surgical network recommendations based on real-time analysis of procedure variables in relation to a

专利摘要:
The present invention relates to systems and methods that provide recommendations based on the analysis of surgical procedure variables. A computer system, such as a central surgical controller, can be configured to be communicably coupled to a surgical device. The computer system can be programmed to determine the contextual data related to the surgical procedure being performed based, at least in part, on the perioperative data received from the surgical device paired with the computer system. In addition, the computer system can determine a procedure variable associated with the determined surgical context and then compare the procedure variable with a baseline. Depending on the result of the comparison, the computer system can provide post- or intraoperative recommendations to the surgical team.
公开号:BR112020013177A2
申请号:R112020013177-6
申请日:2018-11-14
公开日:2020-12-01
发明作者:Frederick E. Shelton Iv；Jason L. Harris；Taylor W. Aronhalt
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] The present application claims the priority benefit of the non-provisional US patent application Serial No. 16 / 182,290, entitled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE
[0002] [0002] The present application claims priority under code 35 U.S.C. $ 119 (e) to provisional US patent application No. 62 / 729.191, entitled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A
[0003] [0003] The present application claims priority under 35 U.S.C. $ 119 (e) to provisional patent application No. 62 / 692,747, entitled
[0004] [0004] This application claims priority under 35 USC8 119 (e) of US provisional patent application No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, the description of which is incorporated in this document reference title in its entirety.
[0005] [0005] The present application also claims priority under 35 U.S.C. $ 119 (e) of US provisional patent application No. 62 / 650,898 filed on March 30, 2018, entitled CAPACITIVE
[0006] [0006] The present application also claims priority under 35 US $ 119 (e) of US provisional patent application Serial No. 62/640 417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018 , and provisional US patent application Serial No. 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018, the respective description of which is hereby incorporated by reference, in its wholeness.
[0007] [0007] The present application also claims the priority provided under title 35 of the USC (United States Code), $ 119 (e) of US provisional patent application Serial No. 62 / 611.341, entitled "INTERACTIVE SURGICAL PLATFORM", filed on December 28, 2017, from US provisional patent application Serial No. 62 / 611,340, entitled "CLOUD-BASED MEDICAL ANALYTICS", filed on December 28, 2017, and from US provisional patent application Serial No. 62 / 611,339 , entitled "ROBOT ASSISTED SURGICAL PLATFORM", filed on December 28, 2017, with the description of each of them in this document incorporated by reference, in its entirety. BACKGROUND
[0008] [0008] The present description refers to several surgical systems. Surgical procedures are typically performed in theaters or surgical operating rooms in a health care facility, such as a hospital. A sterile field is typically created around the patient. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area. Various surgical devices and systems are used to perform a surgical procedure. SUMMARY
[0009] [0009] In a general aspect, a computer system configured to be communicatively coupled to a surgical device. The computer system comprises a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to: receive perioperative data from the surgical device; determine a surgical context based, at least in part, on perioperative data; determine a procedure variable associated with the surgical context; compare the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and provide a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable.
[0010] [0010] In another general aspect, a method implemented by computer to provide recommendations associated with a surgical procedure, the method comprising: receiving, through a computer system, perioperative data from a surgical device; determine, through the computer system, a surgical context based, at least in part, on perioperative data; determine, through the computer system, a procedure variable associated with the surgical context; compare, through the computer system, the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and providing, through the computer system, a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable.
[0011] [0011] In yet another general aspect, a computer system configured to be communicatively coupled to a surgical device and a video camera. The computer system comprises a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to: record a surgical procedure using the video camera; receive perioperative data from the surgical device; determine a surgical context based, at least in part, on perioperative data; determine a procedure variable associated with the surgical context; compare the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and repeat a recording of the surgical procedure, the recording including a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable. FIGURES
[0012] [0012] The various aspects in this document described, both with regard to 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.
[0013] [0013] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present description.
[0014] [0014] Figure 2 is a surgical system that is used to perform a surgical procedure in an operating room, in accordance with at least one aspect of the present description.
[0015] [0015] Figure 3 is a central surgical controller paired with a visualization system, a robotic system, and an intelligent instrument, in accordance with at least one aspect of the present description.
[0016] [0016] Figure 4 is a partial perspective view of a central surgical controller housing, and of a generator module in combination received slidingly in a central surgical controller housing, in accordance with at least one aspect of the present description.
[0017] [0017] Figure 5 is a perspective view of a generator module in combination with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present description.
[0018] [0018] Figure 6 illustrates different power bus connectors for a plurality of side coupling ports of a side modular cabinet configured to receive a plurality of modules, according to at least one aspect of the present description.
[0019] [0019] Figure 7 illustrates a vertical modular housing configured to receive a plurality of modules, in accordance with at least one aspect of the present description.
[0020] [0020] Figure 8 illustrates a surgical data network comprising a modular communication center configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a utility facility especially equipped for surgical operations, to the cloud, in accordance with at least one aspect of the present description.
[0021] [0021] Figure 9 illustrates an interactive surgical system implemented by computer, in accordance with at least one aspect of the present description.
[0022] [0022] Figure 10 illustrates a central surgical controller that comprises a plurality of modules coupled to the modular control tower, in accordance with at least one aspect of the present description.
[0023] [0023] Figure 11 illustrates an aspect of a universal serial bus (USB) central network controller device, in accordance with at least one aspect of the present description.
[0024] [0024] Figure 12 is a block diagram of a cloud computing system that comprises a plurality of intelligent surgical instruments coupled to central surgical controllers that can connect to the cloud component of the cloud computing system, according to the least one aspect of the present description.
[0025] [0025] Figure 13 is a functional module architecture of a cloud computing system, according to at least one aspect of the present description.
[0026] [0026] Figure 14 illustrates a diagram of a surgical system with situational recognition, according to at least one aspect of the present description.
[0027] [0027] Figure 15 is a timeline that represents the situational recognition of a central surgical controller, according to at least one aspect of the present description.
[0028] [0028] Figure 16 is a logical flowchart for a process of providing surgical recommendations, in accordance with at least one aspect of the present description.
[0029] [0029] Figure 17 is a series of graphic displays of a video feed of a surgeon dissecting a vessel to present for transection, in accordance with at least one aspect of the present description.
[0030] [0030] Figure 18 is a graphical user interface for reproducing a surgical procedure, in accordance with at least one aspect of the present description.
[0031] [0031] Figure 19 is a graphical user interface for viewing a recommendation associated with a surgical procedure and its underlying historical data, in accordance with at least one aspect of the present description. DESCRIPTION
[0032] [0032] The applicant for this application holds the following US patent applications, filed on November 6, 2018, with the description of each in this document incorporated by reference, in its entirety: and US patent application No. 16 / 182.224, entitled SURGICAL NETWORK, INSTRUMENT, AND CLOUD RESPONSES
[0033] [0033] The applicant for the present application holds the following US patent applications filed on September 10, 2018, with the description of each in this document incorporated by reference, in its entirety:
[0034] [0034] The applicant for this application holds the following US patent applications, filed on August 28, 2018, with the description of each in this document incorporated by reference in its entirety for reference: and US patent application No. 16 / 115,214, entitled
[0035] [0035] The applicant for this application holds the following US patent applications filed on August 23, 2018, with the description of each in this document incorporated by reference in its entirety for reference: and provisional US patent application No. 62 / 721,995, entitled - CONTROLLING AN ULTRASONIC - SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION; and US provisional patent application No. 62 / 721,998, entitled SITUATIONAL / AWARENESS OF ELECTROSURGICAL SYSTEMS; and US Provisional Patent Application No. 62 / 721,999, entitled INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING; and US Provisional Patent Application No. 62 / 721,994, entitled BIPOLAR COMBINATION DEVICE THAT
[0036] [0036] The applicant for the present application holds the following US patent applications, filed on June 30, 2018, with the description of each of them in this document incorporated by reference in its entirety: and provisional patent application US No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE; and US Provisional Patent Application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE; and and US provisional patent application No. 62 / 692,768, entitled SMART ENERGY DEVICES.
[0037] [0037] The applicant for this application holds the following US patent applications, filed on June 29, 2018, the description of each of which is incorporated herein by reference in its entirety for reference in its entirety: and —US patent application Serial No. 16 / 024.090, entitled
[0038] [0038] The applicant for the present application holds the following provisional US patent applications, filed on June 28, 2018, the description of each of which is incorporated by reference in its entirety for reference in its entirety: and provisional patent application US Serial No. 62 / 691,228, entitled A Method of using reinforced flex circuits with multiple sensors with electrosurgical devices; and —US provisional patent application Serial No. 62 / 691.227, entitled controlling a surgical instrument according to sensed closure parameters; and —US Provisional Patent Application Serial No. 62 / 691,230, entitled - SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE; and —US Provisional Patent Application Serial No. 62 / 691,219, entitled - SURGICAL - EVACUATION SENSING AND MOTOR CONTROL; and US provisional patent application Serial No. 62 / 691,257, entitled COMMUNICATION OF SMOKE EVACUATION
[0039] [0039] The applicant for the present application holds the following provisional US patent applications, filed on April 19, 2018, the description of each of which is incorporated by reference in its entirety for reference, in its entirety: e — patent application US Provisional Serial No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[0040] [0040] The applicant for the present application holds the following provisional US patent applications, filed on March 30, 2018, the description of each of which is incorporated by reference in its entirety for reference in its entirety: and provisional patent application US Serial No. 62 / 650,898, filed March 30, 2018, entitled
[0041] [0041] The applicant for this application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety for reference in its entirety: and —US patent application Serial No. 15 / 940,641, entitled INTERACTIVE - SURGICAL SYSTEMS WITH —ENCRYPTED COMMUNICATION CAPABILITIES;
[0042] [0042] The applicant for the present application holds the following provisional US patent applications, filed on March 28, 2018, the description of each of which is incorporated by reference in its entirety for reference in its entirety: and provisional patent application US No. 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 No. 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS; and —US Provisional Patent Application Serial No. 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER; and US Provisional Patent Application No. 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; and US provisional patent application No. 62 / 649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;
[0043] [0043] The applicant for the present application holds the following provisional US patent applications, filed on March 8, 2018, the description of each of which is incorporated by reference in its entirety for reference in its entirety: and provisional patent application US Serial No. 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and e — US Provisional Patent Application Serial No. 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[0044] [0044] The applicant for the present application holds the following provisional US patent applications, filed on December 28, 2017, the description of each of which is incorporated by reference in its entirety for reference in its entirety: e — provisional patent application US Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM; and —US provisional patent application Serial No. 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and e — US Provisional Patent Application Serial No. 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[0045] [0045] 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. Central Surgical Controllers
