grouped by surgery, but not necessarily linked with dates and the actual surgeons of the surgeries to keep the data anonymous. The following description incorporates by reference all the hardware and software processing techniques of the "central controller" and "cloud" analytical system to implement the specific data collection and management techniques described herein, as incorporated by reference to the present invention. Figures 22 to 41 will be described in the context of the interactive surgical system environment 100 which includes a central surgical controller 106, 206 described with respect to Figures 1a 11 and intelligent instruments and generators described with respect to Figures 12a21.
[0245] [0245] Figure 22 is a 4000 diagram illustrating a technique for interacting with an electronic medical record database (RME) 4002, in accordance with an aspect of the present disclosure. In one aspect, the present disclosure provides a method for incorporating a key 4004 into the RME 4002 database located within the hospital or medical facility. A 4006 data barrier is provided to preserve the privacy of patient data and allows the reintegration of the extracted and isolated data pairs, as described later in this document, from the central surgical controller 106, 206 or cloud 104, 204 regrouped. A schematic diagram of the central surgical controller 206 is described in general in Figures 1 to 11 and, in particular, in Figures 9 to 10. Therefore, in the description of Figure 22, the reader is guided to Figures 1 to 11 and, in in particular, Figures 9 to 10 for any implementation details of the central surgical controller 206 that may be omitted here for brevity and clarity of the disclosure. Returning to Figure 22, the method allows users to have full access to all data collected during a surgical procedure and to patient information stored in the form of 4012 electronic medical records. The regrouped data can be displayed on a 4010 attached monitor to the central surgical controller 206 or secondary surgical monitors, but are not permanently stored on any storage device of the central surgical controller 248. The regrouped data is temporarily stored on a storage device 248 located on the central surgical controller 206 or in the cloud 204 and they are erased at the end of their use and overwritten to ensure that they cannot be recovered. The 4004 key in the RME 4002 database is used to reintegrate anonymous data from the central controller back into fully integrated electronic medical record data 4012.
[0246] [0246] As shown in Figure 22, the RME 4002 database is located within the hospital data barrier 4006. The RME 4002 database can be configured to store, retrieve and manage associative arrays or other known data structures today as a dictionary or hash. Dictionaries contain a collection of objects, or records, which in turn have many different fields within them, each containing data. The patient's 4012 electronic medical records can be stored and retrieved using a key 4004 that uniquely identifies the patient's 4012 electronic medical record, and is used to quickly find data from the RME 4002 RME database. The RME key-value database system 4002 treats the data as a single opaque collection that can have different fields for each record.
[0247] [0247] Information from the RME 4002 database can be transmitted to the central surgical controller 206 and the patient's electronic medical record data 4012 is edited and extracted before being sent to an analytical system based on the central controller 206 or the cloud 204. An anonymous data file 4016 is created by editing the patient's personal data and extracting the relevant data 4018 from the patient's 4012 electronic medical record. For use in the present invention, the editing process includes deleting or removing the patient personal information from electronic medical record 4012 to create an edited record that includes only anonymous patient data.
[0248] [0248] In one aspect, the present disclosure provides a central surgical controller 206, as described in Figures 9 and 10, for example, the central surgical controller 206 comprising a processor 244; and a memory 249 coupled to processor 244. Memory 249 stores instructions executable by processor 244 to interrogate a surgical instrument 235, retrieve a first set of data from surgical instrument 235, interrogate a medical imaging device 238, retrieve a second set data from medical imaging device 238, associate the first and second data sets with a key and transmit the first and second data sets associated with a remote network, for example, cloud 204, outside the surgical controller central 206. Surgical instrument 235 is a first source of patient data and the first data set is associated with a surgical procedure. The medical imaging device 238 is a second source of patient data and the second data set is associated with a result of the surgical procedure. The first and second data records are uniquely identified by the key.
[0249] [0249] In another aspect, the central surgical controller 206 provides a memory 249 that stores instructions executable by processor 244 to retrieve the first data set using the key, anonymize the first data set, retrieve the second data set using the key, anonymize the second data set, pair the first and second anonymized data sets and determine the success rate of the surgical procedures grouped by the surgical procedure based on the first and second paired anonymized data sets.
[0250] [0250] In another aspect, the central surgical controller 206 provides a memory 249 that stores instructions executable by processor 244 to retrieve the first set of anonymized data, retrieve the second set of anonymized data and reintegrate the first and second data sets anonymized with the use of the key.
[0251] [0251] In another aspect, the first and second data sets define a first and a second data payload in the respective first and second data packets.
[0252] [0252] In several respects, the present disclosure provides a control circuit for associating the first and second data sets with a switch as described above. In many respects, the present disclosure provides a computer-readable, non-transitory medium that stores computer-readable instructions that, when executed, cause a machine to associate the first and second data sets with a key as described above.
[0253] [0253] During a surgical procedure, it would be desirable to monitor the data associated with the surgical procedure to enable the configuration and operation of the instruments used during the procedure to optimize the surgical results. The technical challenge is to recover the data in a way that maintains the patient's anonymity to maintain the privacy of the data associated with the patient. The data can be used for conglomeration with other data without individualizing the data.
[0254] [0254] One solution provides a central surgical controller 206 to interrogate a database of patient electronic medical records 4002 to data from electronic medical records 4012, extract desirable or relevant patient data 4018 from patient electronic medical record 4012 and edit any personal information that could be used to identify the patient. The editing technique removes any information that can be used to correlate the relevant patient data extracted 4018 to a specific patient, surgery or time. The central surgical controller 206 and the instruments 235 coupled to the central surgical controller 206 can then be configured and operated based on the relevant patient data extracted 4018.
[0255] [0255] As revealed in connection with Figure 22, extract (or remove) relevant data from patient 4018 from an electronic medical record of patient 4012 while editing any information that can be used to correlate the patient to surgery or a scheduled time of surgery allows the relevant data of patient 4018 to be anonymized. Anonymous data file 4016 can then be sent to cloud 204 for aggregation, processing and manipulation. The anonymous data file 4016 can be used to configure the surgical instrument 235 or any of the modules shown in Figures 9 and 10 or the central surgical controller 206 during surgery based on the extracted anonymous data file 4016.
[0256] [0256] In one aspect, a 4006 hospital data barrier is created so that within the 4006 data barrier the data from several central surgical controllers 206 can be compared with the use of non-anonymized and unedited data, and outside the barrier from data 4006 data from various central surgical controllers 206 are extracted to maintain anonymity and protect the privacy of the patient and the surgeon. This aspect is further discussed in conjunction with Figure 26.
[0257] [0257] In one aspect, data from a central surgical controller 206 can be exchanged between central surgical controllers 206 (for example, from central surgical controller to central surgical controller, from key to key or from router to router) to provide analysis hospital and data display. Figure 1 shows an example of multiple central controllers 106 communicating with each other and with cloud 104. This aspect is also further discussed together with Figure 26.
[0258] [0258] In another aspect, an artificial time measurement is replaced by a real-time clock for all information stored internally within an instrument 235, a robot located in a robotic central controller 222, a central surgical controller 206 and / or computerized hospital equipment.
[0259] [0259] Within the central surgical controller 206, a local decryption key 4004 allows information retrieved from the central surgical controller 206 to restore the real-time information from the anonymized data set located in the anonymous data file 4016. The stored data on the central controller 206 or on the cloud 204, however, cannot be restored to real-time information from the anonymized data set in the anonymized data file 4016. The key 4004 is kept locally on the central surgical controller 206 computer / device 248 storage in an encrypted format. The network processor ID of the central surgical controller 206 is part of the decryption mechanism, so if key 4004 and the data are removed, the anonymized data set in the anonymous data file 4016 cannot be restored without being on the computer of the original central surgical controller 206 / storage device 248. Replacement of artificial time measurement with a real-time clock for all information stored internally and sent to the cloud as a means of anonymizing patient and surgeon data
[0260] [0260] Figure 23 illustrates a 4030 process of anonymity of a surgical procedure by replacing an artificial time measurement for a real time clock for all information stored internally within the instrument, robot, central surgical controller and / or equipment computerized hospital, according to one aspect of the present disclosure. As shown in Figure 23, the start time 4032 of the surgical procedure setup was scheduled to start at a real time of 11:31:14 (EST) based on a real time clock. At the start time 4032 of the configuration of the mentioned procedure, the central surgical controller 206 initiates 4034 a timing scheme of the artificial real time clock selected at random in the artificial real time at 07h36minO0Os. The central surgical controller 206 performs a 4036 ping test from the operating room (for example, sends an ultrasound wave and waits to hear the echo when it bounces off the perimeter walls of an operating room (for example, a fixed operating room , mobile, temporary or a field thereof), as described in connection with Figure 24, to check the size of the operating room and adjust the short-range wireless connection, for example, Bluetooth, time pairing distance limits real artificial 07h36minO1s .In artificial real time of 07h36minO3s, the central surgical controller 206 extracts the relevant data 4038 and applies a timestamp to the extracted data. 4040 only from devices located within the operating room as verified using the 4036 ultrasonic ping process.
[0261] [0261] Figure 24 illustrates an ultrasonic sensor of an operating room wall to determine a distance between a central surgical controller and the operating room wall, in accordance with at least one aspect of the present disclosure. Referring also to Figure 2, the spatial perception of the central surgical controller 206 and its ability to map an operating room for potential components of the surgical system allows the central surgical controller 206 to make autonomous decisions about whether to include or exclude such potential components as part of the surgical system, which relieves the surgical team from dealing with such tasks. In addition, the central surgical controller 206 is configured to make inferences about, for example, the type of surgical procedure to be performed in the operating room based on information collected before, during and / or after the performance of the surgical procedure. Examples of information collected include the types of devices that are taken to the operating room, the time of introduction of such devices into the operating room and / or the activation sequence of the devices.
[0262] [0262] In one aspect, the central surgical controller 206 employs the operating room mapping module, such as the non-contact sensor module 242 to determine the limits of the operating room (for example, an operating room or a fixed, mobile or temporary space) using ultrasonic or laser non-contact measuring devices.
[0263] [0263] Now referring to Figure 24, non-contact sensors based on 3002 ultrasound can be used to scan the operating room by transmitting an ultrasound wave and receiving echo when it bounces off a 3006 perimeter wall of a room of operation to determine the size of the operating room and adjust the short-range wireless connection, for example, Bluetooth, pairing distance limits. In one example, the 3002 non-contact sensors can be ultrasonic ping distance sensors, as shown in Figure 24.
