position detection and patient contact with the use of the monopolar return block electrode to provi

专利摘要:
The present invention relates to a surgical system. The surgical system includes a monopolar return block and a central surgical controller wirelessly coupled to the monopolar return block. The central surgical controller includes a control circuit configured to determine the presence and position of a patient on the monopolar return block according to the data received from the monopolar return block.
公开号:BR112020013196A2
申请号:R112020013196-2
申请日:2018-11-14
公开日:2020-12-01
发明作者:David C. Yates；Frederick E. Shelton Iv；Shane R. Adams；Jason L. Harris
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] This application claims the benefit of the priority of US Non-Provisional Patent Application Serial No. 16 / 182,267, entitled
[0002] [0002] The present application claims priority under 35 U.S.C. 8,119 (e) of US Provisional Patent Application No. 62 / 729,182, entitled
[0003] [0003] This application also claims priority under US $ 35 US $ 119 (e), from US Provisional Patent Application No. 62 / 659,900, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE, filed on June 30, 2018, from US Provisional Patent Application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE, filed on June 30, 2018, and US Provisional Patent Application No. 62 / 692,768, entitled SMART ENERGY DEVICES, filed on June 30, 2018, being description of each of them incorporated by reference, in its entirety.
[0004] [0004] This application also claims priority under US $ 35 US $ 119 (e) of US Provisional Patent Application No. 62 / 692,747, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, the description of which is incorporated herein by way of reference, in its entirety.
[0005] [0005] This application also claims priority under 35 USC $ 119 (e) of US Provisional Patent Application No. 62 / 650,898 filed March 30, 2018, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, of the Application for US Provisional Patent Serial No. 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES, filed on March 30, 2018, US Provisional Patent Application Serial No. 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, filed at March 30, 2018, and US Provisional Patent Application Serial No. 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS, filed on March 30, 2018, the description of which is incorporated herein by reference, in its entirety.
[0006] [0006] This 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 US Provisional 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 incorporated herein by way of reference, in its entirety.
[0007] [0007] This application also claims priority under 35 U.S.C. $ 119 (e) of US Provisional Patent Application Serial No.
[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 OF THE INVENTION
[0009] [0009] In one aspect, the present description provides a surgical system that includes a monopolar return block; a central surgical controller coupled in a communicable way to the monopolar return block, the central surgical controller comprising a control circuit configured to determine the presence and position of a patient on the monopolar return block according to the data received from the block monopolar return.
[0010] [0010] In another aspect, the present description provides a surgical system that includes an electrosurgical instrument; a generator coupled to the electrosurgical instrument; a central surgical controller coupled in a communicable manner to the generator, the central surgical controller comprising a control circuit configured to modulate a nerve and / or power detection waveform supplied by the generator to the electrosurgical instrument based on the situational recognition of the instrument electrosurgical and / or generator.
[0011] [0011] In yet another aspect, the present description provides a surgical system that includes a monopolar return block; and a central surgical controller coupled in a communicable way to the monopolar return block; and a monopolar surgical instrument coupled communicably to the central surgical controller and configured to supply power to a patient on the monopolar return block; the central surgical controller comprising a compensation circuit configured to adjust the power to the monopolar surgical instrument to maintain peak applied power in the monopolar surgical instrument while the patient is in the monopolar return block. FIGURES
[0012] [0012] The various aspects described here, both with regard to the organization and the methods of operation, together with objects and additional advantages of the same, can be better understood in reference to the description presented below, considered together with the drawings in attached as follows.
[0013] [0013] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present description.
[0014] [0014] Figure 2 is a surgical system being used to perform a surgical procedure in an operating room, in accordance with at least one aspect of the present description.
[0015] [0015] Figure 3 is a central surgical controller paired with a visualization system, a robotic system, and an intelligent instrument, 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 combined generator module 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 combined with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present description.
[0018] [0018] Figure 6 illustrates different power bus connectors for a plurality of side coupling ports of a side modular cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present description.
[0019] [0019] Figure 7 illustrates a vertical modular cabinet configured to receive a plurality of modules, according to at least one aspect of the present description.
[0020] [0020] Figure 8 illustrates a surgical data network 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) network central 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 circuit diagram of a circuit for calculating parameters of an antenna, according to at least one aspect of the present description.
[0029] [0029] Figure 17 is a 209100 diagram showing a compensation circuit to adjust the applied power, in accordance with at least one aspect of the present description.
[0030] [0030] Figure 18 is a logical flow chart of a process to reach the peak of applied power, according to at least one aspect of the present description.
[0031] [0031] Figure 19 is an illustration of a set of graphs that represents the generator power level and patient continuity as a function of time, respectively, according to at least one aspect of the present description.
[0032] [0032] Figure 20 is an illustration of a patient located in a monopolar return block during a surgical procedure, according to at least one aspect of the present description.
[0033] [0033] Figure 21 is a block diagram of a system for controlling a power level applied by a monopolar instrument, in accordance with at least one aspect of the present description.
[0034] [0034] Figure 22 shows an illustration of a probe that approaches a nerve.
[0035] [0035] Figure 23 shows an illustration of a probe that directly touches a nerve at the site. DESCRIPTION
[0036] [0036] The applicant for the present application holds the following US patent applications, filed on November 6, 2018, the description of which is incorporated herein by reference, in its entirety:. US Patent Application No. 16 / 182,224, entitled SURGICAL NETWORK, INSTRUMENT, AND CLOUD RESPONSES
[0037] [0037] The applicant for the present application holds the following US patent applications filed on September 10, 2018, the description of which is incorporated herein by reference in its entirety:. US Provisional Patent Application No. 62 / 729,183, entitled A CONTROL FOR A SURGICAL NETWORK OR SURGICAL
[0038] [0038] The applicant of the present application holds the following US patent applications, filed on August 28, 2018, the description of each of which is incorporated herein by reference in its entirety:. US Patent Application No. 16 / 115,214, entitled
[0039] [0039] The applicant for the present application holds the following US patent applications filed on August 23, 2018, the description of which is incorporated herein by reference in its entirety:. US Provisional Patent Application No. 62 / 721,995, entitled - CONTROLLING AN ULTRASONIC - SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION; . US Provisional Patent Application No. 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS; . US Provisional Patent Application No. 62 / 721,999, entitled
[0040] [0040] The applicant of the present application holds the following US patent applications, filed on June 30, 2018, the description of each of which is incorporated herein, by reference, in its entirety:. US Provisional Patent Application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE;
[0041] [0041] The applicant of the present application holds the following US patent applications, filed on June 29, 2018, the description of each of which is incorporated herein, by reference, in its entirety:. US Patent Application Serial No. 16 / 024,090, entitled
[0042] [0042] The applicant for this 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:. US Provisional Patent Application Serial No. 62 / 691,228, entitled A Method of using reinforced flex circuits with multiple sensors with electrosurgical devices; . US Provisional Patent Application Serial No. 62 / 691,227, entitled controlling a surgical instrument according to sensed closure parameters; . US Provisional Patent Application Serial No. 62 / 691,230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE; . US Provisional Patent Application Serial No. 62 / 691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL; . US Provisional Patent Application Serial No. 62 / 691,257, entitled COMMUNICATION OF SMOKE EVACUATION
[0043] [0043] The applicant for this application holds the following provisional US patent applications, filed on April 19, 2018, the description of each of which is incorporated herein by reference, in its entirety:. US Provisional Patent Application Serial No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[0044] [0044] The applicant for this application holds the following provisional US patent applications, filed on March 30, 2018, the description of each of which is incorporated herein by reference in its entirety:. US Provisional Patent Application No. 62 / 650,898 filed March 30, 2018, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS; . US Provisional Patent Application Serial No. 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES; . US Provisional Patent Application Serial No. 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and . US Provisional Patent Application Serial No. 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS.
[0045] [0045] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein, by reference, in its entirety:. US Patent Application Serial No. 15 / 940,641, entitled INTERACTIVE - SURGICAL SYSTEMS WITH ENCRYPTED
[0046] [0046] 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 herein by reference in its entirety:. US Provisional Patent Application No. 62 / 649,302, entitled INTERACTIVE - SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; . US Provisional Patent Application Serial No. 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; . US Provisional Patent Application Serial No. 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS; . US Provisional Patent Application Serial No. 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER; . US Provisional Patent Application No. 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; . US Provisional Patent Application No. 62 / 649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT; . US Provisional Patent Application No. 62 / 649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; . US Provisional Patent application Serial No. 62 / 649,333,
[0047] [0047] 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 herein by reference in its entirety:. US Provisional Patent Application Serial No. 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and . US Provisional Patent Application Serial No. 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[0048] [0048] 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 herein by reference in its entirety:. US Provisional Patent Application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM; . US Provisional Patent Application Serial No. 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and . US Provisional Patent Application Serial No. 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[0049] [0049] 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
[0050] [0050] Referring to Figure 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (for example, cloud 104 which may include a remote server 113 coupled to a storage device 105). Each surgical system 102 includes at least one central surgical controller 106 in communication with the cloud 104 which can include a remote server 113. In one example, as illustrated in Figure 1, surgical system 102 includes a visualization system 108, a robotic system 110, a 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.