[0046] [0046] With reference to Figure 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (for example, cloud 104 which may include a remote server 113 coupled to a 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 smart handheld surgical instrument 112, which are configured to communicate with one another and / or the central controller 106. In some respects, a surgical system 102 may include a number of central controllers M 106, an N number of visualization systems 108, an O number of robotic systems 110, and a P number of smart, hand-held surgical instruments 112, where M, N, O, and P are whole numbers greater than or equal to one.
[0047] [0047] Figure 2 represents an example of a surgical system 102 being used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in the surgical procedure as part of the surgical system 102. The robotic system 110 includes a surgeon console 118, a patient carriage 120 (surgical robot), and a robotic central surgical controller 122. The patient carriage 120 can handle at least one attached surgical tool removably 117 through a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. An image of the surgical site can be obtained by a medical imaging device 124, which can be manipulated by car 120 to guide imaging device 124. Robotic central surgical controller 122 can be used to process surgical site for subsequent display to the surgeon through the surgeon's console 118.
[0048] [0048] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present description are described in provisional patent application Serial No. 62 / 611.339 , entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the description of which is hereby incorporated by reference in its entirety for reference.
[0049] [0049] Various examples of cloud-based analysis that are performed by the cloud 104, and are suitable for use with the present description, are described in US provisional patent application Serial No. 62 / 611.340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, the description of which is hereby incorporated by reference, in its entirety.
[0050] [0050] In several aspects, the imaging device 124 includes at least one Image sensor and one or more optical components. Suitable image sensors include, but are not limited to, load-coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.
[0051] [0051] 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.
[0052] [0052] 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 "An eye typical human will respond to wavelengths in the air that are from about 380 nm to about 750 nm.
[0053] [0053] 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.
[0054] [0054] 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 description 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.
[0055] [0055] In one aspect, the imaging device uses 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 No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is in the present document incorporated 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.
[0056] [0056] 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.
[0057] [0057] In several 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 shown in Figure 2. In one aspect, the display system 108 includes an interface for HL7, PACS and EMR. Various components of the 108 display system are described under the heading "Advanced Imaging Acquisition Module" in US provisional patent application Serial No. 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is in this document incorporated as a reference in its entirety.
[0058] [0058] 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.
[0059] [0059] In one aspect, 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.
[0060] [0060] With reference to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system 102. The central controller 106 is also configured to coordinate the flow of information to a screen of the surgical instrument 112. For example, the flow of coordinated information is further described in US provisional patent application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the content of which is incorporated in this document as a reference in its entirety. An entry or diagnostic feedback inserted by a non-sterile operator in the viewing tower 111 can be routed by the central controller 106 to the surgical instrument screen 115 in the sterile field, where it can be seen by the surgical instrument operator 112. Exemplary surgical instruments that are suitable for use with surgical system 102 are described under the heading "Hardware of Surgical Instruments" in US provisional patent application Serial No. 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is in the present document incorporated as a reference, in its entirety, for example.
[0061] [0061] 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 smart handheld surgical instrument 112. The central controller 106 includes a central controller screen 135, an imaging module 138, a generator module 140 (which may include a monopolar generator 142, a bipolar generator 144 and / or an ultrasonic generator 143), a communication module 130, a processor module 132 and a storage matrix 134. In certain aspects, as illustrated in Figure 3, the central controller 106 additionally includes a smoke evacuation module 126, a suction / irrigation module 128 and / or an OR 133 mapping module.
[0062] [0062] During a surgical procedure, the application of energy to the tissue, for sealing and / or cutting, is generally associated with the evacuation of smoke, suction of excess fluid and / or irrigation of the tissue. Fluid, power, and / or data lines from different sources are often intertwined during the surgical procedure. Valuable time can be wasted in addressing this issue during a surgical procedure. To untangle the lines, it may be necessary to disconnect the lines from their respective modules, which may require a restart of the modules. The modular housing of the central controller 136 offers a unified environment for managing power, data and fluid lines, which reduces the frequency of entanglement between such lines.
[0063] [0063] Aspects of the present description feature a central surgical controller for use in a surgical procedure that involves applying energy to the tissue at a surgical site. The central surgical controller includes a central controller housing and a combination generator module received slidably at a central controller housing docking station. The docking station includes data and power contacts. The combined generator module includes two or more of an ultrasonic energy generating component, a bipolar RF energy generating component, and a monopolar RF energy generating component 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.
[0064] [0064] 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 in a sliding manner in the central controller housing. In one aspect, the central controller housing comprises a fluid interface.
[0065] [0065] 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 description present a solution in which a modular housing of central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the central modular housing 136 is that it allows quick removal and / or replacement of several modules.
[0066] [0066] Aspects of the present description present a modular surgical wrap for use in a surgical procedure that involves applying energy to the tissue. The modular surgical housing includes a first energy generator module, configured to generate a first energy for application to the tissue, and a first docking station that comprises a first docking port that includes first data and energy contacts, the first module being The power generator is slidingly movable in an electric 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.
[0067] [0067] In addition to the above, the modular surgical enclosure also includes a second energy generator module configured to generate a second energy, different from the first energy, for application to the tissue, and a second docking station 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.
[0068] [0068] 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.
[0069] [0069] With reference to Figures 3 to 7, aspects of the present description are presented for a modular housing of the central controller 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126, and a suction module / irrigation 128. The central modular housing 136 further facilitates interactive communication between modules 140, 126, 128. As shown in Figure 5, generator module 140 can be a generator module with integrated monopoly, bipolar and ultrasonic components, supported in a single cabinet unit 139 slidably insertable into the central modular housing 136. As shown in Figure 5, generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147 and an ultrasonic device 148. Alternatively, generator module 140 may comprise a series of monopolar, bipolar and / or ultrasonic generator modules that interact through the mod shell central ular 136. The central modular enclosure 136 can be configured to facilitate the insertion of multiple generators and interactive communication between the generators anchored in the central modular enclosure 136 so that the generators would act as a single generator.
[0070] [0070] In one aspect, the central modular housing 136 comprises a modular power and a back communication board 149 with external and wireless communication heads to allow removable fixing of modules 140, 126, 128 and interactive communication between them.
[0071] [0071] In one aspect, the central modular housing 136 includes docking stations, or drawers, 151, in this document also called drawers, which are configured to slide modules 140, 126, 128 in a sliding manner. Figure 4 illustrates a partial perspective view of a central surgical controller housing 136, and a combined generator module 145 slidably received at a docking station 151 of the central surgical controller housing 136. A docking port 152 with power and data contacts in a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the central housing modular housing 136 as the combined generator module 145 is slid into position in the corresponding docking station 151 of the modular housing of the central controller 136. In one aspect, the generator module with binado 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.
[0072] [0072] In several respects, the smoke evacuation module 126 includes a fluid line 154 that carries captured / collected fluid smoke 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 housing 136.
[0073] [0073] 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.
[0074] [0074] 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.
[0075] [0075] The irrigation tube can be in fluid communication with a fluid source, and the suction tube can be in fluid communication with a vacuum source. The fluid source and / or the vacuum source can be housed in the suction / irrigation module 128. In one example, the fluid source and / or the vacuum source can be housed in the central controller housing 136 separately from the control module. suction / irrigation 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.
[0076] [0076] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the central modular housing 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts at the stations coupling module of the central modular housing 136. For example, as shown in Figure 4, the combined generator module 145 includes side brackets 155 which are configured to slide the corresponding brackets 156 of the corresponding docking station 151 of the central modular housing 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 housing 136.
[0077] [0077] In some respects, the drawers 151 of the central modular housing 136 are the same, or substantially the same size, and the modules are scaled to be received in the drawers
[0078] [0078] In addition, the contacts of a specific module can be switched to engage with the contacts of a specific drawer to avoid inserting a module in a drawer with unpaired contacts.
[0079] [0079] As shown in Figure 4, the docking port 150 of one drawer 151 can be coupled to the docking port 150 of another drawer 151 via a communication link 157 to facilitate interactive communication between the modules housed in the central modular housing 136. The coupling ports 150 of the central modular enclosure 136 can, alternatively or additionally, facilitate interactive wireless communication between the modules housed in the central modular enclosure 136. Any suitable wireless communication can be used, such as Air Titan Bluetooth.
[0080] [0080] Figure 6 illustrates individual power bus connectors for a plurality of side coupling ports of a side modular compartment 160 configured to receive a plurality of modules from a central surgical controller 206. Side 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 160. Alternatively, modules 161 can be arranged vertically in a side modular cabinet.
[0081] [0081] Figure 7 illustrates a vertical modular cabinet 164 configured to receive a plurality of modules 165 from the central surgical 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 164. In the example in Figure 7, a screen 177 is provided to show data relevant to the operation of modules 165. In addition, the vertical modular compartment 164 includes a master module 178 which houses a plurality of submodules that are received slidingly in the master module 178.
[0082] [0082] 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.
[0083] [0083] During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or other light source may be inefficient. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present description is configured to allow the replacement of a light source module or a "midstream" camera module during a surgical procedure, without the need to remove the imaging device from the surgical field.
[0084] [0084] 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.
[0085] [0085] 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.
[0086] [0086] Various image processors and imaging devices suitable for use with the present description are described in US patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, granted on August 9, 2011 which is hereby incorporated as a title reference in its entirety. In addition, US patent No. 7,982,776, entitled SBIl MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued July 19, 2011, which is incorporated herein by reference in its entirety for reference, describes various systems for removing motion artifacts image data. Such systems can be integrated with imaging module 138. In addition to these, the publication of US patent application No. 2011/0306840, entitled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS, published on December 15, 2011, and the publication of the application for US Patent No. 2014/0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published on August 28, 2014, which are each incorporated herein by reference in their entirety for reference.
[0087] [0087] Figure 8 illustrates a surgical data network 201 comprising a modular communication center 203 configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a utility facility. specially equipped for surgical operations, to a cloud-based system