[0264] [0264] Figure 24 shows how a 3002 ultrasonic sensor sends a short chirp with its 3003 ultrasonic speaker and allows a 3004 microcontroller from the operating room mapping module to assess how long it takes the echo to return to the sensor's ultrasonic microphone ultrasonic 3005. The microcontroller 3004 must send a pulse to the ultrasonic sensor 3002 to start the measurement. Then, the 3002 ultrasonic sensor waits long enough for the microcontroller program to start a pulse input command. Then, almost at the same time as the 3002 ultrasonic sensor chirps a 40 kHz tone, it sends a loud signal to the 3004 microcontroller. When the 3002 ultrasonic sensor detects the echo with its 3005 ultrasonic microphone, it changes that loud signal from back down. The microcontroller pulse input command measures the time between high and low changes, and stores the measurement in a variable. This value can be used together with the speed of sound in the air to calculate the distance between the central surgical controller 106 and the wall of the operating room 3006.
[0265] [0265] In one example, a central surgical controller 206 can be equipped with four ultrasonic sensors 3002, each of the four ultrasonic sensors being configured to evaluate the distance between the central surgical controller 206 and a wall in the operating room 3000. A central surgical controller 206 can be equipped with more or less than four ultrasonic sensors 3002 to determine the limits of an operating room.
[0266] [0266] Other distance sensors can be used by the operating room mapping module to determine the limits of an operating room. In one example, the operating room mapping module can be equipped with one or more photoelectric sensors that can be used to assess the limits of an operating room. In one example, suitable laser distance sensors can also be employed to assess the limits of an operating room. Laser-based non-contact sensors can scan the operating room by transmitting pulses of laser light, receiving pulses of laser light that bounce off 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 adjust the short-range wireless connection, for example, Bluetooth, pairing distance limits. Removing image data and data from connected smart instruments to enable conglomeration, but not individualization
[0267] [0267] In one aspect, the present disclosure provides a data extraction method that interrogates the provided electronic patient records, extracts the relevant portions to configure and operate the central surgical controller and the instruments attached to the central surgical controller, while anonymizing the surgery, the patient and all identifying parameters to maintain patient privacy.
[0268] [0268] Now again with reference to Figure 23 and also with reference to Figures 1 to 11 to show the interaction with an interactive surgical system 100, an environment that includes a central surgical controller 106, 206, when the size of the operating room has been verified and the Bluetooth pairing is complete, based on artificial real time, the computer processor 244 of the central surgical controller 206 begins extracting 4038 of the data received from the modules coupled to the central surgical controller 206. In one example, the processor 244 begins extracting 4083 of the images received from the imaging module 238 and connected smart instruments 235, for example. The 4038 extraction of the data allows for the conglomeration of the data, but not the individualization of the data. This makes it possible to extract the 4038 data identifier, link the data and monitor an event, while maintaining patient privacy by anonymizing the data.
[0269] [0269] With reference to Figures 1 to 24, in one aspect, a 4038 data extraction method is provided. According to data extraction method 4038, processor 244 of central surgical controller 206 interrogates patient records stored in the database of central surgical controller 238 and extracts relevant portions of patient records to configure and operate the surgical controller central 206 and its instruments 235, robots and other modular devices, for example, modules. The 4038 data extraction method anonymizes the surgical procedure, the patient and all the identification parameters associated with the surgical procedure. The dynamic extraction of 4038 data ensures that the data is never correlated to a specific patient, surgical procedure, surgeon, time or other possible identifiers that can be used to correlate the data.
[0270] [0270] The data can be extracted 4038 for compilation of the base information on a remote cloud database storage device 205 attached to the remote server 213. The data stored on the database storage device 248 can be used in an advanced cloud-based analysis, as described in US provisional patent application serial number 62 / 611,340, filed on December 28, 2017, entitled CLOUD-BASED MEDICAL ANALYTICS, which is hereby incorporated by reference in its entirety. A copy of the information with intact data links can also be stored in patient's RME database 4002 (Figure 22). For example, the central surgical controller 206 can import irregularities or comorbidities from the patient's tissue to add to an existing data set stored in database 248. Data can be extracted 4038 before surgery and / or 4038 can be extracted according to data is transmitted to the storage device 205 of the cloud database 204 coupled to the remote server 213.
[0271] [0271] Still with continued reference to Figures 1a 11 and 22a 24, Figure 25 is a 4050 diagram representing the process of importing patient 4012 electronic medical records containing relevant surgical procedure and patient 4018 data stored in the database from RME 4002, extraction 4038 of relevant patient data 4018 from imported medical records 4012 and identification 4060 of the implications, or inferences, of the smart device 4062 according to one aspect of the present disclosure. As shown in Figure 25, patient 4012 electronic medical records, which contain information stored in the patient's RME database 4002, are retrieved from the REM 4002 database, imported into the central surgical controller 206 and stored in the device. central surgical controller storage 248 206. Unedited data is removed or deleted 4019 from patient 4012 electronic medical records before being stored on central surgical controller storage device 248 206 as an anonymous data file 4016 (Figure 22). Relevant patient data 4018 is then extracted 4038 from medical records 4012 to remove desired relevant patient data 4018 and erase 4019 unedited data to maintain patient anonymity. In the illustrated example, the data extracted 4058 includes emphysema, high blood pressure, small lung cancer, warfarin / anticoagulant and / or radiation pretreatment. The data extracted 4058 is used to identify 4060 the implications of the smart device while maintaining patient anonymity, as described later in this document.
[0272] [0272] Although surgical procedure data and relevant 4018 patient data are described as being imported from patient 4012 electronic medical records stored in the RME 4002 database, in several respects, surgical procedure data and relevant data patient 4018 can be retrieved from a modular device attached to the central surgical controller 206 before being stored in the RME 4002 database. For example, the central surgical controller 206 can interrogate the module to retrieve the surgical procedure data and the relevant patient data 4018 of the module. As described here, a module includes an imaging module 238 that is attached to an endoscope 239, a generator module 240 that is attached to a power device 241, a smoke evacuation module 226, a suction / irrigation module 228, a communication module 230, a processor module 232, a storage matrix 234, an intelligent device / instrument 235 optionally coupled to a screen 237 and a non-contact sensor module 242, among other modules, as shown in Figures 3 and 8 to 10.
[0273] [0273] For example, anonymized data extracted 4058 can be used to identify 4060 catastrophic failures of instruments, and other intelligent devices, and can initiate an automatic data filing and submission process for analysis of other implications. For example, the implication of detecting a counterfeit component or adapter in an original equipment manufacturer ("OEM") device would be to start documenting the component and recording the results and consequences of its use. For example, the central surgical controller 206 can execute situational awareness algorithms, as described in connection with Figure 41. In one aspect, the central surgical controller 206 can receive or initially identify a variety of implications 4062 that are derived from anonymized data extracted 4058. Central surgical controller 206 is configured to control instruments 235, or other modules, so that they operate in a manner corresponding to the derived implications 4062. In one example, the control logic of central surgical controller 206 identifies that (i ) lung tissue may be more fragile than normal (for example, due to emphysema), (ii) hemostasis problems are more likely (for example, due to high blood pressure and / or the patient is taking an anticoagulant, such as warfarin), (iii) the cancer may be more aggressive (for example, because the target of the procedure is small cell lung cancer), and (iv) the tissue pulmonary artery may be more rigid and more prone to rupture (for example, due to the fact that the patient has received previous radiation treatment) The control logic or processor 244 of the central surgical controller 206 then interprets how this data affects instruments 235, or other modules, so that instruments 235 are operated consistently with the data and then communicate the settings corresponding to each of the 235 instruments.
[0274] [0274] In an example related to a stapler type of a 235 surgical instrument, based on the 4062 implications identified 4060 from anonymized data extracted 4058, the control logic or processor 244 of the central surgical controller 206 may (i) notify the stapler to adjust the compression rate limit parameter, (ii) adjust the viewing limit value of the central surgical controller 206 to quantify bleeding and internal parameters, (ili) notify the tissue combo 240 generator module pulmonary and vascular tissue types so that the control algorithms of generator module 240 and energy are adjusted accordingly, (iv) notify imaging module 238 of the aggressive cancer marker to adjust margin ranges accordingly, ( v) notify the stapler of the required margin parameter adjustment (the margin parameter corresponds to the distance or amount of tissue around the cancer that will be removed), and (vi) not ify the stapler that the fabric is potentially fragile. In addition, the anonymized data extracted 4058, on which the implications 40602 are based, are identified by the central surgical controller 206 and are fed into the situational perception algorithm (see Figure 41). Examples include, without limitation, thoracic resection of the lungs, for example, segmentectomy, among others.
[0275] [0275] Figure 26 is a 4070 diagram illustrating the application of cloud-based analysis to unedited patient data, relevant patient data extracted 4018 and independent data pairs, in accordance with one aspect of the present disclosure. As shown, multiple central surgical controllers, the Central surgical controller 41 4072, the Central surgical controller% 3 4074 and the Central surgical controller tt4 4076 are located within the hospital data barrier 4006 (see also Figure 22). The electronic medical record of the unedited patient 4012, which includes patient data and data related to surgery, can be used and exchanged between the central surgical controllers: the Central surgical controller H1 4072, the Central surgical controller 443 4074 and the Central surgical controller 4 4076 located within the hospital data barrier
[0276] [0276] Figure 27 is a 4080 logic flow diagram of a process representing a control program or a logical configuration for associating patient data sets from a first and a second data source, according to at least an aspect of the present revelation. With reference to Figure 27 and also with reference to Figures 1 to 11, to show interaction with an interactive surgical system environment 100 that includes a central surgical controller 106, 206, in one aspect, the present disclosure provides a central surgical controller 206, comprising a processor 244; and a memory 249 coupled to processor 244. Memory 249 stores instructions executable by processor 244 to interrogate 4082 a surgical instrument 235, retrieve 4084 a first data set from surgical instrument 235, interrogate 4086 a medical imaging device 238, retrieve 4088 a second set of data from medical imaging device 238, associate 4090 the first and second sets of data with a key and transmit the first and second sets of data associated with a remote network outside the central surgical controller 206. Surgical instrument 235 is a first source of patient data and the first data set is associated with a surgical procedure. The medical imaging device 238 is a second source of patient data and the second data set is associated with a result of the surgical procedure. The first and second data records are uniquely identified by the key.
[0277] [0277] In another aspect, the central surgical controller 206 provides a memory 249 that stores instructions executable by processor 244 to retrieve the first data set using the key, anonymize the first data set, retrieve the second data set using the key, anonymize the second data set, pair the first and second anonymized data sets and determine the success rate of the surgical procedures grouped by the surgical procedure based on the first and second paired anonymized data sets.