[0051] [0051] In several respects, smart instruments 112 as described in the present description with reference to Figures 1 to 7 can be implemented as a monopolar powered surgical device 209415 (see, for example, Figures 16 to 23), configured to supply power monopolar RF to a surgical site. The patient can be placed on a 209410 return path block. In some cases, smart instruments 112 may include other features, such as smoke evacuation, gripping and / or cutting functionality. Intelligent instruments 112 (for example, devices 1a to 1n) such as the monopolar powered surgical device 209415 and the return path block 209410 are configured to operate on a surgical data network 201, as described with reference to Figure 8.
[0052] [0052] Figure 2 represents an example of a surgical system 102 being used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in the 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 of patient 120 to orient imaging device 124. Robotic central surgical controller 122 can be used to process images from the surgical site for subsequent display to the surgeon through the surgeon's console 118.
[0053] [0053] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present description are described in provisional patent application serial number 62 / 611.339 , entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, whose description is hereby incorporated by reference in its entirety for reference.
[0054] [0054] Several examples of cloud-based analysis that are performed by 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 incorporated herein by reference, in its entirety.
[0055] [0055] In several aspects, the imaging device 124 includes at least one Image sensor and one or more optical components. Suitable image sensors include, but are not limited to, load-coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.
[0056] [0056] The optical components of the imaging device 124 may include one or more light sources and / or one or more lenses. One or more light sources can be directed to illuminate portions of the surgical field. The one or more image sensors can receive reflected or refracted light from the surgical field, including reflected or refracted light from tissue and / or surgical instruments.
[0057] [0057] The one or more light sources can be configured to radiate electromagnetic energy in the visible spectrum, as well as in the invisible spectrum. The visible spectrum, sometimes called the optical spectrum or light spectrum, is that portion of the electromagnetic spectrum that is visible to (that is, can be detected by) the human eye and can be called visible light or simply light. A typical human eye will respond to wavelengths in the air that are from about 380 nm to about 750 nm.
[0058] [0058] The invisible spectrum (that is, the non-luminous spectrum) is that portion of the electromagnetic spectrum located below and above the visible spectrum (that is, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the visible red spectrum, and they become invisible infrared (IR), microwaves, radio and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and electromagnetic gamma-ray radiation.
[0059] [0059] 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.
[0060] [0060] In one aspect, the imaging device employs multiple spectrum monitoring to discriminate topography and underlying structures. A multispectral image is one that captures image data within wavelength bands across the electromagnetic spectrum. Wavelengths can be separated by filters or 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 incorporated herein as a reference in its entirety. Multispectral monitoring can be a useful tool for relocating a surgical field after a surgical task is completed to perform one or more of the tests previously described on the treated tissue.
[0061] [0061] It is axiomatic that strict sterilization of the operating room and surgical equipment is necessary during any surgery. The strict hygiene and sterilization conditions required in an "operating room", that is, an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including imaging device 124 and its connectors and components. It will be understood that the sterile field can be considered a specified area, such as inside a tray or on a sterile towel, which is considered free of microorganisms, or the sterile field can be considered an area, immediately around a patient, who was prepared to perform a surgical procedure. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area.
[0062] [0062] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays and one or more screens that are strategically arranged in relation to the sterile field, as shown in Figure 2. In one aspect, the display system 108 includes an interface for HL7, PACS and EMR. Various components of the visualization system 108 are described under the heading "Advanced Imaging Acquisition Module" in US Provisional Patent Application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is incorporated herein reference title in its entirety.
[0063] [0063] As shown in Figure 2, a primary screen 119 is positioned in the sterile field to be visible to the operator on the operating table 114. In addition, a viewing tower 111 is positioned outside the sterile field. The display tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. The visualization system 108, guided by the central controller 106, is configured to use screens 107, 109, and 119 to coordinate the flow of information to operators inside and outside the sterile field. For example, 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.
[0064] [0064] 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.
[0065] [0065] With reference to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system 102. The central controller 106 is also configured to coordinate the flow of information to a screen of the surgical instrument 112. For 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 hereby incorporated by 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 incorporated herein as a reference, in its entirety, for example.
[0066] [0066] Now with reference to Figure 3, a central controller 106 is shown in communication with a visualization system 108, a robotic system 110 and a smart handheld surgical instrument 112. Central controller 106 includes a central controller screen 135, an imaging module 138, a generator module 140 (which may include a monopolar generator 142, a bipolar generator 144 and / or an ultrasonic generator 143), a communication module 130, a processor module 132 and a storage matrix 134. In certain 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.
[0067] [0067] During a surgical procedure, the application of energy to the tissue, for sealing and / or cutting, is generally associated with the evacuation of smoke, suction of excess fluid and / or irrigation of the tissue. Fluid, power, and / or data lines from different sources are often intertwined during the surgical procedure. Valuable time can be wasted in addressing this issue during a surgical procedure. To untangle the lines, it may be necessary to disconnect the lines from their respective modules, which may require a restart of the modules. The modular housing of central controller 136 offers a unified environment for managing power, data and fluid lines, which reduces the frequency of interleaving between such lines.
[0068] [0068] 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 combined 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.
[0069] [0069] In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module received slidingly in the central controller housing. In one aspect, the central controller housing comprises a fluid interface.
[0070] [0070] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the 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 modular housing of the central controller 136 is that it allows quick removal and / or replacement of several modules.
[0071] [0071] Aspects of the present description feature a modular surgical wrap for use in a surgical procedure that involves applying energy to the tissue. The modular surgical enclosure 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.
[0072] [0072] In addition to the above, the modular enclosure also includes a second energy generator module configured to generate a second energy, different from the first energy, for application to the fabric, and a second docking station comprising a second docking port that includes second power and data 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 out of the electrical coupling with the second power and data contacts.
[0073] [0073] In addition, the modular surgical enclosure also includes a communication bus between the first coupling port and the second coupling port, configured to facilitate communication between the first energy generating module and the second energy generating module.
[0074] [0074] With reference to Figures 3 to 5, 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 / irrigation module
[0075] [0075] In one aspect, the modular housing of the central controller 136 comprises a rear communication and modular power board 149 with external and wireless communication heads to allow the removable connection of modules 140, 126, 128 and interactive communication between the themselves.
[0076] [0076] In one aspect, the modular housing of the central controller 136 includes docking stations, or drawers, 151, here 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 power contacts data on a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the central enclosure modular housing 136 as the combined generator module 145 is slid to the position in the corresponding docking station 151 of the modular housing of the central controller 136. In one aspect, the module combined generator 145 includes a bipolar, ultrasonic and monopolar module and a smoke evacuation module integrated into a single housing unit 139, as shown in Figure 5.
[0077] [0077] In several respects, the smoke evacuation module 126 includes a fluid line 154 that carries captured / collected fluid fluid away from a surgical site and to, for example, the smoke evacuation module 126. 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.
[0078] [0078] In several aspects, the suction / irrigation module 128 is coupled to a surgical tool comprising a fluid suction line and a fluid suction line. In one example, the suction and suction fluid lines are in the form of flexible tubes that extend from the surgical site towards the suction / irrigation module 128. One or more drive systems can be configured to cause irrigation and aspiration of fluids to and from the surgical site.
[0079] [0079] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end of the same and at least an energy treatment associated with the end actuator, a suction tube, and a 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.
[0080] [0080] The irrigation tube can be in fluid communication with a fluid source, and the suction tube can be in fluid communication with a vacuum source. The fluid source and / or the vacuum source can be housed in the suction / irrigation module 128. In one example, the fluid source and / or the vacuum source can be housed in the central controller housing 136 separately from the control module. suction / irrigation 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.
[0081] [0081] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the modular housing of central controller 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts at the docking stations of the modular housing of the central controller 136. For example, as shown in Figure 4, the combined generator module 145 includes side supports 155 which are configured to slide the corresponding supports 156 of the corresponding docking station 151 of the enclosure. central controller module 136.
[0082] [0082] In some respects, the drawers 151 of the modular housing of the central controller 136 are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers 151. For example, the side supports 155 and / or 156 can be larger or smaller depending on the size of the module. In other respects, drawers 151 are different in size and are each designed to accommodate a specific module.
[0083] [0083] In addition, the contacts of a specific module can be switched to engage with the contacts of a specific drawer to avoid the insertion of a module in a drawer with misalignment of contacts.
[0084] [0084] As shown in Figure 4, the coupling port 150 of a drawer 151 can be coupled to the coupling port 150 of another drawer 151 via a communication link 157 to facilitate interactive communication between the modules housed in the modular housing of the central controller 136. The coupling ports 150 of the modular housing of the central controller 136 can, alternatively or additionally, facilitate interactive wireless communication between the modules housed in the modular housing of the central controller 136. Any suitable wireless communication can be used, such as Air Titan Bluetooth.
[0085] [0085] Figure 6 illustrates individual power bus connectors for a plurality of side coupling ports of a lateral modular enclosure 160 configured to receive a plurality of modules from a central surgical controller 206. The lateral modular enclosure 160 is configured to receive and laterally interconnect modules 161. Modules 161 are slidably inserted into docking stations 162 of side modular housing 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.
[0086] [0086] 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
[0087] [0087] 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 housing that can be mounted with a light source module and a camera module. The wrapper can be a disposable wrapper. In at least one example, the disposable housing is removably attached to a reusable controller,
[0088] [0088] During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or other light source may be inefficient. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present description is configured to allow the replacement of a light source module or a "midstream" camera module during a surgical procedure, without the need to remove the imaging device from the surgical field.