[0088] [0088] Modular devices 1a to 1n located in the operating room can be coupled to the modular communication center 203. The central network controller 207 and / or the network switch 209 can be coupled to a network router 211 to connect the devices 1a to 1n to the cloud 204 or to the local computer system 210. The data associated with devices 1a to 1n can be transferred to cloud-based computers through the router for remote data processing and manipulation. The data associated with devices 1a to 1h can also be transferred to the local computer system 210 for processing and manipulation of the local data. Modular devices 2a to 2m located in the same operating room can also be attached to a network switch 209. The network switch 209 can be attached to the central network controller 207 and / or to network router 211 to connect devices 2a 2m to cloud 204. The data associated with devices 2a to 2n can be transferred to cloud 204 via network router 211 for data processing and manipulation. The data associated with devices 2a to 2m can also be transferred to the local computer system 210 for processing and manipulation of the local data.
[0089] [0089] It will be understood that the surgical data network 201 can be expanded by interconnecting multiple central network controllers 207 and / or multiple network keys 209 with multiple network routers 211. The modular communication center 203 may be contained in a modular control roaster configured to receive multiple devices 1a to 1n / 2a to 2m. The local computer system 210 can also be contained in a modular control tower. The modular communication center 203 is connected to a screen 212 to display the images obtained by some of the devices 1a to 1n / 2a to 2m, for example, during surgical procedures. In several respects, devices 1a to 1n / 2a to 2m 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 center 203 of the surgical data network 201.
[0090] [0090] In one aspect, the surgical data network 201 may comprise a combination of central network controllers,
[0091] [0091] The application of cloud computer data processing techniques to the data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs, and better patient satisfaction.
[0092] [0092] In an implementation, operating room devices 1a to 1n can be connected to the modular communication center 203 via a wired channel or a wireless channel depending on the configuration of devices 1a to 1n on a central network controller . The central network controller 207 can be implemented, in one aspect, as a LAN transmission device that acts on the physical layer of the open system interconnection model ("OSI" - open system interconnection). The central network controller provides connectivity to devices 1a to 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends it to the router in half - duplex mode. The central network controller 207 does not store any media access control / Internet protocol (MACY / IP) to transfer data from the device. Only one of the devices 1a to 1n at a time can send data through the central network controller 207. The central network controller 207 does not have routing tables or intelligence about where to send information and transmits all network data through each connection and to a remote server 213 (Figure 9) in the cloud 204. The central network controller 207 can detect basic network errors, such as collisions, but having all (admit that) the information transmitted to multiple input ports can be a security risk and cause bottlenecks.
[0093] [0093] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 through a wired or wireless channel. The network key 209 works in the data connection layer of the OSI model. The network 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. Network key 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.
[0094] [0094] The central network controller 207 and / or network key 209 are coupled to network router 211 for a connection to the cloud 204. Network router 211 works on the network layer of the OSI model. The network router 211 creates a route to transmit data packets received from the central network controller 207 and / or the network key 211 to a computer with cloud resources for future processing and manipulation of the data collected by any of all or all of the devices 1a to 1n / 2a to 2m. The network router 211 can be used to connect two or more different networks located in different locations, such as different operating rooms in the same health care facility or different networks located in different operating rooms of different service facilities of health. Network router 211 sends data in packet form to cloud 204 and works in full duplex mode. Multiple devices can send data at the same time. Network router 211 uses | P addresses to transfer data.
[0095] [0095] 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.
[0096] [0096] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the modular communication center 203 via standard Bluetooth wireless technology for exchanging data over short distances (using short-wavelength UHF radio waves in the ISM band of 2.4 to 2.485 GHz) from fixed and mobile devices and to build personal area networks ("PANS" - personal area networks). operation 1a to 1n / 2a to 2m can communicate with the modular communication center 203 via 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, long-term evolution ("LTE" - long-term evolution), and Ev-DO, HSPA +, HSDPA +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and derived from them, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond m. 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.
[0097] [0097] The modular communication center 203 can serve as a central connection for one or all devices in the operating room 1a to 1n / 2a to 2m and handles a type of data known as frames. The tables carry the data generated by the devices
[0098] [0098] The modular communication center 203 can be used as a standalone device or be connected to compatible central network controllers and network switches to form a larger network. The modular communication center 203 is, in general, easy to install, configure and maintain, making it a good option for the network of devices 1a to 1n / 2a to 2m from the operating room.
[0099] [0099] 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 interactive surgical system implemented by computer 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one central surgical controller 206 in communication with a cloud 204 which may include a remote server 213. In one aspect , the computer-implemented interactive surgical system 200 comprises a modular control tower 236 connected to multiple operating room devices such as, for example, smart surgical instruments, robots and other computerized devices located in the operating room. As shown in Figure 10, the modular control tower 236 comprises a modular communication center 203 coupled to a computer system 210. As illustrated in the example in Figure 9, the modular control tower 236 is coupled to an imaging module 238 that it is coupled to an endoscope 239, a generator module 240 that is coupled to a power device 241, a smoke evacuation module 226, a suction / irrigation module 228, a communication module 230, a processor module 232, a matrix storage device 234, an intelligent device / instrument 235 optionally coupled to a screen 237 and a non-contact sensor module 242. Operating room devices are coupled with cloud computing resources and data storage via the modular control tower 236. The robotic central controller 222 can also be connected to the modular control tower 236 and cloud computing resources. Devices / Instruments 235, display systems 208, among others, can be coupled to the modular control tower 236 by means of wired or wireless communication standards or protocols, as described in the present invention. The modular control tower 236 can be coupled to a central controller screen 215 (for example, monitor, screen) to display and overlay images received from the imaging module, device / instrument screen and / or other display systems 208. A The central controller screen can also display data received from devices connected to the modular control tower in conjunction with images and overlapping images.
[0100] [0100] 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 modular communication center 203, for example, a network connectivity device, and a computer system 210 for providing local processing, visualization, and imaging, for example. As shown in Figure 10, the modular communication center 203 can be connected in a layered configuration to expand the number of modules
[0101] [0101] The central surgical controller 206 uses a non-contact sensor module 242 to measure the dimensions of the operating room and generate a map of the operating room using non-contact measuring devices such as laser or ultrasonic. An ultrasound-based non-contact sensor module scans the operating room by transmitting an ultrasound explosion and receiving the echo when it bounces off the perimeter of the operating room walls, as described under the heading Surgical Hub Spatial Awareness Within an Operating Room "in provisional US patent application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is hereby incorporated 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 walls. perimeter 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.
[0102] [0102] 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.
[0103] [0103] 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.
[0104] [0104] 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.
[0105] [0105] 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).
[0106] [0106] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, for example disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card or memory stick (pen drive). 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 device (CD-ROM) disc drive recordable compact disc (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a versatile digital disk 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.
[0107] [0107] It is to be understood that computer system 210 includes software that acts as an intermediary between users and the basic computer resources described in a suitable operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from the management capabilities of the operating system through program modules and “program data stored in system memory or on the storage disk. It is to be understood that the various components described in the present invention can be implemented with various operating systems or combinations of operating systems.
[0108] [0108] A user enters commands or information into computer system 210 through the input device (s) coupled to the 1 / 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.
[0109] [0109] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. Remote cloud computers can be a personal computer, server, router, personal network computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include many or all elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system via a network interface and then physically connected via a communication connection. The network interface covers communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include fiber distributed data interface (FDDI), copper distributed data interface (CDDI), Ethernet / IEEE 802.3, Token ring / IEEE 802.5 and the like. WAN technologies include, but are not limited to, point-to-point links, circuit switching networks such as digital integrated service networks (ISDN) and variations in them, packet switching networks and digital subscriber lines (DSL).
[0110] [0110] 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, image processing engine, media processor, or any specialized digital signal processor (DSP) used for processing digital images. The image processor can use parallel computing with multi-data single instruction (SIMD) or multiple data multi-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.
[0111] [0111] Communication connections refer to the hardware / software used to connect the network interface to the bus. Although the communication connection is shown for illustrative clarity within the computer system, it can also be external to 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.
[0112] [0112] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 central network controller device, in accordance with at least one aspect of the present description. In the illustrated aspect, the USB 300 central network controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The USB 300 core network controller is a CMOS device that provides one USB transceiver port 302 and up to three USB transceiver ports downstream 304, 306, 308 in accordance with the USB 2.0 specification. Upstream USB transceiver port 302 is a differential data root port comprising a "minus" differential data input (DMO) paired with a "plus" differential data input (DPO0). 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) .
[0113] [0113] 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 central network controller device can be configured in bus powered or self powered mode and includes 312 central power logic to manage power.
[0114] [0114] The USB 300 central network controller device includes a 310 series interface motor (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 repeating circuit 318 of the central controller to control communication between the upstream USB transceiver port 302 and the downstream USB transceiver 304, 306, 308 through the logic circuits of ports 320, 322, 324. The SIE 310 is coupled to a command decoder 326 through logic interface 328 to control the commands of a serial EEPROM via an interface 330 series EEPROM.
[0115] [0115] 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 transceiver port 302 is plugged into a USB host controller, and the USB transceiver ports downstream 304, 306, 308 are exposed to connect compatible USB devices, and so on.
[0116] [0116] Additional details regarding the structure and function of the central surgical controller and / or networks of central surgical controllers can be found in US provisional patent application No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018 , which is incorporated herein by reference, in its entirety. Cloud system hardware and functional modules