[0278] [0278] In another aspect, the central surgical controller 206 provides a memory 249 that stores instructions executable by processor 244 to retrieve the first anonymized data set, retrieve the second anonymized data set and reintegrate the first and second data sets anonymized with the use of the key.
[0279] [0279] Figure 28 is a logic flow diagram of a 4400 process that represents a control program or a logical configuration for extracting data in order to extract relevant portions of the data to configure and operate the central surgical controller 206 and the modules ( for example, instruments 235) coupled to the central surgical controller 206, in accordance with an aspect of the present disclosure. Referring to Figure 28 and also referring to Figures 1 to 11, to show interaction with an interactive surgical system environment 100 that includes a central surgical controller 106, 206, in one aspect, the central surgical controller 206 can be configured to interrogate a module coupled to the central surgical controller 206 for data, and extracting the data to extract relevant portions of the data to configure and operate the central surgical controller 206 and the modules (eg instruments 235) coupled to the central surgical controller 206 and to anonymize the surgery , the patient, and other parameters that can be used to identify the patient to maintain patient privacy. According to process 4400, in one aspect, the present disclosure provides a central surgical controller 206 that includes a processor 244, a central modular communication controller 203 coupled to processor 244, the central modular communication controller 203 being configured to connect modular devices located in one or more operating rooms to the central surgical controller 206. Processor 244 is coupled to memory 249, with memory 249 storing instructions executable by processor 244 to make the processor interrogate 4402 a modular device coupled to processor 244 via central modular communication controller 203. The modular device is a source of data sets that include patient identity data and surgical procedure data. Processor 244 receives a 4404 data set from the modular device. Processor 244 discards 4406 patient identity data and any portion of the surgical procedure data that identifies the patient from the data set. Processor 244 extracts 4408 anonymous data from the data set and creates 4410 an anonymized data set. The processor 244 configures 4412 the operation of the central surgical controller 206 or the modular device based on the anonymized data set.
[0280] [0280] In another aspect, where the anonymized data set includes a catastrophic failure of a modular device, memory 249 stores instructions executable by processor 244 to start archiving and submitting data automatically for analysis of implications based on catastrophic failure of the modular device. In another aspect, memory 249 stores instructions executable by processor 244 to detect counterfeit component information from the anonymized data set. In another aspect, memory 249 stores instructions executable by processor 244 to derive the implications of the modular device from the anonymized data set and memory 249 stores instructions executable by processor 244 to configure the modular device to operate based on the derived implications or configure the central surgical controller based on derived implications. In another aspect, memory 249 stores instructions executable by processor 244 to conglomerate anonymized data. In another aspect, memory 249 stores instructions executable by processor 244 to extract anonymized data before storing received data in a storage device coupled to the central surgical controller. In another aspect, memory 249 stores instructions executable by the processor to transmit the anonymized data to a remote network outside the central surgical controller, compile the anonymized data on the remote network and store a copy of the data set from the modular device in a database of electronic medical records of the patient. Data creation storage and use of self-describing data that includes identification features
[0281] [0281] In one aspect, the present disclosure provides self-describing data packets generated in the issuing instrument and which include identifiers for all devices that handled the packet. Self-description allows the processor to interpret the data in the self-description package without knowing the data type in advance before receiving the self-description package. The data applies to each data point or data chain and includes the type of data, the source of the self-describing package, the identification of the device that generated the package, the units, the generation time of the package and an authentication that the data contained in the package is unchanged. When the processor (on the device or central surgical controller) receives an unexpected package and checks the source of the package, the processor changes collection techniques to be ready for any subsequent packages from that source.
[0282] [0282] Referring also to Figures 1 to 11 to show the interaction with an interactive surgical system environment 100 that includes a central surgical controller 106, 206, during a surgical procedure that is performed in a central surgical controller environment 206, the the size and amount of data that is generated by surgical devices 235 coupled to the central surgical controller 206 can become very large. In addition, the data exchanged between surgical devices 235 and / or the central surgical controller 206 can become quite large.
[0283] [0283] One solution provides techniques to minimize the size of the data and manipulate the data within a central surgical controller 206 by generating a self-describing package. The self-description package is initially assembled by the 235 instrument that generated it. The package is then ordered and encrypted by generating an encryption certificate that is unique to each data package. The data is then communicated from the instrument 235 via encrypted wired or wireless protocols and stored in the central surgical controller 206 for processing and transmission to a cloud analysis mechanism 204. Each self-describing data package includes an identifier for identify the specific instrument that generated it and the time it was generated. The identifier of the central surgical controller 206 is added to the package when the package is received by the central surgical controller 206.
[0284] [0284] In one aspect, the present disclosure provides a central surgical controller 206 comprising a processor 244 and a memory coupled to processor 244 249. Memory 249 stores instructions executable by processor 244 to receive a first data packet from a first source, receiving a second data packet from a second source, associating the first and second data packets and generating a third data packet comprising the first and second data payloads. The first data packet comprises a first preamble, a first data payload, a source of the first data payload and a first encryption certificate. The first preamble defines the first data payload and the first encryption certificate verifies the authenticity of the first data packet. The second data packet comprises a second preamble, a second data payload, a source of the second data payload and a second encryption certificate. The second preamble defines the second data payload and the second encryption certificate verifies the authenticity of the second data packet.
[0285] [0285] In another aspect, memory 249 stores instructions executable by processor 244 to determine that a data payload is from a new source, verify the new data payload source and change a data collection process in the controller central surgical unit to receive subsequent data packets from the new source.
[0286] [0286] In another aspect, memory 249 stores instructions executable by processor 244 to associate the first and second packets based on a key. In another aspect, memory 249 stores instructions executable by processor 244 to anonymize the data payload of the third data packet. In another aspect, memory 249 stores instructions executable by processor 244 to receive a third anonymized data packet and to reintegrate the third anonymized data packet into the first and second data packets using the key.
[0287] [0287] In several respects, the present disclosure provides a control circuit for receiving and processing data packets as described above. In many respects, the present disclosure provides a computer-readable, non-transitory medium that stores computer-readable instructions that, when executed, cause a machine to receive and process packages as described above.
[0288] [0288] In other respects, the present disclosure refers to a method for generating a data package that comprises self-describing data. In one aspect, a surgical instrument includes a processor and memory attached to the processor, a control circuit and / or a computer-readable medium configured to generate a data packet comprising a preamble, a data payload, a source of data. data payload and an encryption certificate. The preamble defines the data payload and the encryption certificate verifies the authenticity of the data packet. In many ways, the data package can be generated by any module attached to the central surgical controller. Self-describing data packets minimize data size and data transmission in the central surgical controller.
[0289] [0289] In one aspect, the present disclosure provides a package of self-describing data generated on an emitting device (eg, instrument, tool, robot). The self-describing data package comprises identifiers for all devices that handle the data package along a communication path; a self-description to enable a processor to interpret that data contained in the data packet without having been informed in advance of receiving the data packet along a trajectory; data for each data point or data chain; and data type, data source, the IDs of the device that generated the data, units of the data, generation time and authentication that the data packet is unchanged. In another aspect, when a processor receives a data packet from an unexpected source and checks the data source, the processor changes the data collection technique to prepare for any subsequent data packets from the source.
[0290] [0290] When creating and using a data package that comprises self-describing data, the central surgical controller includes identification features. The central surgical controller and smart devices use self-describing data packets to minimize data size and data manipulation. In a central surgical controller that generates large volumes of data, self-describing data packages minimize data size and data manipulation, thereby saving time and enabling the operating room to function more efficiently.
[0291] [0291] Figure 29 is illustrates a 4100 self-describing data package comprising self-describing data, in accordance with an aspect of the present disclosure. Referring also to Figures 1 to 11, to show the interaction with an interactive surgical system environment 100 that includes a central surgical controller 106, 206, in one aspect, the 4100 self-describing data packages, as shown in Figure 29, are generated on an emitting instrument 235, or device or module located in the operating room or communicating with it, and include identifiers for all devices 235 that handle the packet along a communication path. Self-description allows a processor 244 to interpret the data payload of the 4100 packet without having prior knowledge of the data payload definition before receiving the self-describing 4100 data packet. Processor 244 can interpret the data payload by analyzing an incoming 4100 self-describing packet as it is received and identifies the data payload without being previously notified that the 4100 self-describing packet has been received. The data is for each data point or data chain. The data payload includes the data type, the data source, the device IDs that generated the data, the data units when the data was generated and an authentication that the 4100 self-describing data pack is unchanged. When processor 244, which may be located on the device or central surgical controller 206, receives an unexpected self-describing data packet 4100 and verifies the source of the 4100 self-describing data packet, processor 244 changes the data collection medium to be ready for any subsequent 4100 self-describing data packets from that source. In one example, the information contained in a 4100 self-describing package can be recorded during the first 4172 shot in the surgical procedure for resection of a lung tumor described in connection with Figures 31 to 35.
[0292] [0292] The 4100 self-describing data package includes not only the data, but a preamble that defines what data is and where the data came from, as well as an encryption certificate that verifies the authenticity of each 4100 data package. As shown in Figure 29, the 4100 data packet may comprise a self-describing data head 4102 (for example, force to fire ["FTF" - force-to-fire], force to close ["FTC" - force-to-close], energy amplitude, energy frequency, energy pulse width, firing speed, and the like), a device ID 4104 (for example, 002), a drive shaft ID 4106 (for example, W30), an ID cartridge 4108 (for example, 28ESN736), a unique 4110 time stamp (for example, 9:35min15s), a force to fire 4112 value (for example, 85) when the 4102 self-describing data head includes FTF fire), otherwise this position in the 4100 data packet includes the value of fo power to close, energy amplitude, energy frequency, energy pulse width, firing speed, and the like. The 4100 data pack additionally includes the fabric thickness value 4114 (eg 1.1 mm) and a 4116 data value identification certificate (eg 01101010001001) that is unique to each data pack
[0293] [0293] Each 4100 self-describing data package comprising self-describing data is initially assembled by the 235 instrument, device, or module that generated the self-describing data package.
[0294] [0294] Each 4100 self-describing data package comprising self-describing data includes a device ID 4104 to identify the specific instrument 235 that generated the 4100 self-describing data package, a 4110 timestamp to indicate the time when the data package 4100 was generated, and when the 4100 data packet was generated and when the self-describing data packet is received by the central surgical controller 206. The ID of the central surgical controller 206 can also be added to the self-describing data packet
[0295] [0295] Each of the 4100 self-describing data packets comprising self-describing data may include a packet wrapper that defines the beginning of the 4100 data packet and the end of the 4100 data packet which includes any identifiers necessary to predict the number and order of the bits in the self-describing data packet.