[0089] [0089] In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. A first channel is configured to receive the Camera module in a sliding way, which can be configured for a snap-fit fit (pressure fit) with the first channel. A second channel is configured to slide the camera module, which can be configured for a snap-fit fit (pressure fit) with the first channel. In another example, the camera module and / or the light source module can be rotated to an end position within their respective channels. A threaded coupling can be used instead of a pressure fitting.
[0090] [0090] In several examples, multiple imaging devices are placed in different positions in the surgical field to provide multiple views. Imaging module 138 can be configured to switch between imaging devices to provide an ideal view. In several respects, imaging module 138 can be configured to integrate images from different imaging devices.
[0091] [0091] Various image processors and imaging devices suitable for use with the present description are described in US patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, granted on August 9, 2011 which is incorporated herein by reference in its entirety. In addition, US patent No. 7,982,776, entitled SBIl MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued on July 19, 2011, which is incorporated herein by reference in its entirety, describes various systems for removing motion artifacts from the data of image. Such systems can be integrated with the imaging module 138. In addition to these, the publication of US Patent Application No. 2011/0306840, entitled CONTROLLABLE MAGNETIC. SOURCE TO FIXTURE INTRACORPOREAL APPARATUS, published on December 15, 2011, and the publication of US Patent Application No. 2014/0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published on August 28, 2014, which are each of which are incorporated herein by reference in their entirety.
[0092] [0092] 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 (for example, cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular communication center 203 comprises a central network controller 207 and / or a network key 209 in communication with a network router. The modular communication center 203 can also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 can be configured as a passive, intelligent, or switching network. A passive surgical data network serves as a conduit for the data, allowing the data to be transmitted from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network includes features to allow traffic to pass through the surgical data network to be monitored and to configure each port on the central network controller 207 or network key 209. An intelligent surgical data network can be called a a central controller or controllable key. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.
[0093] [0093] Modular devices 1a to 1n located in the operating room can be coupled to the modular communication center 203. The central network controller 207 and / or the network 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. To 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.
[0094] [0094] It will be understood that the surgical data network 201 can be expanded by interconnecting multiple central network controllers 207 and / or multiple network keys 209 with multiple network routers 211. The central communication controller 203 may be contained in a modular control tower 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.
[0095] [0095] In one aspect, the surgical data network 201 may comprise a combination of central network controllers, network switches, and network routers that connect devices 1a to 1n / 2a to 2m to the cloud.
[0096] [0096] The application of cloud computer data processing techniques to data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs, and better patient satisfaction.
[0097] [0097] 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 local network transmission device that acts on the physical layer of the open system interconnection model ("OSI" - open system interconnection). The central network controller provides connectivity to devices 1a to 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends it to the router in "half-duplex" mode. The central network controller 207 does not store any media / Internet protocol (MAC / IP) access control for transferring data from the device. Only one of the devices 1a to 1n at a time can send data through the central network controller 207. The central network controller 207 has no routing tables or intelligence about where to send information and transmits all network data through each connection and to a remote server 213 (Figure 9) in cloud 204. The central network controller 207 can detect basic network errors, such as collisions, but having all (admit that) the information transmitted to multiple input ports can be a security risk and cause bottlenecks.
[0098] [0098] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 through a wired or wireless channel. The network key 209 works in the data connection layer of the OSI model. The network 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.
[0099] [0099] The central network controller 207 and / or the network key 209 are coupled to the network router 211 for a connection to the cloud
[0100] [0100] In one example, the central network controller 207 can be implemented as a central USB controller, which allows multiple USB devices to be connected to a host computer. The central USB controller can expand a single USB port on several levels so that more ports are available to connect the devices to the system's host computer. The central network controller 207 can include wired or wireless capabilities to receive information about a wired channel or a wireless channel. In one aspect, a wireless wireless, broadband, short-range wireless USB communication protocol can be used for communication between devices 1a to 1h and devices 2a to 2m located in the operating room.
[0101] [0101] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the modular communication center 203 via standard Bluetooth wireless technology for exchanging data over short distances (using short-wavelength UHF radio waves in the 2.4 to 2.485 GHz ISM band) from fixed and mobile devices and to build personal area networks ("PANs"). In other respects, operating room devices 1a to 1n / 2a to 2m can communicate with the modular communication center 203 through a number of wireless and wired communication standards or protocols, including, but not limited to , Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution ("LTE" - long-term evolution), and Ev-DO, HSPA +, HSDPA +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , WiMAX, LTE, Ev-DO and others.
[0102] [0102] The modular communication center 203 can serve as a central connection for one or all devices in the operating room 1a to 1n / 2a to 2m and handles a data type known as frames. The tables carry the data generated by the devices 1a to 1n / 2a to 2m. When a frame is received by the modular communication center 203, it is amplified and transmitted to the network router 211, which transfers the data to the cloud computing resources using a series of wireless communication standards or protocols or with wire, as described in the present invention.
[0103] [0103] The modular communication center 203 can be used as a standalone device or be connected to compatible central network controllers and network switches to form a larger network. The modular communication center 203 is, in general, easy to install, configure and maintain, making it a good option for the network of devices 1a to 1n / 2a to 2m from the operating room.
[0104] [0104] Figure 9 illustrates an interactive surgical system, implemented by computer 200. The interactive surgical system implemented by computer 200 is similar in many ways to the interactive surgical system, implemented by computer 100. For example, the surgical system, interactive, implemented per computer 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one central surgical controller 206 in communication with a cloud 204 which may include a remote server
[0105] [0105] Figure 10 illustrates a central surgical controller 206 comprising a plurality of modules coupled to the modular control tower 236. The modular control tower 236 comprises a modular communication center 203, for example, a network connectivity device, and a computer system 210 for providing local processing, visualization, and imaging, for example. As shown in Figure 10, the modular communication center 203 can be connected in a layered configuration to expand the number of modules (for example, devices) that can be connected to the modular communication center 203 and transfer data associated with the modules to the computer system 210, cloud computing resources, or both. As shown in Figure 10, each of the central controllers / network switches in the modular communication center 203 includes three downstream ports and one upstream port. The central controller / network switch upstream is connected to a processor to provide a communication connection to the cloud computing resources and a local display 217. Communication with the cloud 204 can be done via a wired communication channel or wireless.
[0106] [0106] The central surgical controller 206 employs a non-contact sensor module 242 to measure the dimensions of the operating room and generate a map of the operating room using non-contact measuring devices such as laser or ultrasonic. An ultrasound-based non-contact sensor module scans the operating room by transmitting an ultrasound explosion and receiving the echo when it bounces outside the perimeter of the operating room walls, as described under the heading "Surgical Hub Spatial Awareness Within an Operating Room "in US Provisional Patent Application Serial 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 perimeter walls of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust the Bluetooth pairing distance limits, for example.
[0107] [0107] Computer system 210 comprises a processor 244 and a network interface 245. Processor 244 is coupled to a communication module 247, storage 248, memory 249, non-volatile memory 250 and input / output interface 251 via a system bus. The system bus can be any of several types of bus structure (s), including the memory bus or memory controller, a peripheral bus or external bus and / or a local bus that uses any variety of available bus architectures including, but 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), network interconnection peripheral components (PCI), USB, advanced graphics port (AGP), international memory card association bus for personal computers ("PCMCIA" - Personal Computer Memory Card International Association), systems interface for small computers (SCSI) or any another proprietary bus.
[0108] [0108] 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.
[0109] [0109] In one aspect, processor 244 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[0110] [0110] System memory includes volatile and non-volatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during startup, is stored in non-volatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), 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).
[0111] [0111] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, for example disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card or memory stick (pen drive). drive). In addition, the storage disc may include storage media separately or in combination with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM (CD-ROM) device writable
[0112] [0112] It is to be understood that computer system 210 includes software that acts as an intermediary between users and basic computer resources described in an appropriate operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, 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.
[0113] [0113] A user enters commands or information into computer system 210 via the input device (s) coupled to the / O 251. interface. Input devices include, but are not limited to, a pointing device 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). 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.
[0114] [0114] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. Remote cloud computers can be a personal computer, server, router, personal network computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include many or all elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system via a network interface and then physically connected via a communication connection. The network interface covers communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include fiber distributed data interface (FDDI), copper distributed data interface (CDDI), Ethernet / IEEE 802.3, Token / IEEE 802.5 ring and the like. WAN technologies include, but are not limited to, point-to-point links, circuit switching networks such as digital integrated service networks (ISDN) and variations in them, packet switching networks and digital subscriber lines (DSL).
[0115] [0115] In several respects, computer system 210 of Figure 10, imaging module 238 and / or display system 208, and / or processor module 232 of Figures 9 to 10, may comprise an image processor, image processing engine, media processor, or any specialized digital signal processor (DSP) used for processing digital images. The image processor can employ parallel computing with single multi-data instruction (SIMD) or multiple multi-data instruction (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor can be an integrated circuit system with a multi-core processor architecture.
[0116] [0116] Communication connections refer to the hardware / software used to connect the network interface to the bus. Although the communication connection is shown for illustrative clarity within the computer system, it can also be external to 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.
[0117] [0117] In several respects, the devices / instruments 235 described with reference to Figures 9 and 10, can be implemented as a monopolar powered surgical device 209415 (see, for example, Figures 16 to 23), configured to provide monopolar energy of RF for a surgical site. The patient can be placed on a 209410 return path block. In some cases, devices / instruments 235 may include other features, such as smoke evacuation, gripping and / or cutting functionality.