[0117] [0117] Figure 12 is a block diagram of the interactive surgical system implemented by computer, according to at least one aspect of the present description. In one aspect, the computer-implemented interactive surgical system is configured to monitor and analyze data related to the operation of various surgical systems that include central surgical controllers, surgical instruments, robotic devices, and operating rooms or healthcare facilities. The computer-implemented interactive surgical system comprises a cloud-based data analysis system. Although the cloud-based data analysis system is described as a surgical system, it is not necessarily limited with such and could be a cloud-based medical system in general. As shown in Figure 12, the cloud-based data analysis system comprises a plurality of surgical instruments 7012 (may be the same or similar to instruments 112), a plurality of central surgical controllers 7006 (may be the same or similar to central controllers 106 ) and a surgical data network 7001 (can be the same or similar to network 201) to couple central surgical controllers 7006 to cloud 7004 (can be the same or similar to cloud 204). Each of the plurality of central surgical controllers 7006 is communicatively coupled to one or more surgical instruments 7012. Central controllers 7006 are also communicably coupled to the cloud 7004 of the interactive surgical system implemented by computer over the 7001. network. 7004 is a remote centralized source of hardware and software for storing, manipulating and communicating data generated based on the operation of various surgical systems. As shown in Figure 12, access to the 7004 cloud is achieved through the 7001 network, which can be the Internet or some other suitable computer network. Central surgical controllers 7006 that are coupled to the 7004 cloud can be considered the client side of the cloud computing system (ie, cloud-based data analysis system). Surgical instruments 7012 are paired with central surgical controllers 7006 for control and implementation of various surgical operations or procedures as described in this document.
[0118] [0118] In addition, surgical instruments 7012 may comprise transceivers for transmitting data to and from their corresponding central surgical controllers 7006 (which may also comprise transceivers). Combinations of instruments - surgical 7012 and corresponding central controllers 7006 can indicate specific locations, such as operating rooms in health posts (for example, hospitals), to provide medical operations. For example, the memory of a central surgical controller 7006 can store location data. As shown in Figure 12, cloud 7004 comprises central servers 7013 (which can be the same or similar to remote server 113 in Figure 1 and / or remote server 213 in Figure 9), application servers for central controllers 7002, analysis modules data 7034 and an input / output interface ("I / O") 7007. Central servers 7013 of the cloud 7004 collectively administer the cloud computing system, which includes monitoring requests by central client controllers 7006 and managing the capacity of 7004 cloud processing to execute requests. The central servers 7013 each comprise one or more processors 7008 coupled to suitable memory devices 7010 which may include volatile memory, such as random access memory (RAM), and non-volatile memory such as magnetic storage devices. The 7010 memory devices can comprise machine executable instructions that, when executed, cause the 7008 processors to run the 7034 data analysis modules for cloud-based data analysis, operations, recommendations and other operations described below. In addition, 7008 processors can run data analysis modules 7034 independently or in conjunction with controller applications - independently central - run by central controllers 7006. Central servers 7013 also comprise aggregated medical databases 2212, which can reside in memory 2210.
[0119] [0119] Based on connections to several 7006 surgical centers via the 7001 network, the 7004 cloud can aggregate data from specific data generated by various 7012 surgical instruments and their corresponding 7006 central controllers. Such aggregated data can be stored in the aggregated medical data databases 7011 of the cloud 7004. In particular, the cloud 7004 can advantageously perform data analysis and operations on the aggregated data to produce insights and / or perform functions that the individual central controllers 7006 they couldn't reach on their own.
[0120] [0120] The configuration of the specific cloud computing system described in this description is designed specifically to address various issues raised in the context of medical operations and procedures performed using medical devices, such as surgical instruments 7012, 112. In particular, surgical instruments 7012 can be digital surgical devices configured to interact with the 7004 cloud to implement techniques to improve the performance of surgical operations. Various surgical instruments 7012 and / or central surgical controllers 7006 can comprise touch-controlled user interfaces, so that clinicians can control aspects of interaction between surgical instruments 7012 and the cloud 7004. Other user interfaces suitable for control, such as interfaces controlled by auditory alert, can also be used.
[0121] [0121] Figure 13 is a block diagram that illustrates the functional architecture of the interactive surgical system implemented by computer, in accordance with at least one aspect of the present description. The cloud-based data analysis system includes a plurality of 7034 data analysis modules that can be run by the 7008 cloud 7004 processors to provide analytical data solutions for problems that arise specifically in the medical field. As shown in Figure 13, the functions of the 7034 cloud-based data analysis modules can be supported through applications for central controllers 7014 hosted by the application servers for central controllers 7002 that can be accessed on central surgical controllers 7006. cloud computing 7008 and applications for central controllers 7014 can operate together to perform 7034 data analysis modules. 7016 application program interfaces ("API") define the set of protocols and routines that correspond to applications for central controllers 7014. In addition, APIs 7016 manage the storage and retrieval of data in / from the aggregated medical data databases 7011 for the operations of 7014 applications. 7018 cache memories also store data (for example, temporarily ) and are coupled to APIs 7016 for more efficient recovery of data the ones used by the 7014 applications. The data analysis modules 7034 in Figure 13 include modules for resource optimization 7020, data collection and aggregation 7022, authorization and security 7024, updating 7026 control programs, analyzing patient results 7028, recommendations 7030 and classification and prioritization of data 7032. Other suitable data analysis modules could also be implemented by the 7004 cloud, according to some aspects. In one respect, data analysis modules are used for specific recommendations based on analysis of trends, results and other data.
[0122] [0122] For example, the 7022 data collection and aggregation module could be used to generate self-describing data (for example, metadata), including the identification of notable features or configuration (for example, trends), the management of data sets redundant data storage in paired data sets that can be grouped by surgery, but not necessarily switched to surgical dates and to actual surgeons. In particular, paired data sets generated from operations of the 7012 surgical instruments may comprise application of a binary classification, for example, a bleeding or non-bleeding event. More generally, the binary classification can be characterized as a desirable event (for example, a successful surgical procedure) or an undesirable event (for example, a surgical instrument with failure or misuse 7012). The aggregated self-describing data can correspond to individual data received from various groups or subgroups of central surgical controllers 7006. Consequently, the 7022 data collection and aggregation module can manage aggregated metadata or other data organized based on raw data received from the central surgical controllers.
[0123] [0123] The resource optimization module 7020 can be configured to analyze this aggregated data to determine an optimal use of resources for a specific group or group of health posts. For example, the resource optimization module 7020 can determine an ideal ordering point for surgical stapling instruments 7012 for a group of clinics based on the corresponding expected demand for such instruments
[0124] [0124] The 7028 patient results analysis module can analyze surgical results associated with currently used operating parameters of 7012 surgical instruments. The 7028 patient results analysis module can also analyze and evaluate other potential operational parameters. In this context, the 7030 recommendations module could recommend the use of these other potential operating parameters based on obtaining better surgical results, such as better sealing or less bleeding. For example, the 7030 recommendation module could transmit recommendations to a central surgical controller 7006 on when to use a particular cartridge for a corresponding 7012 stapling surgical instrument. In this way, the cloud-based data analysis system, while controlling common variables, can be configured to analyze the large collection of raw data and provide centralized recommendations on multiple health posts (advantageously determined based on aggregated data). For example, the cloud-based data analysis system could analyze, evaluate and / or aggregate data based on the type of medical practice, type of patient, number of patients, geographical similarity between medical providers, which providers / medical posts use types similar instruments, etc., in a way that no health post alone would be able to analyze independently.
[0125] [0125] The 7026 control program update module can be configured to implement various instrument recommendations - surgical 7012 when the corresponding control programs are updated. For example, the Patient Results Analysis Module 7028 could identify correlations that link specific control parameters with successful (or unsuccessful) results. These correlations can be addressed when updated control programs are transmitted to 7012 surgical instruments via the 7026 control program update module. Updates to 7012 instruments that are transmitted via a corresponding central controller 7006 can incorporate aggregated performance data that has been gathered and analyzed by the cloud data collection and aggregation module 7022
[0126] [0126] The cloud-based data analysis system can include safety features implemented by the 7004 cloud. These safety features can be managed by the authorization and safety module 7024. Each central surgical controller
[0127] [0127] In addition, for security purposes, the cloud could maintain a database of 7006 central controllers, 7012 instruments and other devices that may comprise a "black list" of prohibited devices. In particular, a blacklisted central surgical controller 7006 may not be allowed to interact with the cloud, while blacklisted 7012 surgical instruments may not have functional access to a corresponding 7006 central controller and / or may be prevented from functioning fully when paired with its corresponding central controller 7006. In addition or alternatively, cloud 7004 can signal instruments 7012 based on incompatibility or other specified criteria. In this way, counterfeit medical devices and inappropriate reuse of such devices throughout the cloud-based data analysis system can be identified and addressed.
[0128] [0128] 7012 surgical instruments can use wireless transceivers to transmit wireless signals that can represent, for example, authorization credentials to access the corresponding central controllers 7006 and the 7004 cloud. Wired transceivers can also be used to transmit signals.
[0129] [0129] The cloud-based data analysis system can allow monitoring of multiple health posts (for example, medical posts such as hospitals) to determine improved practices and recommend changes (through the 2030 recommendations module, for example) accordingly . In this way, processors 7008 from the 7004 cloud can analyze the data associated with an individual health clinic to identify the health clinic and aggregate the data with other data associated with other health clinics in a group. Groups could be defined based on similar operating practices or geographic location, for example. In this way, the 7004 cloud can provide analysis and recommendations for the entire group of health posts. The cloud-based data analysis system could also be used to increase situational awareness. For example, 7008 processors can predictively model the effects of recommendations on cost and effectiveness for a specific post (in relation to general operations and / or various medical procedures). The cost and effectiveness associated with that specific station can also be compared to a corresponding local region of other stations or any other comparable stations.
[0130] [0130] The 7032 data classification and prioritization module can prioritize and classify data based on severity (for example, the severity of a medical event associated with the data, unpredictability, distrust). This classification and prioritization can be used in conjunction with the functions of the other 7034 data analysis modules described above to improve the operation and cloud-based data analysis described in this document. For example, the 7032 data classification and prioritization module can assign a priority to the data analysis performed by the 7022 data collection and aggregation module and the 7028 patient outcome analysis module. Different levels of prioritization can result in specific responses from the 7004 cloud (corresponding to a level of urgency), such as escalation to an accelerated response, special processing, exclusion of aggregated medical databases 7011 or other appropriate responses. In addition, if necessary, the 7004 cloud can transmit a request (for example, a push message) through the application servers to central controllers for additional data from corresponding 7012 surgical instruments. The push message may result in a notification displayed on the corresponding 7006 central controllers to request support or additional data. This push message may be necessary in situations where the cloud detects an irregularity or results outside significant limits and the cloud cannot determine the cause of the irregularity. Central 7013 servers can be programmed to activate this push message in certain significant circumstances, such as when data is determined to be different from an expected value beyond a predetermined threshold or when it appears that security has been compounded, for example.
[0131] [0131] Additional details related to the cloud data analysis system can be found in US provisional patent application No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, which is hereby incorporated as a title reference, in its entirety. Situational recognition
[0132] [0132] Although a "smart" device, including control algorithms responsive to detected data, may be an improvement over a "stupid" device that operates without taking the detected data, some detected data can be incomplete or inconclusive when considered in isolation, that is, without the context of the type of surgical procedure being performed or the type of tissue that is undergoing the surgery.