[0296] [0296] The central surgical controller 206 also manages redundant data sets. As device 235 works and interconnects with other central surgical controllers 206, multiple sets of the same data can be created and stored on multiple devices 235. Consequently, central surgical controller 206 manages multiple redundant data images as well as anonymization and data security. The central surgical controller 206 also provides temporary visualization and communication, incident management, peer processing or distributed processing, and storage backup and data protection.
[0297] [0297] Figure 30 is a 4120 logical flow chart of a process that represents a control program or a logical configuration for using data packages that comprise self-describing data, in accordance with an aspect of the present disclosure. Referring to Figures 1 to 29, in one aspect, the present disclosure provides a central surgical controller 206 comprising a processor 244 and a memory coupled to processor 244 249. Memory 249 stores instructions executable by processor 244 to receive a first packet of data from a first source, receiving a second data packet from a second source, associating the first and second data packets and generating a third data packet comprising the first and second data payloads. The first data packet comprises a first preamble, a first data payload, a source of the first data payload and a first encryption certificate. The first preamble defines the first data payload and the first encryption certificate verifies the authenticity of the first data packet. The second data packet comprises a second preamble, a second data payload, a source of the second data payload and a second encryption certificate. The second preamble defines the second data payload and the second encryption certificate verifies the authenticity of the second data packet.
[0298] [0298] In another aspect, memory 249 stores instructions executable by processor 244 to determine that a data payload is from a new source, verify the new data payload source and change a data collection process in the controller central surgical unit to receive subsequent data packets from the new source.
[0299] [0299] In another aspect, memory 249 stores instructions executable by processor 244 to associate the first and second packets based on a key. In another aspect, memory 249 stores instructions executable by processor 244 to anonymize the data payload of the third data packet. In another aspect, memory 244 stores instructions executable by processor 244 to receive a third anonymized data packet and to reintegrate the third anonymized data packet into the first and second data packets using the key.
[0300] [0300] Figure 31 is a 4130 logic flow diagram of a process representing a control program or a logical configuration for using data packages that comprise self-describing data, in accordance with an aspect of the present disclosure. With reference to Figure 31 and also with reference to Figures 1 to 11, to show interaction with an interactive surgical system environment 100 that includes a central surgical controller 106, 206, in one aspect, the present disclosure provides a central surgical controller 206 that comprises a processor 244 and a memory 249 coupled to processor 244. Memory 249 stores instructions executable by processor 244 to receive 4132 a first packet of self-describing data from a first data source, the first packet of self-describing data comprising a first preamble, a first data payload, a source of the first data payload, and a first encryption certificate. The first preamble defines the first data payload and the first encryption certificate verifies the authenticity of the first data packet. The memory 249 stores instructions executable by the processor 244 to analyze 4134 the first preamble received and interpret 4136 the first data payload based on the first preamble.
[0301] [0301] In various respects, memory 249 stores instructions executable by processor 244 to receive a second packet of self-describing data from a second data source, the second packet of self-describing data comprising a second preamble, a second payload data, a source of the second data payload, and a second encryption certificate. The second preamble defines the second data payload and the second encryption certificate verifies the authenticity of the second data packet. Memory 249 stores instructions executable by processor 244 to analyze the second preamble received, interpret the second data payload based on the second preamble, associate the first and second self-describing data packets and generate a third self-describing data packet comprising the first and second payloads of data. In one respect, memory stores instructions executable by the processor to anonymize the data payload of the third self-describing data packet.
[0302] [0302] In several respects, memory stores instructions executable by the processor to determine that a data payload has been generated by a new data source, check the new data source for the data payload, and change a data collection process on the central surgical controller to receive subsequent data packets from the new data source. In one respect, memory stores instructions executable by the processor to associate the first and second self-describing data packets based on a key. In another aspect, the memory stores instructions executable by the processor to receive a third anonymous self-describing data packet and to reintegrate the third anonymous self-describing data packet into the first and second self-describing data packets using the key. Data storage in a manner of paired data sets that can be grouped by surgery, but not necessarily keyed to surgery dates and actual surgeons
[0303] [0303] In one aspect, the present disclosure provides a method of data pairing that allows a central surgical controller to interconnect to a measured device parameter with a surgical outcome. The data pair includes all relevant surgical data or patient qualifiers without any data that identifies the patient. The data pair is generated in two separate and distinct time periods. The disclosure additionally provides the configuration and storage of the data in order to be able to reconstruct a chronological series of events or merely a series of coupled but not restricted data sets. The disclosure additionally provides data storage in an encrypted form with predefined backup and mirrored to the cloud.
[0304] [0304] To determine the success or failure of a surgical procedure, the data stored on a surgical instrument must be correlated with the result of the surgical procedure while simultaneously anonymizing the data to protect the patient's privacy. One solution is to pair the data associated with a surgical procedure, as recorded by the surgical instrument during the surgical procedure, with the data that assess the effectiveness of the procedure. The data is paired without identifiers associated with the surgery, the patient or the time to preserve anonymity. Paired data is generated in two separate and distinct time periods.
[0305] [0305] In one aspect, the present disclosure provides a central surgical controller configured to communicate with a surgical instrument. The central surgical controller comprises a processor and a memory attached to the processor. The memory stores instructions executable by the processor to receive a first set of data associated with a surgical procedure, receive a second set of data associated with the effectiveness of the surgical procedure, anonymize the first and second sets of data by removing the information that identifies a patient , a surgery or a scheduled surgery time, and store the first and second anonymized data sets to generate a pair of data grouped by surgery. The first data set is generated in a first time, the second data set is generated in a second time, and the second time is separate and distinct from the first time.
[0306] [0306] In another aspect, the memory stores instructions executable by the processor to reconstruct a series of chronological events based on the data pair. In another aspect, memory stores instructions executable by the processor to reconstruct a series of coupled but unrestricted data sets based on the data pair. In another aspect, the memory stores instructions executable by the processor to encrypt the data pair, define a backup format for the data pair and mirror the data pair to a cloud storage device.
[0307] [0307] In several respects, the present disclosure provides a control circuit for receiving and processing data sets as described above. In many respects, the present disclosure provides a computer-readable, non-transitory medium that stores computer-readable instructions that, when executed, cause a machine to receive and process the assemblies as described above.
[0308] [0308] Storing anonymous paired data allows the hospital or surgeon to use data pairs locally to link to specific surgeries or to store data pairs to analyze general trends without extracting specific events in a chronological manner.
[0309] [0309] In one aspect, the central surgical controller provides storage and configuration of user-defined data. Data storage can be done in a manner of paired data sets that can be grouped by surgery, but not necessarily keyed to actual surgical dates and surgeons. This technique provides anonymity of data with respect to the patient and the surgeon.
[0310] [0310] In one aspect, the present disclosure provides a method of pairing data. The data pairing method comprises enabling a central surgical controller to interconnect to a parameter measured by the device with a result, with a data pair including all relevant tissue or patient qualifiers without any of the identifiers, the pair being of data is generated in two separate and distinct time periods. In another aspect, the present disclosure provides a data configuration that includes the question of whether the data is stored in a way that allows the reconstruction of a chronological series of events or merely a series of coupled but not restricted data sets. In another aspect, data can be stored in an encrypted form. The stored data can comprise a predefined backup and mirror to the cloud.
[0311] [0311] The data can be encrypted locally on the device. The data can be backed up automatically to an integrated secondary load storage device. The device and / or the central surgical controller can be configured to maintain the data storage time and compile and transmit the data to another location for storage, for example, another central surgical controller or a cloud storage device. The data can be grouped together and switched for transmission to the analysis location in the cloud. A cloud-based analysis system is described in provisional US patent application serial number 62 / 611,340 by the same applicant, which was filed on December 28, 2017, entitled CLOUD-BASED MEDICAL ANALYTICS, which is incorporated herein by reference in its wholeness.
[0312] [0312] In another aspect, the central surgical controller provides the user with selectable options for data storage. In one technique, the central controller allows the hospital or the surgeon to select whether data should be stored in a way that allows it to be used locally on a central surgical controller to link to specific surgeries. In another technique, the central surgical controller allows data to be stored as data pairs so that general trends can be analyzed without specific events extracted in a chronological manner.
[0313] [0313] Figure 32 is a diagram 4150 of a tumor 4152 located in the right upper posterior lobe 4154 of the direct lung 4156, according to one aspect of the present disclosure. To remove tumor 4152, the surgeon cuts around tumor 4152 along the perimeter generically designated as a margin 4158. A fissure 4160 separates the upper lobe 4162 and the intermediate lobe 4164 from the right lung 4156. To remove tumor 4152 around of margin 4158, the surgeon must cut the bronchial vessels 4166 that connect to and from the intermediate lobe 4164 and the upper lobe 4162 of the right lung 4156. The bronchial vessels 4166 need to be sealed and cut using a device such as a surgical stapler, an electrosurgical instrument, an ultrasonic instrument, a combination of an electrosurgical / ultrasonic instrument and / or a combination of a stapler / electrosurgical device generically represented in the present invention as the 235 instrument / device coupled to the central surgical controller 206. The 235 device is configured to record data as described above, which is formed as a data package, encrypted, stored and / or transmitted to a remote data storage device 105 and processed by server 113 in cloud 104. Figures 37 and 38 are diagrams illustrating the right lung 4156 and the bronchial tree 4250 embedded within the lung parenchyma tissue .
[0314] [0314] In one aspect, the data package may be in the form of the self-describing data 4100 described in connection with Figures 29 to 31. The self-describing data package 4100 will contain the information recorded by device 235 during the procedure. This information may include, for example, a 4102 self-describing data head (for example, force to fire [FTF], force to close [FTC], energy amplitude, energy frequency, energy pulse width, firing speed, and the like) based on the specific variable. The device ID 4104 (for example, 002) of the instrument / device 235 used in the procedure includes components of the instrument / device 235 such as the drive shaft ID 4106 (for example, W30) and the cartridge ID 4108 (for example, ESN736). The 4100 self-describing package also records a unique 4110 timestamp (for example, O9h35min15s) and procedural variables as a force value to trigger 4112 (for example, 85) when the 4102 self-describing data head includes FTF (force for fire), otherwise, this position in the 4100 data packet includes the force to close (FTC) value, energy amplitude, energy frequency, energy pulse width, firing speed, and the like, as shown in Table 1, for example. The 4100 data pack may further include the tissue thickness value 4114 (e.g., 1.1 mm), which in this example refers to the thickness of the bronchial vessel 4166 exposed in the fissure 4160 that has been sealed and cut. Finally, each 4100 self-describing package includes a data value identification certificate 4116 (for example, 01101010001001) that uniquely identifies each 4100 data package transmitted by device / instrument 235 to central surgical controller 206, additionally transmitted from the central surgical controller 206 for cloud 204 and stored in storage device 205 coupled to server 213 and / or additionally transmitted to central robotic surgical controller 222 and stored.