[0118] [0118] 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 network central controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The central USB network controller 300 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 (DPO). The three ports of the downstream USB transceiver 304, 306, 308 are differential data ports, with each port including "more" differential data outputs (DP1-DP3) paired with "less" differential data outputs (DM1-DM3) .
[0119] [0119] The USB 300 central network controller device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compatible USB transceivers are integrated into the circuit for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full speed as low speed automatically configuring the scan rate according to the speed of the device attached to the doors. The USB 300 network central controller device can be configured in bus powered or self powered mode and includes 312 central power logic to manage power.
[0120] [0120] The USB 300 central network controller device includes a 310 serial interface engine (SIE). The SIE 310 is the front end of the USB 300 central network controller hardware and handles most of the protocol described in chapter 8 of the USB specification. SIE 310 typically comprises signaling down to the transaction level. The functions it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection / generation only, 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 to 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 transceiver ports Downstream USB 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 EEPROM interface serial 330.
[0121] [0121] 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.
[0122] [0122] 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 April 19, 2018 , which is incorporated herein by reference, in its entirety. Cloud system hardware and functional modules
[0123] [0123] 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.
[0124] [0124] 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).
[0125] [0125] Based on connections to multiple 7006 surgical centers over 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 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 individual 7006 central controllers could not perform on your own. For this purpose, as shown in Figure 12, cloud 7004 and central surgical controllers 7006 are communicably coupled to transmit and receive information. The I / O interface 7007 is connected to the plurality of central surgical controllers 7006 over the network 7001. In this way, the I / O interface 7007 can be configured to transfer information between the central surgical controllers 7006 and the aggregated medical databases 7011. Consequently, the 7007 I / O interface can facilitate the read / write operations of the cloud-based data analysis system. Such read / write operations can be performed in response to requests from central controllers 7006. These requests can be transmitted to central controllers 7006 through applications for central controllers. The 7007 I / O interface may include one or more high-speed data ports, which may include universal serial bus (USB) ports, IEEE 1394 ports, as well as Wi-Fi and Bluetooth I / O interfaces for connecting to 7004 cloud to central controllers 7006. Cloud 7004 central controller application servers 7004 are configured to host and provide shared capabilities to software applications (for example, central controller applications) run by 7006 central surgical controllers. application servers for central controllers 7002 can manage requests submitted by applications to central controllers through central controllers 7006, control access to aggregated medical databases 7011 and perform load balancing. The 7034 data analysis modules are described in more detail with reference to Figure 13.
[0126] [0126] The configuration of the specific cloud computing system described in this description is specifically designed to address various issues raised in the context of medical operations and procedures performed using medical devices, such as 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.
[0127] [0127] Figure 13 is a block diagram that illustrates the functional architecture of the interactive surgical system implemented by computer, according to 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.
[0128] [0128] 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 sets of redundant data and the storage of data 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. 7006. For this purpose, 7008 processors can be operationally coupled with applications for central controllers 7014 and aggregated medical databases 7011 to perform data analysis modules 7034. The data collection and aggregation module 7022 can store data aggregates organized in the aggregated medical databases 2212.
[0129] [0129] The resource optimization module 7020 can be configured to analyze this aggregated data to determine an optimal use of resources for a specific group or group of health posts. For example, the resource optimization module 7020 can determine an ideal ordering point for surgical stapling instruments 7012 for a group of clinics based on the corresponding expected demand for such instruments 7012. The resource optimization module 7020 could also assess resource use or other operational settings at various health posts to determine whether resource use could be improved. Similarly, the 7030 recommendation module can be configured to analyze aggregated data organized from the 7022 data collection and aggregation module to provide recommendations. For example, the 7030 recommendations module could recommend to health care facilities (for example, medical providers such as hospitals) that a specific surgical instrument 7012 should be upgraded to an improved version based on a higher than expected error rate, for example example. In addition, the 7030 recommendation module and / or the 7020 resource optimization module could recommend better supply chain parameters, such as product refueling points, and provide suggestions for a different 7012 surgical instrument, its uses or procedural steps to improve surgical results. Health clinics can receive such recommendations through corresponding 7006 central surgical controllers. More specific recommendations on parameters or configurations of various 7012 surgical instruments can also be provided. Central controllers 7006 and / or surgical instruments 7012 can each also have display screens that display data or recommendations provided by the cloud
[0130] [0130] 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.
[0131] [0131] The 7026 control program update module can be configured to implement various 7012 surgical instrument recommendations when the corresponding control programs are updated. For example, the Patient Results Analysis Module 7028 could identify correlations that link specific control parameters with successful (or unsuccessful) results. These correlations can be addressed when updated control programs are transmitted to 7012 surgical instruments via the 7026 control program update module. Updates to 7012 instruments that are transmitted via a corresponding central controller 7006 can incorporate aggregated performance data that has been gathered and analyzed by the data collection and aggregation module 7022 of the 7004 cloud. Additionally, the patient results analysis module 7028 and the recommendations module 7030 could identify better methods of using 7012 instruments based on aggregated performance data.
[0132] [0132] The cloud-based data analysis system can include security features implemented by the 7004 cloud. These security features can be managed by the authorization and security module 7024. Each central surgical controller 7006 can have unique credentials associated with it as username, password and other appropriate security credentials. These credentials could be stored in memory 7010 and associated with a level of access allowed to the cloud. For example, based on the provision of accurate credentials, a central surgical controller 7006 can be granted access to communicate with the cloud to a predetermined point (for example, only certain defined types of information can participate in transmitting or receiving). For this purpose, the aggregated medical databases 7011 of the cloud 7004 may comprise a database of authorized credentials to verify the accuracy of the supplied credentials. Different credentials can be associated with varying levels of permission to interact with the 7004 cloud, such as a predetermined level of access to receive data analysis generated by the 7004 cloud.
[0133] [0133] 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.
[0134] [0134] The 7012 surgical instruments can use wireless transceivers to transmit wireless signals that can represent, for example, authorization credentials for access to the corresponding central controllers 7006 and the 7004 cloud. Wired transceivers can also be used to transmit signals. These authorization credentials can be stored in the respective memory devices of the 7012 surgical instruments. The authorization and security module 7024 can determine whether the authorization credentials are accurate or falsified. The 7024 authorization and security module can also dynamically generate authorization credentials for increased security. Credentials could also be encrypted, such as using hash-based encryption. After transmitting the appropriate authorization, surgical instruments 7012 can transmit a signal to the corresponding central controllers 7006 and finally to cloud 7004 to indicate that instruments 7012 are ready to obtain and transmit medical data. In response, the 7004 cloud can transition to a state enabled to receive medical data for storage in the aggregated medical databases 7011. This availability for data transmission could be indicated, for example, by an indicator light on the instruments
[0135] [0135] The cloud-based data analysis system can allow monitoring of multiple health posts (for example, medical posts like hospitals) to determine improved practices and recommend changes (through the 2030 recommendations module, for example) applicable . 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.
[0136] [0136] The 7032 data classification and prioritization module can prioritize and classify data based on severity (for example, the severity of a medical event associated with the data, unpredictability, distrust). This classification and prioritization can be used in conjunction with the functions of the other 7034 data analysis modules described above to improve the operation and cloud-based data analysis described here. For example, the 7032 data classification and prioritization module can assign a priority to the data analysis performed by the 7022 data collection and aggregation module and the 7028 patient outcome analysis module. Different levels of prioritization can result in specific responses from the 7004 cloud (corresponding to a level of urgency), such as escalation to an accelerated response, special processing, 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.
[0137] [0137] In several respects, the surgical instrument (or instruments) 7012 described above with reference to Figures 12 and 13, can be implemented as a monopolar powered surgical device 209415 (see, for example, Figures 16 to 23.), configured to provide monopolar RF energy to a surgical site. The patient can be placed on a 209410 return path block. In some cases, devices / instruments 235 may include other features, such as smoke evacuation, gripping and / or cutting functionality. Consequently, the monopolar powered surgical device 209415 and the return path block 209410 are configured to interface with the central surgical controller 7006 and the network 2001,
[0138] [0138] 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 by reference , in its entirety.
[0139] [0139] 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. Without knowing the context of the procedure (for example, knowing the type of tissue that is undergoing surgery, or the type of procedure that is being performed), the control algorithm may control the modular device incorrectly or suboptimally, provided the detected data without specific context. For example, the ideal way for a control algorithm to control a surgical instrument in response to a particular detected parameter can vary according to the type of particular tissue being operated on. This is due to the fact that different types of tissue have different properties (for example, tear resistance) and thus respond differently to actions performed by surgical instruments. Therefore, it may be desirable for a surgical instrument to perform different actions when the same measurement is detected for a specific parameter. As a specific example, the ideal way to control a surgical stapling and cutting instrument in response to the instrument's detection of an unexpectedly high force to close its end actuator will vary depending on whether the tissue type is susceptible or resistant to tearing. For tissues that are susceptible to tearing, such as lung tissue, the instrument's control algorithm would optimally slow the engine in response to an unexpectedly high force to close to prevent tearing of the tissue. For tissues that are tear resistant, such as stomach tissue, the instrument's control algorithm would optimally accelerate the engine in response to an unexpectedly high force to close to ensure that the end actuator is properly attached to the tissue. Without knowing whether lung or stomach tissue has been trapped, the control algorithm can make a decision below what is considered ideal.