[0133] [0133] One solution uses a central surgical controller including a system configured to derive information about the surgical procedure being performed based on data received from various data sources, and then control, accordingly, the paired - modular devices . In other words, the central surgical controller is configured to infer information about the surgical procedure from received data and then control modular devices paired with the central surgical controller based on the inferred context of the surgical procedure. Figure 14 illustrates a diagram of a surgical system with 5100 situational recognition, in accordance with at least one aspect of the present description. In some examples, data sources 5126 include, for example, modular devices 5102 (which may include sensors configured to detect parameters associated with the patient and / or the modular device itself), databases 5122 (for example, a base EMR data containing the patient's medical record), and 5124 monitoring devices (for example, a blood pressure monitor (BP) and an electrocardiography monitor (ECG)).
[0134] [0134] A 5104 central surgical controller that can be similar to surgical controller 106 in many ways, can be configured to derive contextual information related to the surgical procedure from data based, for example, on the combination (s) specific data (s) received or in the specific order in which data is received from data sources 5126. Contextual information inferred from data received may include, for example, the type of surgical procedure being performed, the specific stage of the surgical procedure that the surgeon is performing, the type of tissue being operated on, or the body cavity that is the object of the procedure. This ability for some aspects of the central surgical controller 5104 to derive or infer information related to the surgical procedure from received data, can be called "situational perception." In one example, the central surgical controller 5104 can incorporate a situational perception system, which is the hardware and / or programming associated with the central surgical controller 5104 that derives contextual information related to the surgical procedure based on the data received.
[0135] [0135] The situational perception system of the central surgical controller 5104 can be configured to derive contextual information from data received from data sources 5126 in several ways. In one example, the situational awareness system includes a pattern recognition system, or machine learning system (for example, an artificial neural network), that has been trained in training data to correlate various inputs (for example, data from databases 5122, patient monitoring devices 5124, and / or modular devices - 5102) to corresponding contextual information regarding a surgical procedure. In other words, a machine learning system can be trained to accurately derive contextual information regarding a surgical procedure from the inputs provided. In another example, the situational perception system may include a lookup table that stores pre-characterized contextual information regarding a surgical procedure in association with one or more entries (or ranges of entries) corresponding to the contextual information. In response to a query with one or more entries, the lookup table can return the corresponding contextual information to the situational perception system to control modular devices 5102. In an example, the contextual information received by the surgical controller's situational perception system central 5104, are associated with a specific control setting or set of control settings for one or more 5102 modular devices. In another example, the situational awareness system includes an additional machine learning system, research table, or other such system type, generating or retrieving one or more control settings for one or more 5102 modular devices, when contextual information is provided as input.
[0136] [0136] A 5104 central surgical controller, which incorporates a situational awareness system, provides several benefits to the 5100 surgical system. One benefit includes improving the interpretation of detected and captured data, which in turn improves processing accuracy and / or the use of data during the course of a surgical procedure. To return to an earlier example, a 5104 central surgical controller with situational awareness could determine what type of tissue was being operated on; therefore, when an unexpectedly high force is detected to close the end actuator of the surgical instrument, the central surgical controller with situational perception 5104 could correctly accelerate or decelerate the surgical instrument motor for the tissue type.
[0137] [0137] As another example, the type of tissue being operated on may affect the adjustments that are made to the load and compression rate thresholds of a stapling and surgical cutting instrument for a specific span measurement. A central surgical controller with situational perception 5104 could infer whether a surgical procedure being performed is a thoracic or abdominal procedure, allowing the central surgical controller 5104 to determine whether tissue pinched by an end actuator of the surgical cutting and stapling instrument it is lung tissue (for a chest procedure) or stomach tissue (for an abdominal procedure). The central surgical controller 5104 can then properly adjust the loading and compression rate thresholds of the surgical stapling and cutting instrument for the tissue type.
[0138] [0138] As yet another example, the type of body cavity being operated during an insufflation procedure, can affect the function of a smoke evacuator. A central surgical controller with situational perception 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure is using insufflation) and determine the type of procedure. As a type of procedure is usually performed in a specific body cavity, the 5104 central surgical controller can then adequately control the speed of the smoke evacuator motor to the body cavity being operated. Thus, a central surgical controller with situational awareness! 5104 can provide a consistent amount of smoke evacuation to both thoracic and abdominal procedures.
[0139] [0139] As yet another example, the type of procedure being performed can affect the ideal energy level for an ultrasonic surgical instrument or radio frequency electrosurgical instrument (RF) to operate. Arthroscopic procedures, for example, require higher energy levels because the end actuator of the ultrasonic surgical instrument or RF electrosurgical instrument is immersed in fluid. A central surgical controller with situational perception 5104 can determine whether the surgical procedure is an arthroscopic procedure. The central surgical controller 5104 can then adjust the RF power level or the ultrasonic amplitude of the generator (i.e., the "energy level") to compensate for the fluid-filled environment. Related to this, the type of tissue being operated on can affect the ideal energy level at which an ultrasonic surgical instrument or RF electrosurgical instrument operates. A central surgical controller with situational awareness 5104 can determine what type of surgical procedure is being performed and then customize the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument, respectively, according to the tissue profile expected for the surgical procedure. In addition, a central surgical controller equipped with 5104 situational awareness can be configured to adjust the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than just on a procedure-by basis. -procedure. A central surgical controller with situational perception 5104 can determine which stage of the surgical procedure is being performed or will be performed subsequently and then update the control algorithms for the generator and / or ultrasonic surgical instrument or RF electrosurgical instrument to adjust the level of energy in an appropriate value for the type of tissue, according to the stage of the surgical procedure.
[0140] [0140] As yet another example, data can be extracted from additional data sources 5126 to improve the conclusions that the central surgical controller 5104 draws from a 5126 data source. A central surgical controller with situational perception 5104 can augment the data that it receives from modular devices 5102 with contextual information it has accumulated, referring to the surgical procedure, from other data sources 5126. For example, a central surgical controller with situational perception 5104 can be configured to determine whether hemostasis has occurred (ie , if bleeding stopped at a surgical site), according to video or image data received from a medical imaging device. However, in some cases, video or image data may be inconclusive. Therefore, in one example, the 5104 central surgical controller can be additionally configured to compare a physiological measurement (for example, blood pressure detected by a BP monitor communicatively connected to the 5104 central surgical controller) with the visual or image data of hemostasis (for example, from a Medical Imaging device 124 (Figure 2) coupled communicably to the central surgical controller 5104) to make a determination on the integrity of the staple line or tissue union. In other words, the situational perception system of the central surgical controller 5104 can consider the physiological measurement data to provide additional context in the analysis of the visualization data. The additional context can be useful when the visualization data can be inconclusive or incomplete in itself.
[0141] [0141] Another benefit includes proactively and automatically controlling paired modular devices 5102, according to the specific stage of the surgical procedure being performed to reduce the number of times medical personnel are required to interact with or control the 5100 surgical system during the course of a surgical procedure. For example, a central surgical controller with 5104 situational awareness can proactively activate the generator to which an RF electrosurgical instrument is connected, if it is determined that a subsequent step in the procedure requires the use of the instrument. Proactively activating the power source allows the instrument to be ready for use as soon as the preceding step of the procedure is complete.
[0142] [0142] As another example, a central surgical controller with situational perception 5104 could determine whether the current or subsequent stage of the surgical procedure requires a different view or degree of magnification of the screen, according to the resource (s) in the surgical site that the surgeon is expected to see. The central surgical controller 5104 could then proactively change the displayed view (provided, for example, by a Medical Imaging device to the visualization system 108), so that the screen automatically adjusts throughout the surgical procedure.
[0143] [0143] As yet another example, a central surgical controller with situational perception 5104 could determine which stage of the surgical procedure is being performed or will be performed subsequently and whether specific data or comparisons between the data will be required for that stage of the surgical procedure. The central surgical controller 5104 can be configured to call screens automatically based on data about the stage of the surgical procedure being performed, without waiting for the surgeon to request specific information.
[0144] [0144] Another benefit includes checking for errors during the configuration of the surgical procedure or during the course of the surgical procedure. For example, a central surgical controller with 5104 situational awareness could determine whether the operating room is properly or ideally configured for the surgical procedure to be performed. Central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding checklists, product location, or configuration needs (for example, from a memory), and then compare O current operating room layout with the standard layout for the type of surgical procedure that the 5104 central surgical controller determines is being performed. In one example, the central surgical controller 5104 can be configured to compare the list of items for the procedure scanned by a suitable CT scanner 5132, for example and / or a list of devices paired with the central surgical controller 5104, with a recommended manifest or advance of items and / or devices for the given surgical procedure. If there are any discontinuities between the lists, the central surgical controller 5104 can be configured to provide an alert indicating that a specific modular device 5102, patient monitoring device 5124 and / or other surgical item is missing. In one example, the central surgical controller 5104 can be configured to determine the position or relative distance of modular devices 5102 and patient monitoring devices 5124 using proximity sensors, for example. The 5104 central surgical controller can compare the relative positions of the devices with a recommended or anticipated layout for the specific surgical procedure. If any - any discontinuities between the layouts, the 5104 central surgical controller can be configured to provide an alert indicating that the current layout for the surgical procedure deviates from the recommended layout.
[0145] [0145] As another example, the central surgical controller with situational awareness 5104 could determine whether the surgeon (or other medical personnel) was making a mistake or otherwise deviating from the expected course of action during the course of a procedure surgical. For example, the central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding list of steps or order of use of the equipment (for example, from a memory), and then compare the steps being performed or the equipment being used during the course of the surgical procedure with the steps or equipment expected for the type of surgical procedure that the 5104 central surgical controller determined is being performed. In one example, the central surgical controller 5104 can be configured to provide an alert indicating that an unexpected action is being taken or an unexpected device is being used at the specific stage in the surgical procedure.
[0146] [0146] In general, the situational perception system for the central surgical controller 5104 improves the results of the surgical procedure by adjusting surgical instruments (and other 5102 modular devices) to the specific context of each surgical procedure (such as adjusting to different types tissue), and when validating actions during a surgical procedure. The situational perception system also improves the surgeon's efficiency in performing surgical procedures by automatically suggesting the next steps, providing data, and adjusting screens and other 5102 modular devices in the operating room, according to the specific context of the procedure.
[0147] [0147] With reference now to Figure 15, a time line 5200 is shown representing the situational recognition of a central controller, such as the central surgical controller 106 or 206 (Figures 1 to 11), for example. Timeline 5200 is an illustrative surgical procedure and the contextual information that the central surgical controller 106, 206 can derive from data received from data sources at each stage in the surgical procedure. Timeline 5200 represents 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.
[0148] [0148] 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 paired modular devices and other data sources and continuously derive inferences (ie, contextual information) about the ongoing procedure as new data is received, such as which stage of the procedure. procedure is being performed at any given time. The situational recognition system of the central surgical controller 106, 206 is capable of, for example, recording data related to the procedure to generate reports, checking the steps being taken by medical personnel, providing 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.