[0315] [0315] The data transmitted via a 4100 self-describing data packet is sampled by the device of the instrument 235 at a predetermined sampling rate. Each sample is formed into a self-describing data packet 4100 that is transmitted to the central surgical controller 206 and eventually is transmitted from the central surgical controller 206 to cloud 204. The samples can be stored locally on the device of the instrument 235 prior to packaging. or they can be transmitted in real time. The predetermined sample rate and transmission rate are dictated by communication traffic at central controller 206 and can be dynamically adjusted to accommodate current bandwidth limitations. Consequently, in one aspect, the instrument device 235 can record all samples taken during surgery and at the end of the procedure pack each sample in a 4100 self-describing package and transmit the 4100 self-description package to the central surgical controller 206. In another In this respect, the sampled data can be packaged as it is recorded and transmitted to the central surgical controller 206 dynamically.
[0316] [0316] Figure 33 is a 4170 diagram of a surgical procedure for resection of a lung tumor that includes four separate shots of a 235 surgical stapling device to seal and cut 4166 bronchial vessels exposed in fissure 4160 up to and from the upper lobes and lower 4162, 4164 of the right lung 4156 shown in Figure 32, according to an aspect of the present disclosure. Surgical stapling device 235 is identified by a device ID "002". The data for each shot of the 235 surgical stapling device is recorded and formed into a 4100 data package that comprises the self-describing data as shown in Figure 30. The 4100 self-describing data package shown in Figure 30 is representative of the first shot of the " 002 "which has an ESN736 staple cartridge, for example. In the following description, reference is also made to Figures 12 to 19 for descriptions of various instrument / device architectures 235 which include a processor or a control circuit coupled with a memory to record (for example, save or store) data collected during a surgical procedure.
[0317] [0317] The first shot 4172 is recorded at the anonymous time of 9:35min15s. The first shot 4172 seals and cuts a first bronchial vessel 4166 up to and from the intermediate lobe 4164 and up to and from the upper lobe 4162 of the right lung 4156 in a first portion 4166a and a second portion 4166b, with each portion 4166a, 4166b is sealed by a respective first and second staple line 4180a, 4180b. The information associated with the first shot 4172, for example, the information described in connection with Figure 30, is recorded in the memory of surgical stapling device 235 and is used to build a first self-describing data package 4100 described in connection with Figures 29 to 31. The first 4100 self-describing package can be transmitted upon completion of the first 4172 shot or can be stored in the memory of surgical stapling device 235 until the surgical procedure is completed. Once transmitted by the surgical stapling device 235, the first 4100 self-describing data packet is received by the central surgical controller 206. The first 4100 self-describing data packet is anonymized by extracting and stamping the 4038 date and time from the data, as discussed, by example, in connection with Figure 23. After the surgical pulmonary resection is completed, the integrity of the seals on the first and second staple lines 4182a, 4182b will be evaluated as shown in Figure 34, for example, and the evaluation results will be paired with the information associated with the first 4172 shot.
[0318] [0318] The second shot 4174 seals and cuts a second bronchial vessel between the bronchial vessels 4166 to and from the intermediate lobe 4164 and to and from the upper lobe 4162 of the right lung 4156 in a first portion 4166c and in a second portion 4166d, each portion 4166c, 4166d being sealed by a first and a second line of staples 4180c, 4180d. The information associated with second shot 4174, for example, the information described in connection with Figures 29 to 31, is recorded in the memory of surgical stapling device 235 and is used to build a second self-describing data packet 4100 described in connection with the Figures 29 to 31. The second self-descriptive data packet 4100 can be transmitted at the end of the second shot 4174 or can be kept stored in the memory of surgical stapling device 235 until the surgical procedure is completed. Once transmitted by the surgical stapling device 235, the second self-describing data packet 4100 is received by the central surgical controller 206. The second self-descriptive data packet 4100 is anonymized by extracting and stamping the 4038 date and time from the data, as discussed, by example, in connection with Figure 23. After the surgical pulmonary resection is completed, the integrity of the seals of the first and second staple lines 4182c, 4182d will be evaluated as shown in Figure 34, for example, and the evaluation results will be paired with the information associated with the second 4174 shot.
[0319] [0319] The third shot 4176 is recorded at the anonymous time of 09h42min12s. The third shot 4176 seals and cuts an outer portion of the upper and intermediate lobes 4162, 4164 of the right lung 4156. The first and second lines of clamps 4182a, 4182b are used to seal the outer portion of the upper and intermediate lobes 4162,
[0320] [0320] The fourth shot 4178 seals and cuts an inner portion of the upper and intermediate lobes 4162, 4162 of the right lung 4156. The first and second rows of staples 4182c, 4182d are used to seal the outer portions of the upper and intermediate lobes 4162 ,
[0321] [0321] Figure 34 is a graphical illustration 4190 of a force to close (FTC) curve versus time 4192 and a force to fire (FTF) curve versus time 4194 featuring the first trigger 4172 of device 002 shown in Figure 33, according to one aspect of the present disclosure. Surgical stapling device 235 is identified as 002 with a staple cartridge of mm serial number ESN736 with a PVS drive shaft serial number M3615N (drive shaft ID W30). Surgical stapling device 235 was used for the first 4172 firing to complete the pulmonary resection surgical procedure shown in Figure 33. As shown in Figure 34, the peak force of the 85 N firing force is recorded at anonymous time of 09h35min15s . The algorithms in the surgical stapler device 235 determine a tissue thickness of about 1.1 mm. As described later in this document, the FTC curve versus time 4192 and the FTF curve versus time 4194 featuring the first shot 4172 of surgical device 235 identified by ID 002 will be paired with the result of the pulmonary resection surgical procedure, transmitted to the surgical center 206, anonymized and stored in the central surgical controller 206 or transmitted to cloud 204 for aggregation, further processing, analysis, among others.
[0322] [0322] Figure 35 is a 4200 diagram illustrating a laser Doppler of the staple line visualization to assess the integrity of the staple line seals by monitoring bleeding from a vessel after a surgical stapler is triggered, according to with an aspect of the present revelation. A laser Doppler technique is described above under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, filed on December 28, 2017, entitled INTERACTIVE SURGICAL PLATFORM, which is incorporated herein reference in its entirety. The laser Doppler provides a 4202 image suitable for inspecting the seals along staple lines 4180a, 4180b, 4182a and visualizing 4206 bleeding from any defective seals. Laser Doppler inspection of the first shot 4172 of device 002 shows a defective seal on the first staple line 4180a of the first portion 4166a of the sealed bronchial vessel during the first shot 4172. The staple line 4180a seal is bleeding 4206 in one volume 0.5 cc. The 4202 is recorded in the anonymous time of 09h55min15s 4204 and is paired with the force curve to close
[0323] [0323] Figure 36 illustrates two 4210 paired data sets grouped by surgery, according to one aspect of the present disclosure. The upper paired data set 4212 is grouped by one surgery and a lower paired data set 4214 is grouped by another surgery. The upper paired data set 4212, for example, is grouped by the lung tumor resection surgery discussed in connection with Figures 33 to 36. Consequently, the remainder of the description in Figure 36 will refer to the information described in Figures 32 to 35 and in Figures 1a 21 to show the interaction with an interactive surgical system environment 100 that includes a central surgical controller 106, 206. The lower paired data set 4214 is grouped by a surgical procedure for resection of a liver tumor in which the surgeon treated the parenchyma tissue. The upper paired data set is associated with a failed staple line seal and the lower paired data set is associated with a successful staple line seal. The upper and lower paired data sets 4212, 4214 are sampled by the device of the instrument 235 and for each sample formed in a self-describing data packet 4100 that is transmitted to the central surgical controller 206 and eventually is transmitted from the central surgical controller 206 to cloud 204. Samples can be stored locally on the device of instrument 235 prior to packaging or can be transmitted in real time. The sample rate and transmission rate are dictated by the communication traffic at the central controller 206 and can be dynamically adjusted to accommodate current bandwidth limitations.
[0324] [0324] The upper paired data set 4212 includes a left data set 4216 registered by the instrument / device 235 during the first trigger 4172 connected 4224 to a right data set 4218 registered at the time the sealing of the staple line 4180a of the first 4166a bronchial vessel was evaluated. Left data set 4216 indicates a type of "vase" fabric 4236 that has a thickness 4238 of 1.1 mm. Also included in left data set 4216 is the force curve to close 4192 and the force curve to fire 4194 versus the time (anonymous real time) recorded during the first trigger 4172 of the lung tumor resection surgical procedure. The left data set 4216 shows that the force to fire reached a peak of 85 lbs and was recorded in anonymous real time 4240 aunt (09h35min15s). The right data set 4218 represents the viewing curve of staple line 4228 that shows a leak versus time. The right data set 4218 indicates that a type of "vase" fabric 4244 having a thickness 4246 of 1.1 mm has suffered a sealing failure 4242 of the staple line 4180a. The viewing curve of the staple line 4228 represents the leak (cc) versus the sealing time of the staple line 4180a. The viewing curve of the staple line 4228 shows that the leakage volume reached 0.5 cc, indicating a sealing of the staple line 4180a failure of the bronchial vessel 4166a, recorded at anonymous time 4248 (09h55min15s).
[0325] [0325] The lower paired data set 4214 includes a left data set 4220 recorded by the instrument / device 235 during a triggering 4226 to a right data set 4222 recorded at the time the sealing of the staple line of the parenchyma was evaluated. The left data set 4220 indicates a tissue type "parenchyma" 4236 that has a thickness 4238 of 2.1 mm. Also included in the left data set 4220 is the force curve to close 4230 and the force curve to fire 4232 versus the time (anonymous real time) recorded during the first trigger of the liver tumor resection surgical procedure. The left data set 4220 shows that the firing force reached a peak of 100 Ibs and was recorded in anonymous real time 4240 ti (09h42min12s). The right data set 4222 represents the viewing curve of staple line 4228 that shows a leak versus time. The right data set 4234 indicates that a type of "parenchyma" fabric 4244 having a thickness of 4246 of 2.2 mm had a successful staple line seal. The display curve 4234 of the staple line represents the leak (cc) versus the sealing time of the staple line. The viewing curve for staple line 4234 shows that the leakage volume was 0.0 cc, indicating a successful staple line sealing of the parenchyma tissue, recorded at anonymous time 4248 (10:02:12).