[0140] [0140] One solution uses a central surgical controller that includes a system configured to derive information about the surgical procedure being performed based on data received from various data sources, and then properly control 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 the modular devices paired with the central surgical controller based on the inferred context of the surgical procedure. Figure 14 illustrates a diagram of a surgical system with 5100 situational recognition, 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)).
[0141] [0141] 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 5104 central surgical controller to derive or infer information related to the surgical procedure from received data, can be called "situational recognition". In one example, the central surgical controller 5104 can incorporate a situational recognition 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.
[0142] [0142] The situational recognition 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 recognition system includes a pattern recognition system, or machine learning system (for example, an artificial neural network),
[0143] [0143] A 5104 central surgical controller, which incorporates a situational recognition 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 a previous example, a central surgical controller with situational recognition 5104, 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 recognition 5104 could correctly accelerate or decelerate the surgical instrument motor for the tissue type.
[0144] [0144] 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 recognition 5104 could infer whether a surgical procedure being performed is a thoracic or abdominal procedure, allowing the central surgical controller 5104 to determine whether tissue clamped by an end actuator of the surgical cutting and stapling instrument 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.
[0145] [0145] 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 recognition 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure is using insufflation) and determine the type of procedure. As a type of procedure is usually performed in a specific body cavity, the 5104 central surgical controller can then adequately control the speed of the smoke evacuator motor to the body cavity being operated. In this way, a central surgical controller with situational recognition 5104 can provide a consistent amount of smoke evacuation to both thoracic and abdominal procedures.
[0146] [0146] 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 recognition 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 recognition 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 with situational recognition 5104 can be configured to adjust the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than just one procedure at a time. A central surgical controller with situational recognition 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.
[0147] [0147] As yet another example, data can be extracted from additional data sources 5126 to improve the conclusions that the central surgical controller 5104 extracts from a 5126 data source. A central surgical controller with situational recognition 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 recognition 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 PA monitor communicably 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 recognition 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.
[0148] [0148] 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 situational recognition 5104 can proactively activate the generator to which an RF electrosurgical instrument is connected if it is determined that a subsequent step in the procedure requires the use of the instrument. Proactively activating the power source allows the instrument to be ready for use as soon as the preceding step of the procedure is complete.
[0149] [0149] As another example, a central surgical controller with situational recognition 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) on the site surgical procedure 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.
[0150] [0150] As yet another example, a central surgical controller with situational recognition 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.
[0151] [0151] Another benefit includes checking for errors during the configuration of the surgical procedure or during the course of the surgical procedure. For example, a central surgical controller with situational recognition 5104 could determine whether the operating room is properly or ideally configured for the surgical procedure to be performed. The central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding checklists, product location, or configuration needs (for example, from a memory), and then compare the current operating room layout with the standard layout for the type of surgical procedure that the 5104 central surgical controller determines is being performed. In one example, the 5104 central surgical controller can be configured to compare the list of items for the procedure scanned by a suitable scanner, for example, and / or a list of devices paired with the 5104 central surgical controller with a recommended or expected list 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 there are 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.
[0152] [0152] As another example, the 5104 situational recognition central surgical controller could determine whether the surgeon (or other medical personnel) was making a mistake or otherwise deviating from the expected course of action during the course of a surgical procedure . For example, the central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding list of steps or order of use of the equipment (for example, from a memory), and then compare the steps being performed or 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.
[0153] [0153] In general, the situational recognition system for the central surgical controller 5104 improves the results of the surgical procedure by adjusting surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure (such as adjusting to different types tissue), and when validating actions during a surgical procedure. The situational recognition 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.
[0154] [0154] In one aspect, as described later in this document with reference to Figures 16 to 23, modular device 5102 is implemented as a monopolar powered surgical device 209415 (see, for example, Figures 16 to 23.), configured for provide monopolar RF energy to a surgical site. The patient can be placed on a return path block
[0155] [0155] 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.
[0156] [0156] The central surgical controller with situational recognition 106, 206 receives data from data sources throughout the course of the surgical procedure, including the data generated each time medical personnel use a modular device that is paired with the central surgical controller 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.
[0157] [0157] In the first step 5202, in this illustrative procedure, members of the hospital team retrieve the electronic patient record (PEP) from the hospital's PEP database. Based on patient selection data in the PEP, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.
[0158] [0158] 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).
[0159] [0159] 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.
[0160] [0160] In the fourth step 5208, the medical staff turns on the auxiliary equipment. The auxiliary equipment being used may vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment that is modular devices can automatically pair with the central surgical controller 106, 206 which is located within a specific neighborhood of modular devices as part of their initialization process. The central surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices that correspond with it during that preoperative or initialization phase. In this particular example, the central surgical controller 106, 206 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of paired modular devices. Based on the combination of data from the 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.
[0161] [0161] In the fifth step 5210, the team members fix the electrocardiogram (ECG) electrodes and other patient monitoring devices on the patient. ECG electrodes and other patient monitoring devices are able to pair with the central surgical controller 106, 206. As central surgical controller 106, 206 begins to receive data from patient monitoring devices, the central surgical controller 106, 206 thus confirming that the patient is in the operating room.
[0162] [0162] 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.
[0163] [0163] 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.
[0164] [0164] 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 relation to viewing the patient's anatomy, monitoring the number or medical imaging devices being used (ie, that are activated and paired with the central surgical controller 106, 206), and monitoring the types of visualization devices used. For example, a technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient's chest cavity above the diaphragm, while a technique for performing a VATS segmentectomy places the camera in an anterior intercostal position in relation to the segment fissure. With the use of standard recognition or machine learning techniques, for example, the situational 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.
[0165] [0165] 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.
[0166] [0166] 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.
[0167] [0167] 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.
[0168] [0168] 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.
[0169] [0169] In the thirteenth stage 5226, the patient's anesthesia is reversed. The central surgical controller 106, 206 can infer that the patient is emerging from anesthesia based on ventilator data (i.e., the patient's respiratory rate begins to increase), for example.
[0170] [0170] Finally, in the fourteenth step 5228 is that medical personnel remove the various patient monitoring devices from the patient. Central surgical controller 106, 206 can thus infer that the patient is being transferred to a recovery room when the central controller loses ECG, blood pressure and other data from patient monitoring devices. As can be seen from the description of this illustrative procedure, the central surgical controller 106, 206 can determine or infer when each step of a given surgical procedure is taking place according to the data received from the various data sources that are communicably coupled to the central surgical controller 106, 206.
[0171] [0171] 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 hereby incorporated by reference in its entirety. In certain cases, the operation of a robotic surgical system, including the various robotic surgical systems disclosed herein, 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 cloud 104. Detection and Perception improvements
[0172] [0172] In many ways, the surgical system can be configured to provide an RF signal and monitor the block / patient interface for improved detection / perception about the patient.
[0173] [0173] In one aspect, the surgical system can be configured to detect the position and contact of the patient using the monopolar return block electrode to provide contextual indications for the situational recognition of the central surgical controller. In one aspect, this can give the central surgical controller a perception or recognition of the patient's repositioning, which can then be used to affect the visualization system and calculate the shape and positions of tissues, organs and other structures. In one aspect, the RF generator can be used to provide a variable range of frequencies, which can then be monitored by returning the electrode from the block to map the patient's location. In one aspect, the block return path can be used to determine the maximum generator power based on the capacitive coupling variations applied to the block. The generator power can then be adjusted accordingly.
[0174] [0174] In one aspect, the surgical system can be configured to modulate the nerve and / or power detection waveform and the waveform for an advanced energy device based on the situational recognition of the central surgical controller or the generator. In one aspect, situational recognition can be based on the type of surgery, anatomical location, state of activation of the advanced energy device, previous nerve detections due to previous signals in the region, continuity of the return block, and proximity to critical structures. In one aspect, situational recognition of previous measurements could allow the nerve stimulation waveform or amplitude to be increased or decreased as the device approaches or moves away from a detected nerve. In one aspect, the nerve stimulation detection waveform could be adjusted automatically by the type of procedure or location in the anatomy. In one aspect, the nerve stimulation waveform can be adjusted proportionally based on the power level of the device in use.
[0175] [0175] In many ways, a monopolar return block can be used in additional applications in addition to simply a return path for monopolar energy. In one respect, radiative resistance measurement can indicate changes in the patient's position during surgery.
[0176] [0176] In one aspect, an interrogation circuit can constantly monitor the RF radiation resistance of the block at high frequency. This makes it possible to determine the basic radiative resistance, which can then be used in combination with the situational recognition of the central surgical controller to provide an indication of when the patient is on the block. For example, a patient's shoulder placed over a portion of the block can alter a measure of radiative resistance in at least part of the block. This can be compared to the basic radiative resistance, and in some cases the comparison can be examined using situational recognition to determine more specifically whether a specific part or location of the body is placed on the block. In some cases, the radiative resistance can be measurable at different locations in the block, and therefore different parts of the block can provide different readings, based on whether a body part is at that location in the block. These different measurements can then be used to provide a more illustrative image of where the body - and what parts of the body - are placed on the block. Once this is determined, the quality of the monopolar return block coupling to the patient can be determined.