[0149] [0149] In the first step 5202, in this illustrative procedure, members of the hospital team retrieve the patient's electronic medical 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.
[0150] [0150] 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).
[0151] [0151] In the third step 5206, the medical staff scans 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 .
[0152] [0152] In the fourth step 5208, the medical personnel turns on the auxiliary equipment. The auxiliary equipment being used may vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment that is 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 electronic patient record (PEP), the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the central controller, the central surgical controller 106, 206 can, in general , infer the specific procedure that the surgical team will perform. After the central surgical controller 106, 206 recognizes which specific procedure is being performed, the central surgical controller 106, 206 can then retrieve the steps of that process from a memory or from the cloud and then cross the data it subsequently receives from the connected data sources (for example, modular devices and patient monitoring devices) to infer which stage of the surgical procedure the surgical team is performing.
[0153] [0153] 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.
[0154] [0154] In the sixth step 5212, medical personnel induced anesthesia in the patient. Central surgical controller 106, 206 can infer that the patient is under anesthesia based on data from modular devices and / or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations 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.
[0155] [0155] 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.
[0156] [0156] In the eighth step 5216, the medical imaging device (for example, a display device) is inserted and the video from the medical imaging device is started. Central surgical controller 106, 206 receives data from the medical imaging device (i.e., video or image data) through its connection to the medical imaging device. Upon receipt of data from the medical imaging device, the central surgical controller 106, 206 can determine that the portion of the laparoscopic surgical procedure has started. In addition, the central surgical controller 106, 206 can determine that the specific procedure being performed is a segmentectomy, rather than a lobectomy (note that a wedge procedure has already been discarded by the central surgical controller 106, 206 based on the data received in the second step 5204 of the procedure). The medical imaging device data 124 (Figure 2) can be used to determine contextual information about the type of procedure being performed in a number of different ways, including by determining the angle at which the medical imaging device is oriented in regarding visualization of the patient's anatomy, monitor the number or medical imaging devices being used (ie, which are activated and paired with the operating room 106, 206), and monitor 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 recognition 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 communicated 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.
[0157] [0157] 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.
[0158] [0158] 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.
[0159] [0159] 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.
[0160] [0160] 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 cutting / stapling instruments and surgical energy instruments are used can indicate which step of the procedure the surgeon is performing. In addition, in certain cases, robotic tools can be used for one or more steps in a surgical procedure and / or Hand held surgical instruments can be used for one or more steps in the surgical procedure. The surgeon can switch between robotic tools and hand-held surgical instruments and / or can use the devices simultaneously, for example. After the completion of the twelfth stage 5224, the incisions are closed and the post-operative portion of the process begins.
[0161] [0161] 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.
[0162] [0162] 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 controller central surgery 106, 206.
[0163] [0163] Situational recognition is further described in US provisional patent application Serial No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, which is incorporated herein by reference in its entirety for reference. In certain cases, the operation of a robotic surgical system, including the various robotic surgical systems described in this document, for example, can be controlled by the central controller 106, 206 based on its situational recognition and / or feedback from its components and / or based on information from the cloud 104. Recommendations from the analysis of procedure variables
[0164] [0164] In several respects, computer systems, such as central surgical controllers 106, 206 described in connection with Figures 1 to 11, can be programmed to compare variables associated with a particular surgical procedure with data sets that are collected and aggregated by individual central surgical controllers, networks of central surgical controllers, cloud computing systems described under the title CLOUD
[0165] [0165] As described above under the heading "CENTRAL SURGICAL CONTROLLERS", computer systems, such as central surgical controllers 106, 206 (Figures 1 to 11), can be connected or paired with a variety of surgical devices, such as surgical instruments , generators, smoke evacuators, screens, and so on. Through their connections to these surgical devices, the central surgical controllers 206 can receive an array of perioperative data from these paired surgical devices while the devices are in use during a surgical procedure. Additionally, as described above under the heading SITUATIONAL RECOGNITION, central surgical controllers 206 can determine the context of the surgical procedure being performed (for example, the type of procedure or the stage of the procedure being performed) based, at least in part, in the perioperative data received from these connected surgical devices. Based on these perioperative data and the surgical context, central surgical controllers 206 can determine procedure variables associated with the surgical procedure, such as how long the procedure is taking (or a stage of it), which surgical instrument is currently being used, and so on. onwards. In one aspect, a computer system, such as a central surgical controller 206, can be programmed to provide recommendations by monitoring procedure variables to assess when the surgical team is performing a surgical procedure in a way that deviates from the baseline or expectations for the specific type of procedure. For example, Figure 16 is a logical flow chart for a 210000 procedure for providing surgical recommendations, in accordance with at least one aspect of the present description. Process 210000 can be performed by a processor or control circuit of a computer system, such as processor 244 of the central surgical controller 206 illustrated in Figure 10. Consequently, process 210000 can be incorporated as a set of stored computer executable instructions. in a memory 249 which, when executed by processor 244, causes the computer system (for example, a central surgical controller 206) to perform the steps described.
[0166] [0166] Consequently, processor 244 that performs the 210000 process receives 210002 perioperative data from the surgical device (or surgical devices) connected or paired with the central surgical controller 206 and determines
[0167] [0167] Consequently, processor 244 determines 210006 a procedure variable associated with the surgical procedure based on the surgical context and perioperative data from the connected surgical devices. The procedure variable can include any aspect or feature of the surgical procedure that may vary between the individual performances of the type of surgical procedure. For example, the procedure variable can include the length of time for the surgical procedure as a whole, the time period for a particular stage of the surgical procedure, the type of surgical instrument being used, the costs (for example, maintenance costs and replacement costs) associated with surgical devices, the type of staple cartridge being used in a surgical stapler, the power level or mode of an ultrasonic surgical instrument or an electrosurgical instrument, and the configuration of the surgical device for the procedure (that is, the preoperative assortment of surgical devices selected for the procedure). Processor 244 can monitor a single procedure variable or multiple procedure variables. In one aspect, the central surgical controller 206 can monitor the status of each procedure variable that has been programmed to determine. In another aspect, the central surgical controller 206 can monitor one or more procedure variables that have been selected or programmed by users.
[0168] [0168] Consequently, processor 244 compares the determined procedure variable (or variables) with a corresponding baseline (or baselines) 210008.
[0169] [0169] Based on the results of the comparison between the determined procedure variable and its corresponding baseline, the central surgical controller 206 can, in response, perform several actions. In one aspect, processor 244 provides 210010 with a notification or recommendation according to whether or not it deviates from the determined procedure variable from its corresponding baseline. The recommendation may vary depending on the specific type of procedure variable being compared. The recommendation may be for the user to use a different surgical instrument (for example, an instrument with smaller claws, with a greater maximum articulation angle or a larger drive shaft), use a different trocar or another access point, change the position of the patient on the operating table (for example, rolling the patient), and so on.
[0170] [0170] In one aspect, the recommendations provided 210010 by the 210000 process illustrated in Figure 16 can be applied in real time (that is, during the course of the surgical procedure). For example, Figure 17 illustrates a prophetic implementation of the 210000 process where the recommendations provided can be superimposed on a live video broadcast displayed during the course of a surgical procedure, in accordance with at least one aspect of the present description. Video transmission can be provided, for example, by an endoscope 239 (Figure 9) communicatively coupled to the central surgical controller 206 which is being used to view a surgical site 210102 during the surgical procedure. The video transmission from the endoscope 239 can be displayed on a central controller screen 215 (Figure 9), on a local screen 217 (Figure 10), non-sterile screens 107, 109 (Figure 2), a sterile primary screen 119 (Figure 2) and other such screen devices that can be viewed by the surgical team during the surgical procedure.
[0171] [0171] In the first image 210100a, the surgeon is lifting a vessel for transection during a lobotomy procedure. In a lobotomy procedure, the pulmonary vessels that supply blood to the lung lobe that is the object of the procedure need to be dissected and transected. These pulmonary vessels are typically fragile and have a very high volume of blood flowing through them. Therefore, the dissection is delicate and an error can be fatal for the patient. Additionally, the orientation of the pulmonary vessels is not always predictable, which makes it difficult to optimize the placement of the trocar. If the orientation of the pulmonary vessels is poor in relation to the location of the trocars, the surgical procedure can be complicated or especially challenging for the surgeon. Therefore, it would be highly beneficial for a computer system, such as the central surgical controller 206, to recognize when the surgeon performing the specific procedure is having difficulty and provide intraoperative recommendations to assist the surgeon.
[0172] [0172] In the second image 210100b, the surgeon is trying to transect the vessel with a 210106 straight-tipped vascular stapler. As discussed above in connection with Figure 16, the central surgical controller 206 can monitor a number of different - procedure during the course of the surgical procedure. For example, the central surgical controller 206 that performs the 210000 process can determine that the surgeon is taking longer than the average time for that specific step in the procedure.
[0173] [0173] In one aspect, the central surgical controller 206 is programmed to determine the recommendation based on the surgical context and the given procedure variables, and then access the medical facility's inventory database to determine whether the recommended alternative is available for the medical facility. If the recommended alternative is not available, the central surgical controller 206 can be programmed not to make the recommendation intraoperatively or otherwise to record that the alternative surgical device would have been recommended if it were available. If the recommended alternative is available, the central surgical controller 206 can be programmed to provide the intraoperative recommendation, as discussed above. In one aspect, the recommendation can be provided as a 210104 icon or graphic overlay in the displayed live video stream. In other respects, the recommendation can be provided on a separate screen, through audio through a speaker, and so on. After receiving the recommendation, the surgeon switches to the recommended curved-tip vascular stapler 210108, as indicated by the third image 210100c, and then completes the given stage of the surgical procedure, as indicated by the fourth image 210100d of the video transmission.
[0174] [0174] In another prophetic implementation of the 210000 process where recommendations are provided during surgery, the central surgical controller 206 could be programmed to determine when the surgical team is preparing to position the trocars for a laparoscopic procedure (for example, through recognition) or if the surgical team is having difficulties to perform a procedure due to the poor placement of the trocar. Consequently, the central surgical controller 206 can then recommend placement locations for the trocars and / or specific types of trocars to use on a screen coupled to the central surgical controller 206. The recommended placement locations and types of trocar can be selected maximize accessibility to the target tissue for the given surgical procedure.