[0326] [0326] Paired datasets 4212, 4214 grouped by surgery are collected for many procedures and the data contained in paired datasets 4212, 4214 are recorded and stored in cloud storage 205 anonymously to protect patient privacy 205, as described in connection with Figures 22 to 29. In one aspect, data from paired data sets 4212, 4214 are transmitted from the instrument / device 235, or other modules coupled to the central surgical controller 206, to the central surgical controller 206 and for cloud 204 in the form of the self-describing package 4100 as described in connection with Figures 31 and 32 and the examples of surgical procedures described in connection with Figures 32 a
[0327] [0327] Figure 37 is a diagram of the right lung 4156 and Figure 38 is a diagram of the bronchial tree 4250 that includes trachea 4252 and bronchi 4254, 4256 of the lungs. As shown in Figure 37, right lung 4156 is composed of three lobes divided into the upper lobe 4162, the intermediate lobe 4160 and the lower lobe 4165 separated by the oblique fissure 4167 and the horizontal fissure 4160. The left lung consists of only two lobes smaller due to the position of the heart. As shown in Figure 38, inside each lung, the right bronchus 4254 and the left bronchus 4256 divide into many smaller airways called bronchioles 4258, which greatly increase the surface area. Each bronchiolus 4258 ends with a group of air sacs called alveoli 4260, where gas is exchanged with the bloodstream.
[0328] [0328] Figure 39 is a 4300 logical flowchart of a process representing a control program or a logical configuration for storing anonymous paired data sets grouped by surgery, according to one aspect of the present disclosure. Referring to Figures 1 to 39, in one aspect, the present disclosure provides a central surgical controller 206 configured to communicate with a surgical instrument 235. The central surgical controller 206 comprises a processor 244 and a memory 249 coupled to processor 244. A memory 249 stores instructions executable by processor 244 to receive 4302 a first data set a first data set from a first source, the first data set being associated with a surgical procedure, receiving 4304 a second data set from a second source, the second set of data being associated with the effectiveness of the surgical procedure, anonymizing 4306 the first and second sets of data by removing the information identifying a patient, a surgery or a scheduled surgery time, and storing 4308 the first and second sets anonymized data to generate a pair of data grouped by surgery. The first data set is generated in a first time, the second data set is generated in a second time, and the second time is separate and distinct from the first time.
[0329] [0329] In another aspect, memory 249 stores instructions executable by processor 244 to reconstruct a series of chronological events based on the data pair. In another aspect, memory 249 stores instructions executable by processor 244 to reconstruct a series of coupled but unrestricted data sets based on the data pair. In another aspect, memory 249 stores instructions executable by processor 244 to encrypt the data pair, define a backup format for the data pair, and mirror the data pair to a cloud storage device 205. Data determination to be transmitted for cloud-based medical analysis
[0330] [0330] In one aspect, the present disclosure provides a central controller! communication device and a storage device to store parameters and the status of a surgical device that has the ability to determine when, how often, the transmission rate and the type of data to be shared with a cloud-based analysis system. The disclosure additionally provides techniques for determining where the analysis system communicates new operating parameters to the central surgical controller and surgical devices.
[0331] [0331] In a central surgical controller environment, large amounts of data can be generated very quickly and can cause bottlenecks in storage and communication on the central surgical controller network. A solution may include local determination of when and what data is transmitted to the cloud-based medical analysis system for further processing and manipulation of data from the central surgical controller. The timing and speed at which data from the central surgical controller are exported can be determined based on the available local data storage capacity. User-defined inclusion or exclusion of specific users, patients or procedures allows data sets to be included for analysis or to be deleted automatically. The time for uploads or communications to the cloud-based medical analysis system can be determined based on the downtime or available capacity detected from the central surgical controller network.
[0332] [0332] With reference to Figures 1 to 39, in one aspect, the present disclosure provides a central surgical controller 206 comprising a storage device 248, a processor 244 coupled to storage device 248 and a memory 249 coupled to processor 244. Memory 249 stores instructions executable by processor 244 to receive data from a surgical instrument 235, determine a speed at which to transfer data to a cloud-based remote medical analysis network 204 based on the storage device's available storage capacity 248, determine a frequency at which data should be transferred to the cloud-based remote medical analysis network 204 based on the available storage capacity of the storage device 248 or the detected downtime of the central surgical controller network 206 and determine a data type to transfer the data to a remote medical analysis network based ada in cloud 204 based on the inclusion or exclusion of data associated with a user, patient or surgical procedure.
[0333] [0333] In another aspect, memory 249 stores instructions executable by processor 244 to receive new operating parameters for the central surgical controller 206 or surgical instrument 235.
[0334] [0334] In several respects, the present disclosure provides a control circuit to determine the rate, frequency and type of data to transfer the data to the cloud-based remote medical analysis network as described above. In several respects, the present disclosure provides a computer-readable, non-transitory medium that stores computer-readable instructions that, when executed, cause a machine to determine the speed, frequency and type of data to be transferred to the medical analysis network cloud-based remote.
[0335] [0335] In one aspect, the central surgical controller 206 is configured to determine what data to transmit to the cloud-based analysis system 204. For example, a modular device 235 of the central surgical controller 206 that includes local processing capabilities can determine the speed, frequency and type of data to be transmitted to the cloud-based analysis system 204 for analysis and processing.
[0336] [0336] In one aspect, the central surgical controller 206 comprises a modular central surgical controller 203 and a storage device 248 for storing parameters and the status of a device 235 that has the ability to determine when and how often data can be shared with a cloud-based analysis system 204, the transmission speed and the type of data that can be shared with the cloud-based analysis system 204. In another aspect, the cloud analysis system 204 communicates new operational parameters central surgical controller 206 and surgical devices 235 coupled to central surgical controller 206. A cloud-based analysis system 204 is described in provisional US patent application serial number 62 / 611,340, filed on December 28, 2017, entitled CLOUD -BASED MEDICAL ANALYTICS,
[0337] [0337] In one aspect, a device 235 coupled to a local central surgical controller 206 determines when and what data is transmitted to the cloud analysis system 204 for the company's analytical improvements. In one example, the available local data storage capacity remaining on the storage device 248 controls the timing and the speed at which the data is exported. In another example, user-defined inclusion or exclusion of specific users, patients, or procedures allows data sets to be included for analysis or to be deleted automatically. In yet another example, the downtime or available capacity detected from the network determines the time for uploads or communications.
[0338] [0338] In another aspect, the transmission of data for diagnosis of failure modes is switched by specific incidents. For example, the failure of a user-defined device, instrument or tool within a procedure initiates the archiving and transmission of recorded data with respect to that instrument for analysis of failure modes. Additionally, when a failure event is identified, all data surrounding the event is archived and gathered to be sent back for a predictive informatics analysis ("PI"). Data that is part of a PI failure is flagged for storage and maintenance until the hospital or cloud-based analysis system gives up the data domain.
[0339] [0339] Catastrophic instrument failures can initiate automatic data archiving and submission for implications analysis. The detection of a counterfeit component or adapter in an original equipment manufacturer ("OEM") device starts the component's documentation and recording the results and the consequence of its use.
[0340] [0340] Figure 40 is a 4320 logic flow diagram of a process representing a control program or a logical configuration to determine the speed, frequency and type of data to be transferred to a remote cloud-based analytical network, according to one aspect of the present disclosure. Referring to Figures 1 to 40, in one aspect, the present disclosure provides a central surgical controller 206 comprising a storage device 248, a processor 244 coupled to storage device 248 and a memory 249 coupled to processor 244. Memory 249 stores instructions executable by processor 244 to receive 4322 data from a surgical instrument 235 and determine 4324 a speed at which to transfer data to a cloud-based remote medical analysis network 204 based on the storage capacity available from storage device 248 Optionally, memory 249 stores instructions executable by processor 244 to determine 4326 a frequency at which to transfer data to the cloud-based remote medical analysis network 204 based on the available storage capacity of storage device 248. Optionally, memory 249 stores instructions executable by processor 244 to detect the downtime of the central surgical controller network and determine 4326 a frequency at which to transfer data to the cloud-based remote medical analysis network 204 based on the detected downtime of the central surgical controller network 206. Optionally, memory 249 stores instructions executable by processor 244 to determine 4328 a data type for transferring data to a cloud-based remote medical analysis network 204 based on the inclusion or exclusion of data associated with a user, patient or surgical procedure .
[0341] [0341] In another aspect, memory 249 stores instructions executable by processor 244 to receive new operating parameters for the central surgical controller 206 or surgical instrument 235.
[0342] [0342] Situational perception is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from databases and / or instruments. The information may include the type of procedure being performed, the type of tissue being operated on or the body cavity that is the target of the procedure. With contextual information related to the surgical procedure, the surgical system can, for example, improve the way in which it controls the modular devices (for example, a robotic arm and / or robotic surgical instrument) that are connected to it and provide information or contextualized suggestions to the surgeon during the course of the surgical procedure.
[0343] [0343] Now with reference to Figure 41, a 5200 timeline represents the situational perception of a central controller, such as the central surgical controller 106 or 206, 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 the 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 of the patient to an operating room. postoperative recovery.
[0344] [0344] 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 operating room 106 , 206. Central surgical controller 106, 206 can receive this data from the paired modular devices and other data sources and continuously derives 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 perception system of the central surgical controller 106, 206 is able, for example, to record data related to the procedure to generate reports, to verify the steps being taken by medical personnel, to provide data or warnings (for example, through a display) 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 of a ultrasonic surgical instrument or RF electrosurgical instrument), and take any other action described above.
[0345] [0345] In the first step 5202, in this illustrative procedure, members of the hospital team retrieve the electronic patient record (PEP) from the hospital's PEP database. Based on patient selection data in the PEP, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.
[0346] [0346] In the second step 5204, the team members scan the incoming medical supplies for the procedure. 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 supply mix 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 wedge procedure or, otherwise, that inlet supplies do not correspond to a thoracic wedge procedure).
[0347] [0347] 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.
[0348] [0348] In the fourth step 5208, the medical staff 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 modular devices can automatically pair with the central surgical controller 106, 206 which is located within a specific neighborhood of modular devices as part of their 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 that 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 patient's electronic medical record
[0349] [0349] 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 central surgical controller 106, 206. As central surgical controller 106, 206 begins to receive data from patient monitoring devices, central surgical controller 106, 206 thus confirming that the patient is in the operating room.
[0350] [0350] In the sixth step 5212, the 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 of themselves, 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.
[0351] [0351] 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. Central surgical controller 106, 206 can infer that the operative portion of the procedure started when it can compare the detection of the patient's lung collapse at the expected stages of the procedure (which can be accessed or retrieved earlier) and thus determine that the retraction of the patient lung is the first operative step in this specific procedure.