[0177] [0177] For additional indications or information, patients or other conductive RF elements will cause a parasitic charge to the capacitively coupled block when the block is driven by a source with a frequency or frequencies whose wavelengths are a significant fraction of the antenna characteristics and resonances transmission block. Consequently, in one aspect, this load can be measured to track changes during patient placement and the surgical procedure. Changes in the parasitic load may indicate that something around the patient or in the local environment has changed. For example, the patient can be maneuvered to a different point on the block, or can be turned to have different parts of the body on the block, such as turned sideways, or to have one arm raised. In other cases, the patient may be unintentionally moved out of the block, the patient may react physiologically to RF energy in order to alter the capacitive load and / or radiative resistance, or the patient may undergo a sudden change in response to surgery that manifests itself in the capacitive coupling. This information can be used in conjunction with the central surgical controller's situational recognition to determine whether an action or warning is needed. In addition, a "suppressor" circuit can be used to keep the electrosurgical generator out of the circuit being measured for radioactive resistance.
[0178] [0178] In another aspect, a vector network analysis can be used to measure the antenna input impedance as a function of frequency.
[0179] [0179] In another aspect, the H field (ie, the magnetic field strength) can be measured in multiple orthogonal directions (for example, two) to get an idea of what charge the patient is delivering. These measurements can provide additional information that can be taken into account in situational recognition. For example, the combination of radiative resistance measurements, caparticular coupling measurements, antenna input impedance measurements and H field can create a specific signature for a type of surgery or patient condition, so that situational recognition as employed by central medical controller and / or the cloud system can incorporate the specific standard to help determine if the course of surgery is progressing as expected or if something is wrong.
[0180] [0180] Figure 16 is a 209000 circuit diagram of a circuit for calculating parameters of an antenna, in accordance with at least one aspect of the present description. The RF generator 209005 is connected in a monopolar circuit through the patient's body in a conductive block 209010. In one aspect, the surgical system may include a direct and reflected power meter (ie, a directional coupler) 209015 coupled to the block 209010 or another part of the system to measure the standing wave ratio (SWR), which is an indication of how in or out of tune an antenna circuit is. This SWR is another substitute for changes in the antenna load. The example diagram 209025 shows a strip line F / R power measurement that can be expressed within the 209015 F / R power meter. Consequently, the shape of the antenna (for example, rectangular) formed by the 209010 monopolar return block can be considered, for example, a 209020 patch antenna. Parameters for this patch antenna can be calculated using the formulas and assumptions revealed, for example, in "Analysis and Design of the Rectangular Microstrip Patch Antennas for TMono Operating Mode ", Pasquale Dottorato, October 8, 2010, available at http://www.microwavejournal.com/ext/resources/BGDownload/1/f/Anal ysis Design RMPA TMOnNO.pdf),) and https: // wWww .pasternack.com / t- calculator-microstrip-ant.aspx, each of which is incorporated herein by reference, in its entirety. These readings from
[0181] [0181] In one aspect, radiative resistance measurement can be used in conjunction with nerve stimulation to detect the patient's movement that is in sync with the stimulation signal, as revealed, for example, at https: // en. wikipedia.org/wiki/Radiation resistance and https://www.emscan.com/products/antenna-testing/, each of which is incorporated herein by reference in its entirety. Situational recognition can also incorporate these readings, similar to the descriptions above. Automatic adjustment of the Monopolar Return Block
[0182] [0182] In several aspects, the surgical system can be configured for automatic adjustment and compensation of variations in the capacitance of the coupling of the monopolar return block to the patient. In many ways, the system can compensate for variations in coupling capacitance by adjusting the power of the connected devices or by adjusting the frequency.
[0183] [0183] In one aspect, the control system may include compensation networks capable of adjusting the power of the connected devices based on the detected connection. Consequently, the networks could compensate for changes in the capacitance of the monopolar return block.
[0184] [0184] Figure 17 is a 209100 diagram showing a compensation circuit to adjust the applied power, in accordance with at least one aspect of the present description. The RF generator 209110 is coupled to an active probe that touches the patient 209105. The patient is on a conductive return block 209115, which is connected to a return probe that leads to a compensation relay 209120. A relay driver 209125 it can be configured to control the 209120 compensation relay. In one aspect, the surgical system could be configured to measure the power in the patient and the capacitive block and adjust, in real time, a compensation network so that the power reaches a peak. In this example, the compensation relay has five relays, such as A, B, C, D and one offset. Each of relays A to D can be switched on or off in a binary mode, with each successive relay providing a compensation inductance equal to 2 times the previous relay. As an example, the inductance of D can be 2 times the inductance of C, and 4 times the inductance of B, and 8 times the inductance of A. Relay drive 209125 can be governed by a processor that is configured to activate a or more of these relays to provide compensation for the energy applied to achieve peak power. In an alternative aspect, a circuit can be configured to minimize the reflected power, instead of reaching the peak of the applied power. The relays can instead be used in a similar way to minimize reflected power.
[0185] [0185] Figure 18 is a logical flow chart 209200 of a process to reach the peak of applied power, according to at least one aspect of the present description. In one respect, switches on various networks (for example, inductors) can be used to constantly "peak" the generator's power output, such as those described in Figure 17. This process is similar to an automatic antenna tuner on sense that it is always seeking to reach peak power in the load when there are static and dynamic conditions that provide a disparity between the source and the load.
[0186] [0186] Figure 19 is a 209300 illustration of a set of graphs 209305 and 209330 representing the generator power level and patient continuity versus time, respectively, in accordance with at least one aspect of the present description. The two graphs are synchronized to the same geometric time axis. Illustration 209300 can show an example of the interrelationships between the generator power level and the patient continuity to the return block (expressed by ohms measured in the return block), as an example of some types of information that can be incorporated in situational recognition when a patient is placed on a return block.
[0187] [0187] In the first graph 209305, some sample readings may include a 209310 limit line for maximum generator power and a 209315 limit line for maximum generator user configuration power. Plot 204320 therefore reflects the actual applied power of the monopolar probe, and it can be seen that the applied power reaches a maximum at the user configuration threshold
[0188] [0188] In the second graph 209330, plot 209335 represents a measure of resistance in the return block, expressed in ohms. Resistance can be an expression of how connected the patient is to the return block, where the highest measured resistance generally indicates that the patient is not as well connected to the return block.
[0189] [0189] As shown, the markings in ti, to, ta, ta, ts and ts show changes in the state of the generator and the patient that are reflected in both graphs, but in different ways. For example, at t1, the resistance drops as the power of the monopolar probe is applied to the patient, closing the circuit and reflecting the fact that the patient is properly connected to the block. When the power is increased by t and ends at t3, the resistance drops further, which is expected. However, at t, something that may have happened to the patient and the patient is somehow not connected sufficiently to the block, reflecting a sudden increase in resistance. Correspondingly, the generator power can be turned off and / or the probe disconnected from the patient. This is represented by the tw period. During this time, steps can be taken to verify that the patient is well and that any recovery steps are taken before proceeding. From ts to ts, the generator power can be incrementally increased and it is verified that the patient is properly connected to the return block again. After that, the process continues as intended, as reflected in the rest of the charts.
[0190] [0190] This type of combined information can be used to make determinations about the patient's position on the block, and can be incorporated into types of patterns used by the situational recognition of the central medical controller and / or cloud system for future surgeries or operations of a similar nature. In this way, situational recognition can be applied to signal patterns of information that were consistent or even identical to the last anomalous occurrences that may resemble some of the problem situations described in Figure 19. Similarly, when the information appears consistent with the times where an anomaly has not occurred, the central medical controller and / or cloud system can use situational awareness to allow the procedure to continue.
[0191] [0191] Figure 20 is an illustration of a 209400 patient located on a 209410 monopolar return block during a surgical procedure, in accordance with at least one aspect of the present description. The 209410 return block is connected to a 209420 monopolar generator module with a continuity sensor capable of detecting the patient's continuity according to the disclosures of the present invention. The 209415 monopolar pen or probe will be configured to apply RF energy to patient 209405 and complete the monopolar circuit. In some cases, the 209415 probe may also include functionality provided by a 209425 smoke evacuation module to perform smoke and other debris evacuation functions. This configuration is an example that can use situational recognition and make exemplary measurements involving block 209410, as described in this description.
[0192] [0192] Figure 21 is a 209500 block diagram of a system for controlling a power level applied by a monopolar instrument, in accordance with at least one aspect of the present description. The 209500 block diagram shows exemplary interrelationships of a monopolar generator system and the directionality of the power and inputs received from various components. Here, the power of the 209530 RF generator is supplied to a 209505 monopolar pen. The energy flowing through the monopolar pen is applied to a 209510 patient, who is somehow touching capacitive block 209515. A continuity measurement is determined by one or more of the exemplary descriptions provided here, expressed as the block
[0193] [0193] In another aspect, a control system can compensate for variations in the capacitance of the coupling of the monopolar return block to the patient by changing the frequency. Consequently, the control system can change the frequency to compensate for the capacitance in the monopolar return block.
[0194] [0194] In one aspect, an agile frequency generator can constantly sweep the output frequency over a predefined range, in combination with a fixed inductor in series with the return block or with a peak compensation network to reach the peak power output as described above. The reactance of the capacitor formed by the patient and the block will change based on the contact that the patient makes with the block, and this will compensate for these changes.