[0175] [0175] In another aspect, the recommendations provided 210010 by the 210000 process illustrated in Figure 16 can be provided outside the surgical procedure, such as during a postoperative playback of the surgical procedure. For example, Figure 18 illustrates a prophetic implementation of the 210000 process where recommendations can be provided through a 210200 graphical user interface to reproduce a surgical procedure, in accordance with at least one aspect of the present description. The 210200 graphical user interface can be displayed on a screen 215 of the central controller, for example. The 210200 graphical user interface may include video transmission from the surgical procedure (for example, video transmission captured by the 239 endoscope) with various graphic controls, icons and / or suggestions on it or otherwise associated with it for release information to the user or allow the user to control video playback. For example, the 210200 graphical user interface may display a 210208 icon relaying surgical contextual information or perioperative data received from the connected surgical devices corresponding to the current timestamp of the displayed video stream. As another example, the 210200 graphical user interface may display another 210210 icon that relays the recommendation (for example, from process 210000) corresponding to the current timestamp of the displayed video stream. As yet another example, the 210200 graphical user interface can display a 210202 progress bar to indicate the specific portion of the video currently being viewed and control the displayed video. The 210202 progress bar can include, for example, a sliding widget 210206 to control video playback and icons 210204 visually indicating at which points the central surgical controller 206 or another computer system has determined a procedure variable - monitored deviated from its line corresponding base. By visually indicating when the computer system determined that the surgeon was deviating from the baselines during the surgical procedure using icons 210204, the surgeon can focus on those portions of the surgical procedure during the postoperative review of the procedure.
[0176] [0176] In one aspect, the 210200 graphical user interface can be configured to overlay a recommended alternative surgical device over the surgical device shown in the video stream to demonstrate to the surgeon how the procedure step could have proceeded differently with the surgical device alternative. In addition, the 210200 graphical user interface can combine data from recorded video streams of various surgical procedures to show the surgeon their patterns of technique or movement, where the surgeon differs from his peers, where the surgeon can change his patterns to optimize results referring to pairs and / or when and where types of devices, techniques or specific positions are strongly correlated to results for the given type of procedure or stage of it.
[0177] [0177] In another aspect, the recommendations provided 210010 by the 210000 process illustrated in Figure 16 can be provided as reports with historical data, statistics or other evidence to support the recommendations provided. For example, Figure 19 illustrates a prophetic implementation of the 210000 process where recommendations associated with surgical procedures can be provided through a 210300 graphical user interface to display the historical data underlying the recommendation, in accordance with at least one aspect of the present description. . Understanding the basis behind a specific recommendation, users are more likely to adopt the perioperative recommendations provided by the central surgical controller 206.
[0178] [0178] The historical data underlying the recommendations provided by the central surgical controller 206 can be provided in several different graphical formats, including as graphs, charts, raw data, and so on. In the illustrated implementation, the 210300 graphical user interface is displaying a recommendation as to what specific type of surgical instrument should be used during a specific surgical procedure and the historical data on which the recommendation is based. The 210300 graphical user interface can display a 210302 graph including a 210304 vertical geometric axis that indicates the number of cases in which various types of surgical instruments were used for the surgical procedure and a 210306 horizontal geometric axis indicating the types of surgical instrument. Additionally, the uses for each type of surgical instrument can be subdivided by the number of positive and negative results for the procedure. This allows users to view whether each type of surgical instrument is correlated with positive or negative results, in addition to viewing the total number of times the instrument has been used in a surgical procedure. Consequently, the recommendation, which can be indicated by an icon 210308 in the graphical user interface 210300, may correspond to the surgical instrument that was used most often during surgical procedures, is the one most correlated to positive results of the procedure, is the least correlated to negative results of the procedure, and so on.
[0179] [0179] In one respect, the historical data illustrated in the graphical user interface 210300 in Figure 19 can be provided in addition to intraoperative or postoperative recommendations, as discussed above in Figures 17 and 18, respectively. For example, a user can retrieve the historical data on which a given recommendation is based, for example, through a menu on a graphical user interface displayed by the central surgical controller 206. In one aspect, the central surgical controller 206 can be programmed to provide recommendations and / or reports both intraoperatively and postoperatively to users. In one aspect, the central surgical controller 206 can be programmed to provide product information, historical data and other data associated with alternative surgical instruments recommended for a given surgical procedure.
[0180] [0180] In some cases, the recommendations that the central surgical controller 206 is programmed to provide can be predetermined or set by the administrators of the computer network to which the central surgical controller 206 is connected, rather than being determined by the computer system itself from the aggregated data. For example, Daniel L. Miller et al., Impact of Powered and Tissue-Specific Endoscopic Stapling Technology on Clinical and Economic Outcomes of Video-Assisted Thoracic Surgery Lobectomy
[0181] [0181] In one aspect, a computer system can be configured to collect, analyze and compare external research and other data sets with results in the medical facility or in the network of central surgical controllers 206. The computer system can in some ways , imitate the analytical procedure performed by a particular piece of research to confirm the investigation. If the investigation is confirmed, then the computer system can provide recommendations corresponding to the investigation. For example, the article by Miller et al. above shows that energized staplers are associated with fewer complications related to hemostasis and lower procedure costs, specific types of instruments (eg energized staplers) are associated with fewer complications related to hemostasis than other types of instruments (eg , manual staplers), and the effect size is greater in patients with chronic obstructive pulmonary disease (COPD). Consequently, when this investigation is confirmed, the computer system can automatically implement corresponding recommendations dictated by the investigation across the entire network of central surgical controllers.
[0182] [0182] In one aspect, the central surgical controller 206 can be programmed to highlight the specific feature of an alternative product that makes the alternative product superior. Again with reference to the example discussed in connection with Figure 17, the central surgical controller 206 could be programmed to indicate that the curved-tip vascular stapler 210108 is recommended in comparison with the straight-tip vascular stapler 210106, because its curved tip is more easy to maneuver through vascular structures and easier to see than the straight tip. In another aspect, the central surgical controller 206 can be programmed to directly compare various statistics between two products as part of the recommendations provided. Returning again to Figure 17, the central surgical controller 206 can be programmed to display the difference in the average surgical procedure time, differences in procedure results and other statistics for surgeons who used the 210108 curved vascular stapler, compared to surgeons who used straight-edge vascular stapler 210106.
[0183] [0183] As discussed above with respect to Figures 17 to 18, a computer system that performs the 210000 process illustrated in Figure 16 can provide intraoperative and / or post-operative recommendations regarding alternative products, such as surgical instruments. However, a computer system that runs the 210000 process can provide recommendations for alternative products in several other contexts. In one aspect, the central surgical controller 206 can be programmed to determine what type of product is being used, calculate costs associated with the given product, and then recommend an alternative product that has the same or similar performance to the given product, but with lower costs associated companies.
[0184] [0184] In several respects, a computer system that performs the 210000 process illustrated in Figure 16 can be additionally programmed to indicate the impact of forgeries and reprocessing of surgical results and provide this data to users. In one aspect, a procedure variable evaluated by the 210000 process may include determining whether a surgical device being used in the surgical procedure is authorized or unauthorized (that is, it is a forgery or has been reprocessed) and the corresponding baseline may be the device surgical device is an authorized surgical device. In other words, the 210000 process can assess whether a surgical device is authorized and, if the surgical device is not authorized, provide an intraoperative or postoperative recommendation to the surgical team to use an authorized surgical device instead. As part of the recommendation provided, the central surgical controller 206 can provide a range of qualitative or quantitative evidence that supports the recommendation not to use the counterfeit or reprocessed surgical device.
[0185] [0185] In one aspect, the computer system that performs the 210000 process can be configured to determine or quantify the effects of surgical devices that are not authentic.
[0186] [0186] In one aspect, the functions and results associated with an individual surgical device can be compared with themselves, rather than being compared with a defined baseline for the type of surgical device, to determine if there is any degradation in the performance of the surgical device over time. Such analyzes can be useful in determining when a surgical device should be replaced or serviced, for example. Reports on functions and results associated with the individual surgical devices can be highlighted in a report generated regularly (for example, compiled weekly) at the medical facility, for example.
[0187] [0187] In one aspect, the computer system can be configured to compare different brands of products and provide recommendations accordingly. For example, the computer system could show when another branded product provides the same or better performance at a lower cost than the brand name of a given product used during a surgical procedure or that must be used during a surgical procedure. Examples
[0188] [0188] Various aspects of the subject described in this document are defined in the following numbered examples:
[0189] [0189] Example 1. A computer system configured to be communicatively coupled to a surgical device. The computer system comprises a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to: receive perioperative data from the surgical device; determine a surgical context based, at least in part, on perioperative data; determine a procedure variable associated with the surgical context; compare the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and provide a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable.
[0190] [0190] Example 2. The computer system, according to Example 1, the procedure variable comprising a type of surgical instrument that is used during a surgical procedure.
[0191] [0191] Example 3. The computer system, according to Example 2, the notification comprising a recommendation for an alternative type of surgical instrument for the surgical procedure.
[0192] [0192] Example 4. The computer system, according to Example 3, and the type of alternative surgical instrument is associated with improved procedure results for the surgical procedure.
[0193] [0193] Example 5. The computer system, according to Example 1, the procedure variable comprising a duration of the surgical procedure.
[0194] [0194] Example 6. The computer system, according to Example 5, the notification comprising a recommendation for an alternative configuration of the surgical device.
[0195] [0195] Example 7. The computer system, according to the
[0196] [0196] Example 8. The computer system, according to Example 7, the notification comprising a recommendation for a less expensive surgical device configuration.
[0197] [0197] Example 9. A computer-implemented method to provide recommendations associated with a surgical procedure, the method comprising: receiving, via a computer system, perioperative data from a surgical device; determine, through the computer system, a surgical context based, at least in part, on perioperative data; determine, through the computer system, a procedure variable associated with the surgical context; compare, through the computer system, the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and providing, through the computer system, a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable.
[0198] [0198] Example 10. The method, according to Example 9, the procedure variable comprising a type of surgical instrument that is used during a surgical procedure.
[0199] [0199] Example 11. The method, according to Example 10, the notification comprising a recommendation for an alternative type of surgical instrument for the surgical procedure.
[0200] [0200] Example 12. The method, according to Example 11, and the type of alternative surgical instrument is associated with improved procedure results for the surgical procedure.
[0201] [0201] Example 13. The method, according to Example 9, the procedure variable comprising a duration of the surgical procedure.
[0202] [0202] Example 14. The method, according to Example 13, the notification comprising a recommendation for an alternative configuration of the surgical device.
[0203] [0203] Example 15. The method, according to Example 9, the procedure variable comprising a cost of surgical devices used during a surgical procedure.
[0204] [0204] Example 16. The method, according to Example 15, the notification comprising a recommendation for a less expensive surgical device configuration.
[0205] [0205] Example 17. A computer system configured to be communicably coupled to a surgical device and a video camera. The computer system comprises a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to: record a surgical procedure using the video camera; receive perioperative data from the surgical device; determine a surgical context based, at least in part, on perioperative data; determine a procedure variable associated with the surgical context; compare the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and repeat a recording of the surgical procedure, the recording including a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable.