[0352] [0352] 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 in relation to visualizing the patient's anatomy, monitoring the number or medical imaging devices being used (ie, which are activated and paired with the operating room 106, 206), and monitoring the types of visualization devices used. For example, a technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient's chest cavity above the diaphragm, while a technique for performing a VATS segmentectomy places the camera in an anterior intercostal position in relation to the segment fissure. With the use of standard recognition or machine learning techniques, for example, the situational perception system can be trained to recognize the positioning of the medical imaging device according to the visualization of the patient's anatomy. As another example, a technique for performing a VATS lobectomy uses a single medical imaging device, while another technique for performing a VATS segmentectomy uses multiple cameras. As yet another example, a technique for performing a VATS segmentectomy uses an infrared light source (which can be communicably coupled to the central surgical controller as part of the visualization system) to visualize the segment crack, which is not used in a VATS lobectomy. By tracking any or all of these data from the medical imaging device, the central surgical controller 106, 206 can thus determine the specific type of surgical procedure being performed and / or the technique being used for a specific type of procedure surgical.
[0353] [0353] 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 fired. The 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 being fired at that point in the process (that is, after the completion of the previously discussed steps of the procedure) corresponds to the step of dissection. In certain cases, the energy instrument may be a power tool mounted on a robotic arm in a robotic surgical system.
[0354] [0354] 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.
[0355] [0355] 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 segmentectomy portion of the procedure is being performed.
[0356] [0356] 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 switch between surgical stapling / cutting instruments and surgical energy instruments (that is, RF or ultrasonic) depending on the specific step in the procedure because different instruments are better adapted for specific tasks. Therefore, the specific sequence in which the cutting / stapling instruments and surgical energy instruments are used can indicate which stage 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 portable surgical instruments can be used for one or more steps in the surgical procedure. The surgeon can switch between robotic tools and portable 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.
[0357] [0357] In the thirteenth step 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 (i.e., the patient's respiratory rate begins to increase), for example.
[0358] [0358] Finally, in the fourteenth step 5228 is that medical personnel remove the various patient monitoring devices from the patient. 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 communicably coupled to the central surgical controller 106, 206.
[0359] [0359] Situational perception is further described in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, 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 perception and / or feedback from its components and / or based on information from the cloud
[0360] [0360] In one aspect, the present disclosure features a central surgical controller comprising: a processor; and a memory attached to the processor, the memory stores instructions executable by the processor to: interrogate a surgical instrument, the surgical instrument being a first source of patient data; retrieving a first set of data from the surgical instrument, the first set of data being associated with a patient and a surgical procedure; interrogating a medical imaging device, the medical imaging device being a second source of patient data; recovering a second set of data from the medical imaging device, the second set of data being associated with the patient and a result of the surgical procedure; associate the first and second data sets with a key; and transmitting the first and second data sets associated with the remote network outside the central surgical controller.
[0361] [0361] In another aspect, the present disclosure provides a central surgical controller comprising: a processor; and a memory coupled to the processor, the memory stores instructions executable by the processor to: receive a first data packet from a first source, the first data packet comprising a first preamble, a first data payload, a source the first data payload and a first encryption certificate, the first preamble defining the first data payload and the first encryption certificate verifies the authenticity of the first data packet; receive a second data packet from a second source, the second data packet comprising a second preamble, a second data payload, a source of the second data payload and a second encryption certificate, the second preamble defines the second data payload and the second encryption certificate verifies the authenticity of the second data packet; associate the first and second data packets; and generating a third data packet comprising the first and second data payloads. The present disclosure additionally provides a central surgical controller, in which the memory stores instructions executable by the processor to: determine that a data payload comes from a new source; verify the new source of the data payload; and changing a data collection process at the central surgical controller to receive subsequent data packets from the new source. The present disclosure additionally provides a central surgical controller in which the memory stores instructions executable by the processor to associate the first and second data packets based on a key. The present disclosure additionally provides a central surgical controller in which the memory stores instructions executable by the processor to anonymize the anonymized data payload of the third data packet. The present disclosure additionally provides a central surgical controller, the memory stores instructions executable by the processor to receive a third anonymized data packet and to reintegrate the third anonymized data packet into the first and second data packets using the key. The present disclosure additionally provides a control circuit to perform any of the above-mentioned functions and / or a non-transitory, computer-readable medium that stores computer-readable instructions that, when executed, cause a machine to perform any of the above-mentioned functions. .
[0362] [0362] In another aspect, the present disclosure provides a central surgical controller configured to communicate with a surgical instrument, the central surgical controller comprising: a processor; and a memory coupled to the processor, the memory stores instructions executable by the processor to: receive a first set of data associated with a surgical procedure, the first set of data being generated in a first time; receiving a second set of data associated with the effectiveness of the surgical procedure, the second set of data being generated in a second stage, the second stage being separate and distinct from the first stage; anonymize the first and second data sets by removing information that identifies a patient, a surgery or a scheduled surgery time; and storing the first and second anonymized data sets to generate a pair of data grouped by surgery. The present disclosure additionally provides a central surgical controller, the memory stores instructions executable by the processor to reconstruct a series of chronological events based on the data pair. The present disclosure additionally provides a central surgical controller, the memory stores instructions executable by the processor to reconstruct a series of coupled but unrestricted data sets based on the data pair. The present disclosure additionally provides a central surgical controller and the memory stores instructions executable by the processor to: encrypt the data pair; define a backup format for the data pair; and mirror the data pair on a cloud storage device. The present disclosure additionally provides a control circuit to perform any of the aforementioned functions and / or a non-transitory, computer-readable medium that stores computer-readable instructions that, when executed, cause a machine to perform any of the functions mentioned above. .
[0363] [0363] In another aspect, the present disclosure provides a central surgical controller which comprises: a storage device; a processor coupled to the storage device; and a memory coupled to the processor, the memory stores instructions executable by the processor to: receive data from a surgical instrument; determine a speed at which to transfer data to a remote cloud-based medical analysis network based on the available storage capacity of the storage device; determine a frequency at which to transfer data to the cloud-based remote medical analysis network based on the available storage capacity of the storage device or the detected downtime of the surgical controller's network; and determining a data type to transfer data to a remote, cloud-based medical analysis network based on the inclusion or exclusion of data associated with a user, patient, or surgical procedure. The present disclosure additionally provides a central surgical controller, the memory stores instructions executable by the processor to receive new operating parameters for the central surgical controller or the surgical instrument. The present disclosure additionally provides a control circuit to perform any of the aforementioned functions and / or a non-transitory, computer-readable medium that stores computer-readable instructions that, when executed, cause a machine to perform any of the functions mentioned above. .
[0364] [0364] In another aspect, the present disclosure provides a central surgical controller that comprises: a control configured to: receive data from a surgical instrument; determine a speed at which to transfer data to a remote cloud-based medical analysis network based on the available storage capacity of the storage device; determine a frequency at which to transfer data to the cloud-based remote medical analysis network based on the available storage capacity of the storage device or the detected downtime of the surgical controller's network; and determining a data type to transfer data to a remote, cloud-based medical analysis network based on the inclusion or exclusion of data associated with a user, patient, or surgical procedure.
[0365] [0365] Various aspects of the subject described in this document are defined in the following numbered examples.
[0366] [0366] Example 1. A central surgical controller configured to communicate with a surgical instrument, the central surgical controller comprising: a processor and a memory attached to the processor, the memory storing instructions executable by the processor to: receive a first set of data associated with a surgical procedure, with the first set of data being generated in a first step; receiving a second set of data associated with the effectiveness of the surgical procedure, the second set of data being generated in a second stage, the second stage being separate and distinct from the first stage; anonymize the first and second data sets by removing information that identifies a patient, a surgery or a scheduled surgery time; and storing the first and second anonymized data sets to generate a pair of data grouped by surgery.
[0367] [0367] Example 2. The central surgical controller of Example 1, the memory stores instructions executable by the processor to reconstruct a series of chronological events based on the data pair.
[0368] [0368] Example 3. The central surgical controller of any of examples 1 to 2, the memory stores instructions executable by the processor to reconstruct a series of coupled, but not restricted, data sets, based on the data pair.
[0369] [0369] Example 4. The central surgical controller of any of Examples 1 to 3, the memory stores instructions executable by the processor to: encode the data pair; define a backup format for the data pair; and mirror the data pair on a cloud storage device.
[0370] [0370] Example 5. A central surgical controller configured to communicate with a surgical instrument, the central surgical controller comprising: a control circuit configured to: receive a first set of data associated with a surgical procedure, the first being data set is generated at first; receiving a second set of data associated with the effectiveness of the surgical procedure, the second set of data being generated in a second stage, the second stage being separate and distinct from the first stage; anonymize the first and second data sets by removing information that identifies a patient, a surgery or a scheduled surgery time; and storing the first and second anonymized data sets to generate a pair of data grouped by surgery.
[0371] [0371] Example 6. The central surgical controller in Example 5, the control circuit being additionally configured to reconstruct a series of chronological events based on the data pair.
[0372] [0372] Example 7. The central surgical controller of any of Examples 5 to 6, the control circuit being additionally configured to reconstruct a series of coupled, but not restricted, data sets, based on the data pair.
[0373] [0373] Example 8. The central surgical controller of any of Examples 5 to 7, the control circuit being additionally configured to: encrypt the data pair; define a backup format for the data pair; and mirror the data pair on a cloud storage device.
[0374] [0374] Example 9. A non-transitory, computer-readable medium that stores computer-readable instructions that, when executed, make a machine: receive a first set of data associated with a surgical procedure, the first set of data being generated in a first moment; receiving a second set of data associated with the effectiveness of the surgical procedure, the second set of data being generated in a second stage, the second stage being separate and distinct from the first stage; anonymize the first and second data sets by removing information that identifies a patient, a surgery or a scheduled surgery time; and storing the first and second anonymized data sets to generate a pair of data grouped by surgery.
[0375] [0375] Example 10. The non-transitory, computer-readable media of Example 9, which stores computer-readable instructions that, when executed, cause a machine to reconstruct a series of chronological events based on the data pair.
[0376] [0376] Example 11. The central surgical controller of any of Examples 9 to 10, which stores computer-readable instructions that, when executed, cause a machine to reconstruct a series of coupled, but not restricted, data sets based on in the data pair.
[0377] [0377] Example 12. The central surgical controller of any of Examples 9 to 11, which stores computer-readable instructions that, when executed, make the machine: encrypt the data pair; define a backup format for the data pair; and mirror the data pair on a cloud storage device.