[0195] [0195] In another aspect, a control system can adjust the output frequency of the generator to look for the peak output power when using a reactive impedance block (for example, capacitive). Return Block Feedback
[0196] [0196] In several respects, a control system can provide feedback on the quality / contact of the return block and inform the operating room staff about the current efficiency of the return block. The central medical controller can provide an indication, through a graphical user interface or one or more auditory signals, of the patient's connectivity to the return block or if there is any disconnection. Some examples of methods for making this determination are described above. Nerve Stimulation Integration
[0197] [0197] In several aspects, the functionality of the monopolar generator and / or return block can be integrated with nerve stimulation indications.
[0198] [0198] In one aspect, the central surgical controller can be configured to modulate energy (for example, energy applied by a generator to a monopolar electrosurgical instrument) based on nerve mapping and situational recognition. In addition to alerting the surgeon when he approaches a nerve, cutting energy (for example, electrosurgical, ultrasonic or similar) can be reduced as the surgeon cuts closer to a nerve structure identified by the central surgical controller. For example, energy can be interrupted when the surgeon is about to damage a nervous structure identified by the central controller. In one aspect, the surgeon needs (for example, through the central surgical controller) to make a conscious decision to override an alert and a drop in power or the inability to deliver power based on the central surgical controller's recognition of a nerve mapping . Consequently, energy modulation by the central surgical controller can be based on nerve mapping and situational recognition. Figure 22 shows a 209600 illustration of a 209605 probe approaching a 209615 nerve. The 20 9605 probe can touch the surgical site at location 209610, which is a short distance from the 209615 nerve. Determining how close the 209605 probe is this nerve's 209615 can be based on a nerve mapping of the patient and augmented by aggregated mappings of that area from other previous patient surgeries. In addition, in some cases, the resistance profile and other measurements through the use of the 209605 probe and the patient standing on the monopolar return block can provide an indication that the probe is touching an area that is close to the 209615 nerve. energy may respond differently to this area compared to when the 209605 probe is touching other parts of the patient, and based on situational recognition that may have aggregated information obtained from similar previous cases, the central surgical controller can alert the surgeon.
[0199] [0199] Similarly, Figure 23 shows an Illustration 209700 of a 209705 probe directly touching a 209715 nerve at the site
[0200] [0200] Various aspects of the subject described in this document are defined in the following numbered examples:
[0201] [0201] Example 1: A surgical system comprising: a monopolar return block; a central surgical controller coupled in a communicable way to the monopolar return block, the central surgical controller comprising a control circuit configured to determine the presence and position of a patient on the monopolar return block according to the data received from the block monopolar return.
[0202] [0202] Example 2. Surgical system of Example 1, the control circuit being configured to control a visualization medium according to the determined presence and / or determined position of the patient on the monopolar return block.
[0203] [0203] Example 3. The surgical system of either Example 1 or 2, the control circuit being additionally configured to: control an electrosurgical generator to provide a variable range of electrosurgical frequencies to the patient; and monitoring a response to the variable range of electrosurgical frequencies by the monopolar return block to determine the patient's position.
[0204] [0204] Example 4. The surgical system of any of Examples 1 to 3, the control circuit being additionally configured to: determine a generator's maximum power according to capacitive coupling variations of the monopolar return block; and properly adjust generator power.
[0205] [0205] Example 5. Surgical system of any of Examples 1 to4, the control circuit is additionally configured to monitor the radiative resistance of the monopolar return block to determine the presence or position of the patient on the monopolar return block .
[0206] [0206] Example 6. Surgical system of any of Examples 1 to 5, the control circuit being additionally configured to use situational recognition in combination with the monitored radiative resistance of the monopolar return block to determine the presence or position of the patient, by comparing the radiative resistance monitored with the previous radiative resistance data obtained in similar situations from other patients on monopolar return blocks located in a similar way.
[0207] [0207] Example 7. Surgical system, from any of Examples 1 to 6, the control circuit being additionally configured to monitor the parasitic load of the monopolar return block to determine the presence or position of the patient on the block monopolar return.
[0208] [0208] Example 8. Surgical system of Example 7, the control circuit being additionally configured to use situational recognition in combination with the monitored parasitic load from the monopolar return block to determine the presence or position of the patient, by comparison of the monitored parasitic load with the previous parasitic load data obtained in similar situations of other patients in similarly located monopolar return blocks.
[0209] [0209] Example 9. Surgical system of any of Examples 1 to 8, which additionally comprises a monopolar surgical device configured to stimulate a nerve using RF energy at a surgical site of the patient, the control circuit being additionally configured to monitor the patient's movement based on nerve stimulation to determine the patient's presence or position on the monopolar return block.
[0210] [0210] Example 10. A surgical system comprising: an electrosurgical instrument; a generator coupled to the electrosurgical instrument; a central surgical controller coupled in a communicable manner to the generator, the central surgical controller comprising a control circuit configured to modulate a nerve and / or power detection waveform supplied by the generator to the electrosurgical instrument based on the situational recognition of the instrument electrosurgical and / or generator.
[0211] [0211] Example 11. Surgical system of Example 10, where situational recognition is based on a type of surgery, an anatomical site, an activation state of the electrosurgical instrument, previous nerve detections due to previous signs at a surgical site, continuity of a return block and / or proximity to critical structures at the surgical site.
[0212] [0212] Example 12. The surgical system of either Example or 11, where: situational recognition comprises knowledge of previous nerve stimulation measurements; and the control circuit is 1 the electrosurgical instrument approaches or moves away from a detected nerve.
[0213] [0213] Example 13. The surgical system of any of Examples 10 to 12, where: situational recognition comprises knowledge of a type of surgery of a surgery being performed and / or an anatomical site of the surgery; and the control circuit is configured to adjust the nerve detection waveform accordingly.
[0214] [0214] Example 14. Surgical system of any of Examples to 13, the control circuit being configured to adjust the nerve detection waveform according to a power level of the electrosurgical instrument.
[0215] [0215] Example 15. A surgical system comprising: a monopolar return block; and a central surgical controller coupled in a communicable way to the monopolar return block; and a monopolar surgical instrument coupled communicably to the central surgical controller and configured to supply power to a patient on the monopolar return block; the central surgical controller comprising a compensation circuit configured to adjust the power to the monopolar surgical instrument to maintain peak applied power in the monopolar surgical instrument while the patient is in the monopolar return block.
[0216] [0216] Example 16. Surgical system of Example 15, the compensation circuit comprising a plurality of binary compensation relays.
[0217] [0217] Example 17. The surgical system of Example 16, the adjustment of power to the monopolar surgical instrument comprises: measuring a power level of the monopolar surgical instrument; increase the power supplied to the monopolar surgical instrument with the use of the plurality of compensation relays per one supply unit; measure the power level of the monopolar surgical instrument after the power is increased; and comparing the power level before the power is increased with the power level after the power has been increased.
[0218] [0218] Example 18. The surgical system of Example 17, the adjustment of the power to the monopolar surgical instrument further comprising: determining that the power level before the power is increased is higher than the power level after the power is incremented; and keep the power level accordingly.
[0219] [0219] Example 19. The surgical system of any of Examples 15 to 18, the control circuit being additionally configured to: determine the presence and position of a patient on the monopolar return block according to the data received the monopolar return block; and automatically interrupting the power supplied to the surgical instrument after determining that the patient is out of position or outside the monopolar return block.
[0220] [0220] Example 20. Surgical system of Example 19, the control circuit being additionally configured to use situational recognition to determine that the patient is out of position or outside the monopolar return block.
[0221] [0221] Although several 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 are revealed for certain components, other materials can be used. It should be understood, therefore, that the preceding description and the appended claims are intended to cover all such modifications,
[0222] [0222] The preceding detailed description presented various forms of devices and / or processes through the use of block diagrams, flowcharts and / or examples. Although these block diagrams, flowcharts and / or examples contain one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation within these block diagrams, flowcharts and / or examples can be implemented, individually and / or collectively, through a wide range of hardware, software, firmware or virtually any combination thereof. Those skilled in the art will recognize, however, that some aspects of the aspects disclosed herein, in whole or in part, can be implemented in an equivalent manner in integrated circuits, such as one or more computer programs running on one or more computers (for example, as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (for example, as one or more programs running on one or more microprocessors), as firmware, or virtually as any combination of them, and that designing the circuitry and / or writing the code for the software and firmware would be within the scope of practice of those skilled in the art, in light of this description. In addition, those skilled in the art will understand that the mechanisms of the subject described herein can be distributed as one or more program products in a variety of ways and that an illustrative form of the subject described here is applicable regardless of the specific type of transmission medium. signals used to effectively carry out the distribution.
[0223] [0223] The instructions used to program the logic to execute various revealed aspects can be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory or other storage. In addition, instructions can be distributed over a network or through other computer-readable media. Thus, machine-readable media can include any mechanism to store or transmit information in a machine-readable form (for example, a computer), but is not limited to, floppy disks, optical discs, read-only compact disc ( CD-ROMs), and optical-dynamos discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), cards magnetic or optical, flash memory, or a 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).
[0224] [0224] 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 instruction processing units - individual, 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)),
[0225] [0225] 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.
[0226] [0226] 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.
[0227] [0227] As used here in one aspect of the present invention, an "algorithm" refers to the self-consistent sequence of steps that lead to the desired result, where a "step" refers to the manipulation of physical quantities and / or logical states that can, although they do not necessarily need to, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is common use to call these signs bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may be associated with adequate physical quantities and are merely convenient identifications applied to those quantities and / or states.