[0206] [0206] Example 18. The computer system, according to Example 17, the procedure variable comprising a type of surgical instrument that is used during a surgical procedure.
[0207] [0207] Example 19. The computer system, according to Example 18, the notification comprising a recommendation for an alternative type of surgical instrument for the surgical procedure.
[0208] [0208] Example 20. The computer system, according to Example 19, the type of alternative surgical instrument being associated with improved procedure results for the surgical procedure.
[0209] [0209] Example 21. The computer system, according to Example 17, the procedure variable comprising a duration of the surgical procedure.
[0210] [0210] Example 22. The computer system, according to Example 21, the notification comprising a recommendation for an alternative configuration of the surgical device.
[0211] [0211] Example 23. The computer system, according to Example 17, the procedure variable comprising a cost of surgical devices used during a surgical procedure.
[0212] [0212] Example 24. The computer system, according to Example 23, the notification comprising a recommendation for a less expensive surgical device configuration.
[0213] [0213] Although various forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the attached claims 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 description. 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 for certain components are described, 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.
[0214] [0214] 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 in this document described, 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 thereof, and that designing the circuitry and / or writing the code for the software and firmware would be within the scope of practice of the person skilled in the art, in the light of this description. In addition, those skilled in the art will understand that the mechanisms of the subject in this document described can be distributed as one or more program products in a variety of ways and that an illustrative form of the subject in this document described is applicable regardless of the specific type of program. means of signal transmission used to effectively carry out the distribution.
[0215] [0215] The instructions used to program the logic to execute various aspects described 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 discs- dynamo 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).
[0216] [0216] As used in any aspect of the present invention, the term "control circuit" can refer to, for example, a set of wired circuits, programmable circuits (for example, a computer processor that includes one or more cores individual instruction processing units, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic matrix (PLA), or 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 performs processes and / or devices in this document described, or a microprocessor configured by a computer program that at least partially performs the processes and / or devices described in this document), 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, u modem, communication key, or optical-electrical equipment). Those skilled in the art will recognize that the subject in this document described can be implemented in an analog or digital way, or in some combination of these.
[0217] [0217] 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.
[0218] [0218] 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.
[0219] [0219] As in the present document used 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 they may, although not necessarily need, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is common use to call these signs bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may be associated with adequate physical quantities and are merely convenient identifications applied to those quantities and / or states.
[0220] [0220] A network can include a packet switched network. Communication devices may be able to communicate with each other using a selected packet switched network communications protocol. 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
[0221] [0221] Unless otherwise stated, as is evident from the preceding description, it is understood that, throughout the preceding description, discussions that use terms such as "processing", or "computation", or "calculation", or " determination ", or" display ", or similar, refer to the action and processes of a computer, or similar electronic computing device, that manipulates and transforms the data represented in the form of physical (electronic) quantities in records and memories of the computer in other data represented in a similar way in the form of physical quantities in the memories or records of the computer, or in other similar devices for storing, transmitting or displaying information.
[0222] [0222] One or more components in the present invention may be called "configured for", "configurable for", "operable / operational for", "adapted / adaptable for", "capable of", "conformable / conformed for", etc. Those skilled in the art will recognize that "configured for" may, in general, cover components in an active state and / or components in an inactive state and / or components in a standby state, except when the context dictates otherwise.
[0223] [0223] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located opposite the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to 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.
[0224] [0224] Persons skilled in the art will recognize that, in general, the terms used in this document, 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,
[0225] [0225] 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".
[0226] [0226] 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 ordering - overlapping, merging, interrupted, reordered, incremental, preparatory, supplementary, simultaneous, inverse or other variant orders, unless the context otherwise determines. 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.
[0227] [0227] 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.
[0228] [0228] Any patent application, patent, non-patent publication or other description material mentioned in this specification and / or mentioned in any order data sheet is in this document incorporated by reference, to the extent that the Embedded materials are not inconsistent with this. Accordingly, and as necessary, the description as explicitly presented herein replaces any conflicting material incorporated into the present invention by reference. Any material, or portion thereof, taken as in this document incorporated by reference, but which conflicts with the definitions, statements, or other description materials present in this document presented will be in this incorporated document only until the point in that there is no conflict between the embedded material and the existing description material.
[0229] [0229] In summary, numerous benefits have been described that result from the use of the concepts described in this document. The previously mentioned description of one or more modalities has been presented for purposes of illustration and description.
This description is not intended to be exhaustive or to limit the invention to the precise form described.
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 (24)
[1]
1. Computer system configured to be communicably coupled to a surgical device, characterized in that the computer system comprises: a processor; and a memory coupled to the processor, the memory stores instructions that, when executed by the processor, cause the computer system to: receive perioperative data from the surgical device; determine a surgical context based, at least in part, on perioperative data; determine a procedure variable associated with the surgical context; compare the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and provide a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable.
[2]
2. Computer system according to claim 1, characterized in that the procedure variable comprises a type of surgical instrument that is used during a surgical procedure.
[3]
3. Computer system according to claim 2, characterized in that the notification comprises a recommendation for an alternative type of surgical instrument for the surgical procedure.
[4]
4, Computer system according to claim 3, characterized in that the type of alternative surgical instrument is associated with improved procedure results for the surgical procedure.
[5]
5. Computer system according to claim 1, characterized in that the procedure variable comprises a duration of the surgical procedure.
[6]
6. Computer system according to claim 5, characterized in that the notification comprises a recommendation for an alternative configuration of the surgical device.
[7]
7. Computer system according to claim 1, characterized in that the procedure variable comprises a cost for surgical devices used during a surgical procedure.
[8]
Computer system according to claim 7, characterized in that the notification comprises a recommendation for a less expensive surgical device configuration.
[9]
9. Method implemented by computer to provide recommendations “associated with a surgical procedure, characterized in that the method comprises: receiving, by a computer system, the perioperative data from a surgical device; determine, through the computer system, a surgical context based, at least in part, on perioperative data; determine, through the computer system, a procedure variable associated with the surgical context; compare, through the computer system, the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and providing, through the computer system, a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable.
[10]
10. Method according to claim 9, characterized in that the procedure variable comprises a type of surgical instrument that is used during a surgical procedure.
[11]
11. Method according to claim 10, characterized in that the notification comprises a recommendation for an alternative type of surgical instrument for the surgical procedure.
[12]
12. Method according to claim 11, characterized in that the type of alternative surgical instrument is associated with improved procedure results for the surgical procedure.
[13]
13. Method according to claim 9, characterized in that the procedure variable comprises a duration of the surgical procedure.
[14]
Method according to claim 13, characterized in that the notification comprises a recommendation for an alternative configuration of the surgical device.
[15]
15. Method according to claim 9, characterized in that the procedure variable comprises a cost of surgical devices used during a surgical procedure.
[16]
16. Method according to claim 15, characterized in that the notification comprises a recommendation for a less expensive surgical device configuration.
[17]
17. Computer system configured to be communicably coupled to a surgical device and a video camera, characterized in that the computer system comprises: a processor; and a memory attached to the processor, the memory stores instructions that, when executed by the processor, cause the computer system to:
record a surgical procedure using the video camera; receive perioperative data from the surgical device; determine a surgical context based, at least in part, on perioperative data; determine a procedure variable associated with the surgical context; compare the procedure variable with a baseline for the procedure variable, the baseline corresponding to the surgical context; and repeat the registration of the surgical procedure, with the registration including a notification according to the deviation or not between the procedure variable and the baseline for the procedure variable.
[18]
18. Computer system according to claim 17, characterized in that the procedure variable comprises a type of surgical instrument that is used during a surgical procedure.
[19]
19. Computer system according to claim 18, characterized in that the notification comprises a recommendation for a type of alternative surgical instrument for the surgical procedure.
[20]
20. Computer system according to claim 19, characterized in that the type of alternative surgical instrument is associated with improved procedure results for the surgical procedure.
[21]
21. Computer system according to claim 17, characterized in that the procedure variable comprises a duration of the surgical procedure.
[22]
22. Computer system according to claim 21, characterized in that the notification comprises a recommendation for an alternative configuration of the surgical device.
[23]
23. Computer system according to claim 17, characterized in that the procedure variable comprises a cost for surgical devices used during a surgical procedure.
[24]
24. Computer system according to claim 23, characterized in that the notification comprises a recommendation for a less expensive surgical device configuration.
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BR112020013177A2|2020-12-01|surgical network recommendations based on real-time analysis of procedure variables in relation to a baseline highlighting differences in relation to the optimal solution

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

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US20210192914A1|2021-06-24|Surgical hub and modular device response adjustment based on situational awareness

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US11278281B2|2022-03-22|Interactive surgical system

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

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

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

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BR112020013024A2|2020-11-24|adjustment of device control programs based on stratified contextual data in addition to the data

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BR112020013229A2|2020-12-01|surgical network, instrument and cloud responses based on validation of received data set and authentication of its source and integrity

同族专利:

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公开号 | 公开日

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JP2021509202A|2021-03-18|

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EP3506275A1|2019-07-03|

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WO2019133132A1|2019-07-04|

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US20190201102A1|2019-07-04|

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US20210205020A1|2021-07-08|

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CN111788636A|2020-10-16|

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US20210205021A1|2021-07-08|

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WO2019133132A8|2020-08-06|

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法律状态:
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