[0378] [0378] Example 13. A central surgical controller comprising: a processor; and a memory attached to the processor, the memory stores instructions executable by the processor to: interrogate a surgical instrument, the surgical instrument being a first source of patient data; retrieving a first set of data from the surgical instrument, the first set of data being associated with a patient and a surgical procedure; interrogating a medical imaging device, the medical imaging device being a second source of patient data; recovering a second set of data from the medical imaging device, the second set of data being associated with the patient and a result of the surgical procedure; associate the first and second data sets with a key; and transmitting the first and second data sets associated with the remote network outside the central surgical controller.
[0379] [0379] Example 14. The central surgical controller of Example 13, the memory stores instructions executable by the processor to: retrieve the first set of data using the key; anonymize the first data set by removing patient information from the first data set; retrieve the second data set using the key; anonymize the second data set by removing patient information from the second data set; pair the first and second anonymized data sets; and determining the success rates of surgical procedures grouped by the surgical procedure based on the first and second anonymized paired data sets.
[0380] [0380] Example 15. The central surgical controller of any of Examples 13 to 14, the memory stores instructions executable by the processor to: retrieve the first set of anonymized data; retrieve the second set of anonymized data; and reintegrate the first and second anonymized data sets using the key.
[0381] [0381] Example 16. The central surgical controller of any of Examples 13 to 15, the first and second data sets defining a first and a second data payload in the respective first and second data packets.
[0382] [0382] Example 17. The central surgical controller of any of Examples 13 to 16, the memory stores instructions executable by the processor to retrieve information from a database of electronic medical records.
[0383] [0383] Example 18. The central surgical controller of any of Examples 13 to 17, the memory stores instructions executable by the processor to anonymize the information retrieved from the electronic medical records database by removing patient information from the information retrieved from the database of electronic medical records.
[0384] [0384] Although various forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the claims attached to such detail. Numerous modifications, variations, alterations, substitutions, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. In addition, the structure of each element associated with the shape can alternatively be described as a means of providing the function performed by the element. In addition, where materials are revealed for certain components, other materials can be used. It should be understood, therefore, that the preceding description and the appended claims are intended to cover all these modifications, combinations and variations that fall within the scope of the modalities presented. The attached claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.
[0385] [0385] 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 virtually any combination thereof. Those skilled in the art will recognize, however, that some aspects of the aspects disclosed herein, in whole or in part, can be implemented in an equivalent manner in integrated circuits, such as one or more computer programs running 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 of them, 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 disclosure. 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.
[0386] [0386] 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 through other computer-readable media. Thus, 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, read-only compact disc ( CD-ROMs), and optical-dynamos discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), cards magnetic or optical, 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 propagation signals (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).
[0387] [0387] 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 comprising 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 field programmable port arrangement (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-chip system (SoC ) desktop computers, laptop computers, tablet computers, servers, smart headsets, etc. Consequently, 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 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 executes 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 here), 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 key, or eq 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.
[0388] [0388] 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 may 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.
[0389] [0389] 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.
[0390] [0390] 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 the appropriate physical quantities and are merely convenient identifications applied to these quantities and / or states.
[0391] [0391] A network may include a packet-switched network. Communication devices may be able to communicate with each other using a selected packet switched network communications protocol. An exemplary communications protocol may include an Ethernet communications protocol that may be able to allow communication using a transmission control protocol / Internet protocol (TCP / IP). The Ethernet protocol can conform to or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) entitled "EEE 802.3 Standard", published in December 2008 and / or later versions of this standard. Alternatively or in addition, communication devices may be able to communicate with each other using an X.25 communications protocol. Can the X.25 communications protocol conform or be compatible ! with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or in addition, communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol can conform to or be compatible with a standard promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, transceivers may be able to communicate with each other using an ATM communication protocol ("asynchronous transfer mode"). The ATM communication protocol can conform to or be compatible with an ATM standard published by the ATM forum entitled "ATM-MPLS Network Interworking 2.0" published in August 2001, and / or later versions of that standard. Obviously, different and / or post-developed connection-oriented network communication protocols are also contemplated in the present invention.
[0392] [0392] Unless otherwise stated, as is evident from the foregoing disclosure, it is understood that, throughout the preceding disclosure, 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 manipulates and transforms the data represented in the form of physical (electronic) quantities in records and memories of the computing system in other data represented in a similar way in the form of physical quantities in the memories or records of the computing system, or in other storage, transmission or display devices of similar information.
[0393] [0393] One or more components in the present invention may be called "configured for", "configurable for", "operable / operational for", "adapted / adaptable for", "capable of",
[0394] [0394] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of the 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 the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[0395] [0395] Persons skilled in the art will recognize that, in general, the terms used here, and especially in the appended claims (for example, bodies of the appended claims) are generally intended as "open" terms (for example, 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 is not limited 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 entered to claims that contain only such a 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.
[0396] [0396] 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, 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 where a convention analogous to "at least one of 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 have 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, any of the terms or both terms, except where the context dictates something different. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "AeB".
[0397] [0397] With respect to the attached claims, those skilled in the art will understand that the operations mentioned in them 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 such alternative orderings may include overlapping, merged, interrupted, reordered, incremental, preparatory, supplementary, simultaneous, inverse or other variant orders, unless the context otherwise requires. In addition, terms such as "responsive to", "related to" or other adjectival participles are not intended in general to exclude these variants, unless the context otherwise requires.
[0398] [0398] 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 feature, structure or feature 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 does not necessarily refer the same aspect. In addition, specific resources, structures or characteristics can be combined in any appropriate way in one or more aspects.
[0399] [0399] 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, to the extent that the materials incorporated are not inconsistent with that. Accordingly, and to the extent necessary, the disclosure as explicitly presented herein replaces any conflicting material incorporated by reference to the present invention. Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other disclosure materials contained herein, will be incorporated here only to the extent that there is no conflict between the embedded material and existing disclosure material.
[0400] [0400] In short, 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 (18)
[1]
1. Central surgical controller configured to communicate with a surgical instrument, characterized by comprising: a processor; and a memory attached to the processor, the memory stores instructions executable by the processor to: receive a first set of data associated with a surgical procedure, the first set of data being generated in a first moment; receiving a second set of data associated with the efficacy of the surgical procedure, with the second set of data being generated in a second moment, the second moment being separate and distinct from the first moment; anonymize the first and second data sets by removing information that identifies a patient, surgery, or a scheduled surgery time; and storing the first and second anonymous data sets to generate a pair of data grouped by surgery.
[2]
Central surgical controller according to claim 1, characterized in that the memory stores instructions executable by the processor to reconstruct a series of chronological events based on the data pair.
[3]
Central surgical controller according to claim 2, characterized in that the memory stores instructions executable by the processor to reconstruct a series of paired but not restricted data sets based on the data pair.
[4]
Central surgical controller according to claim 2, characterized in that the memory stores instructions executable by the processor to:
encrypt the data pair; define a backup format for the data pair; and mirror the data pair on a cloud storage device.
[5]
5. Central surgical controller configured to communicate with a surgical instrument, characterized by comprising: a control circuit configured to: receive a first set of data associated with a surgical procedure, the first set of data being generated in a first moment ; receiving a second set of data associated with the efficacy of the surgical procedure, with the second set of data being generated in a second moment, the second moment being separate and distinct from the first moment; anonymize the first and second data sets by removing information that identifies a patient, surgery, or a scheduled surgery time; and storing the first and second anonymous data sets to generate a pair of data grouped by surgery.
[6]
Central surgical controller according to claim 5, characterized in that the control circuit is additionally configured to reconstruct a series of chronological events based on the data pair.
[7]
Central surgical controller, according to claim 5, characterized in that the control circuit is additionally configured to reconstruct a series of coupled but not restricted data sets, based on the data pair.
[8]
Central surgical controller according to claim 5, characterized in that the control circuit is additionally configured to: encrypt the data pair; define a backup format for the data pair; and mirror the data pair on a cloud storage device.
[9]
9. Non-transient, computer-readable media characterized by storing computer-readable instructions that, when executed, make a machine: receive a first set of data associated with a surgical procedure, the first set of data being generated in a first moment; receiving a second set of data associated with the efficacy of the surgical procedure, with the second set of data being generated in a second moment, the second moment being separate and distinct from the first moment; anonymize the first and second data sets by removing information that identifies a patient, surgery, or a scheduled surgery time; and storing the first and second anonymous data sets to generate a pair of data grouped by surgery.
[10]
10. Computer readable non-transitory media according to claim 9, characterized by storing computer-readable instructions that, when executed, cause a machine to reconstruct a series of chronological events based on the data pair.
[11]
11. Central surgical controller, according to claim 9, characterized by storing computer-readable instructions that, when executed, cause a machine to reconstruct a series of paired, but not restricted, data sets based on the data pair.
[12]
12. Central surgical controller, according to claim 9, characterized by storing computer-readable instructions that, when executed, make a machine: encrypt the data pair; define a backup format for the data pair; and mirror the data pair on a cloud storage device.
[13]
13. Central surgical controller, characterized by comprising: a processor; and a memory attached to the processor, the memory stores instructions executable by the processor to: interrogate a surgical instrument, the surgical instrument being a first source of patient data; retrieving a first set of data from the surgical instrument, the first set of data being associated with a patient and a surgical procedure; interrogating a medical imaging device, the medical imaging device being a second source of patient data; retrieving a second set of data from the medical imaging device, the second set of data being associated with the patient and a result of the surgical procedure; associate the first and second data sets using a key; and transmitting the first and second data sets associated with a remote network outside the central surgical controller.
[14]
14. Central surgical controller, according to claim 13, characterized in that the memory stores instructions executable by the processor to: retrieve the first data set using the key; anonymize the first data set by removing patient information from the first data set; retrieve the second data set using the key; anonymize the second data set by removing patient information from the second data set; pair the first and second anonymized data sets; and determining the success rates of surgical procedures grouped by the surgical procedure based on the first and second paired anonymized data sets.
[15]
15. Central surgical controller, according to claim 13, characterized in that the memory stores instructions executable by the processor to: recover the first set of anonymized data; retrieve the second set of anonymized data; and reinstate the first and second anonymized data sets using the key.
[16]
Central surgical controller according to claim 13, characterized in that the first and second data sets define a first and a second data payload in the respective first and second data packets.
[17]
17. Central surgical controller, according to claim 13, characterized in that the memory stores instructions executable by the processor to retrieve information from a database of electronic medical records.
[18]
18. Central surgical controller, according to claim 13, characterized in that the memory stores instructions executable by the processor to anonymize the information collected from the electronic medical records database by removing patient information from the information retrieved from the base data from electronic medical records.

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同族专利:

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公开号 | 公开日

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

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

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