[0228] [0228] 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 Engineers (IEEE) entitled "IEEE 802.3 Standard", published in December 2008 and / or later versions of this standard. Alternatively or in addition, communication devices may be able to communicate with each other using an X.25 communications protocol. The X.25 communications protocol can conform or be compatible with a standard promulgated by the International Telecommunication — Union-Telecommunication Standardization Sector (ITU-T). Alternatively or in addition, communication devices may be able to communicate with each other using a frame - relay communications protocol. The frame-relay communications protocol can conform to or be compatible with a standard promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, transceivers may be able to communicate with each other using an asynchronous transfer mode ("ATM") communication protocol. The ATM communication protocol can conform to or be compatible with an ATM standard published by the ATM forum entitled "ATM-MPLS Network Interworking 2.0" published in August 2001, and / or later versions of that standard. Obviously, different and / or post-developed connection-oriented network communication protocols are also contemplated in the present invention.
[0229] [0229] 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 information storage, transmission or display devices.
[0230] [0230] 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.
[0231] [0231] 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.
[0232] [0232] Persons skilled in the art will recognize that, in general, the terms used here, and especially in the appended claims (for example, bodies of the appended claims) are generally intended as "open" terms (for example, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having, at least", the term "includes" should be interpreted as "includes, but is not limited to ", etc.). It will also be understood by those skilled in the art that, when a specific number of a claim statement entered is intended, that intention will be expressly mentioned in the claim and, in the absence of such mention, no intention will be present. For example, as an aid to understanding, the following appended claims may contain the use of the introductory phrases "at least one" and "one or more" to introduce claim statements. However, the use of such phrases should not be interpreted as implying that the introduction of a claim statement by the indefinite articles "one, ones" or "one, ones" limits any specific claim containing the mention of the claim entered to claims that contain only such a mention, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles, such as "one, ones" or "one, ones" (for example, "one, ones" and / or "one, ones" should typically be interpreted as meaning "at least one" or "one or more"); the same goes for the use of defined articles used to introduce claims.
[0233] [0233] 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".
[0234] [0234] In relation 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.
[0235] [0235] 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 features, structures or characteristics can be combined in any appropriate way in one or more aspects.
[0236] [0236] Any patent application, patent, non-patent publication or other description material mentioned in this specification and / or mentioned in any order data sheet is hereby incorporated by reference, to the extent that the materials incorporated are not inconsistent with that. Accordingly, and to the extent necessary, the description as explicitly presented herein replaces any conflicting material incorporated by reference to the present invention. Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other description materials contained herein, will be incorporated here only to the extent that there is no conflict between the embedded material and the existing description material.
[0237] [0237] In summary, numerous benefits have been described that result from the use of the concepts described in this document. The previously mentioned description of one or more modalities has been presented for purposes of illustration and description. This description is not intended to be exhaustive or to limit the invention to the precise form disclosed. Modifications or variations are possible in light of the above teachings. One or more modalities were chosen and described in order to illustrate the principles and practical application to, thus, allow those skilled in the art to use the various modalities and with various modifications, as they are convenient to the specific use contemplated.
It is intended that the claims presented in the annex define the global scope.

权利要求:
Claims (20)
[1]
1. Surgical system characterized by comprising: a monopolar return block; and a central surgical controller coupled in a communicable way to the monopolar return block, the central surgical controller comprising a control circuit configured to determine the presence and position of a patient on the monopolar return block according to the data received from the monopolar return block.
[2]
2. Surgical system, according to claim 1, characterized in that the control circuit is configured to control a visualization means according to the determined presence and / or determined position of the patient on the monopolar return block.
[3]
3. Surgical system, according to claim 1, characterized in that the control circuit is additionally configured to: control an electrosurgical generator to provide a variable range of electrosurgical frequencies to the patient; and monitoring a response to the variable range of electrosurgical frequencies by the monopolar return block to determine the patient's position.
[4]
4. Surgical system, according to claim 1, characterized in that the control circuit is additionally configured to: determine a maximum power of a generator according to the capacitive coupling variations of the monopolar return block; and adjust a generator power accordingly.
[5]
5. Surgical system according to claim 1, characterized in that the control circuit is additionally configured to monitor the radiative resistance of the monopolar return block to determine the presence or position of the patient on the monopolar return block.
[6]
6. Surgical system, according to claim 1, characterized in that the control circuit is additionally configured to use situational recognition in combination with the monitored radiative resistance of the monopolar return block to determine the presence or position of the patient, by comparison of the radiative resistance monitored with the previous radiative resistance data obtained in similar situations from other patients on monopolar return blocks located in a similar way.
[7]
7. Surgical system according to claim 1, characterized in that the control circuit is additionally configured to monitor the parasitic loading of the monopolar return block to determine the presence or position of the patient on the monopolar return block.
[8]
8. Surgical system according to claim 7, characterized in that the control circuit is additionally configured to use situational recognition in combination with the monitored parasitic loading of the monopolar return block to determine the presence or position of the patient, by comparison of monitored parasitic loading with previous parasitic loading data obtained in similar situations from other patients in similarly located monopolar return blocks.
[9]
9. Surgical system, according to claim 1, characterized in that it additionally comprises a monopolar surgical device configured to stimulate a nerve using RF energy in a surgical site of the patient, the control circuit being additionally configured to monitor the patient's movement based on the nerve stimulus to determine the patient's presence or position on the monopolar return block.
[10]
10. Surgical system characterized by comprising: an electrosurgical instrument; a generator coupled to the electrosurgical instrument; and a central surgical controller communicably coupled to the generator, the central surgical controller comprising a control circuit configured to modulate a nerve and / or power detection waveform supplied by the generator to the electrosurgical instrument based on the situational recognition of the electrosurgical instrument and / or generator.
[11]
11. Surgical system according to claim 10, characterized in that situational recognition is based on a type of surgery, an anatomical site, an activation state of the electrosurgical instrument, previous nerve detections due to previous signs at a surgical site, continuity of a return block and / or proximity to critical structures at the surgical site.
[12]
12. Surgical system, according to claim 10, characterized by: situational recognition comprising knowledge of previous nerve stimulus measurements; and the control circuit is configured to adjust the nerve detection waveform or generator amplitude as the electrosurgical instrument approaches or moves away from a detected nerve.
[13]
13. Surgical system, according to claim 10, characterized by: the situational recognition comprises the knowledge of a type of surgery of a surgery being performed and / or an anatomical site of the surgery; and the control circuit is configured to adjust the nerve detection waveform accordingly.
[14]
14. Surgical system according to claim 10, characterized in that the control circuit is configured to adjust the nerve detection waveform according to a power level of the electrosurgical instrument.
[15]
15. Surgical system characterized by comprising: a monopolar return block; and a central surgical controller coupled in a communicable way to the monopolar return block; and a monopolar surgical instrument coupled communicably to the central surgical controller and configured to supply power to a patient on the monopolar return block; the central surgical controller comprising a compensation circuit configured to adjust the power to the monopolar surgical instrument to maintain peak applied power in the monopolar surgical instrument while the patient is in the monopolar return block.
[16]
Surgical system according to claim 15, characterized in that the compensation circuit comprises a plurality of binary compensation relays.
[17]
17. Surgical system, according to claim 16, characterized in that the power adjustment to the monopolar surgical instrument comprises: measuring a power level of the monopolar surgical instrument; increase the power supplied to the monopolar surgical instrument with the use of the plurality of compensation relays per one supply unit; measure the power level of the monopolar surgical instrument after the power is increased; and comparing the power level before the power is increased with the power level after the power has been increased.
[18]
18. Surgical system according to claim 17, characterized in that the power adjustment to the monopolar surgical instrument further comprises: determining that the power level before the power is increased is higher than the power level after the power is incremented; and keep the power level accordingly.
[19]
19. Surgical system, according to claim 15, characterized in that the control circuit is additionally configured to: determine the presence and position of a patient on the monopolar return block according to the data received from the monopolar return block; and automatically interrupting the power supplied to the surgical instrument after determining that the patient is out of position or outside the monopolar return block.
[20]
20. Surgical system according to claim 19, characterized in that the control circuit is additionally configured to use situational recognition to determine that the patient is out of position or outside the monopolar return block.
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ES E 8º o and uu 8 as - Ss o E) O |
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ES CSA E / o We
QB MW &
UNR MONITOR 135 MODULE 106
IMAGE 138 [|
SYSTEM OF
GENERATOR MODULE VIEW 140 [| 108 142 [1 44 q sea
D 143 [|
SYSTEM MODULE 126 ROBOTIC SMOKE EVACUATION 110 MODULE OF - SUCTION / 128 IRRIGATION =
INSTRUMENT MODULE 130 INTELLIGENT COMMUNICATION MODULE 2 2 132 | 136 MATRIX PROCESSOR 134 STORAGE
MODULE OF
MAPPING 133 OPERATION ROOM

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同族专利:

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公开号 | 公开日

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US20190201128A1|2019-07-04|

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CN111712206A|2020-09-25|

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JP2021509054A|2021-03-18|

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EP3505122A2|2019-07-03|

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WO2019133147A1|2019-07-04|

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EP3505122A3|2019-11-06|

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