WO2021117024A1

WO2021117024A1 - Scrub nurse robot and sterilization of surgical instruments

Info

Publication number: WO2021117024A1
Application number: PCT/IB2021/050035
Authority: WO
Inventors: Farahnaz SHIRMOHAMMADI; Mohammadali GHAED
Original assignee: Shirmohammadi Farahnaz; Ghaed Mohammadali
Priority date: 2019-12-14
Filing date: 2021-01-05
Publication date: 2021-06-17

Abstract

The scrub nurse robot and surgical instrument sterilization is an innovative idea and has no precedent. Often errors occur that are unjustifiable and irreparable due to forgetfulness and hurried performance.If instruments or gauze accidentally or carelessly were left in the body of the patient during surgery, irreparable dangers for all persons involved would occur. In addition to accurately counting instruments, from the beginning to the end of surgery, the scrub nurse robot is able to interact properly with the surgical team to deliver and receive tools and gauze. In the case of any shortage in number and type of instrument or gauze, by alerting the lights and alarm, the surgical team will be informed by the robot of that shortage. The robot is also able to sterilize all instruments after surgery.

Description

Description of the Invention

Title of the invention as mentioned in the declaration

Scrub nurse robot and sterilization of surgical instruments

Technical background of the related invention

This invention is related to the field of surgical robots that works as a scrub nurse, functioning on electricity and a battery, in the operating room and next to the surgeon. The robot has unique features, including being equipped with electronic eyes and an auditory system for instrument detection, a computer for data analysis, and a system for instrument sterilization. It is also designed with several separate compartments in which to store surgical instruments and deliver at the right time. A sterilization compartment is designed at the bottom area of this robot.

Technical problem and statement of invention goals

People in the world of today are trying to increase speed and accuracy more than before in their daily jobs. However, humans will not be able to achieve these goals without the help of robots. In addition, there are many patients over their lifetime needing surgical treatments by doctors. In the past, one of the biggest hospital challenges was related to the hospital surgical ward, where there was a possibility of instruments remaining, or even sterile gauze, in the bodies of patients during surgery. This has created serious and irreparable risks for patient health as well as many problems for the surgical team by not paying attention in the operating room. In fact, one of the important responsibilities assigned to the staff in the operating room is to count the instruments and gauze, sterile and used, before and after the operation as well as before suturing the body of the patient. The scrub nurse is responsible for controlling the instrument count during surgery. Counting is done in an operating room by two people and all instruments must be carefully recorded after counting, however, they have had many problems, which have led to instruments remaining in the bodies of patients endangering many lives. One of the purposes of inventing the scrub nurse robot was to prevent any fault of instruments and gauze remaining behind in the bodies of patients, eventually allowing the surgical team to work with peace of mind focusing more diligently on patient surgery. Indeed, this robot has permitted the surgical team to entrust one of the most important parts of surgical work over to an intelligent system functioning with more accuracy than any human can. In addition, it creates a feeling of confidence for patients. With the scrub nurse robot, all worries about leaving instruments or gauze in patient bodies are reduced to zero. Another purpose of this invention is to have a sterile class of surgical instruments with greater accuracy after counting.

A description of the state of prior knowledge and history of advances in connection with the claim of the invention

According to previous inventions in the field of health, most have been accomplished with only one application. A robot, which is only responsible for the count of instruments and gauze as a scrub nurse, and in more advanced robots, designed in such a way to provide all instruments and gauze needed to deliver and later receive them from the surgeon. The robot was used by interaction with the medical team having some restrictions. Designs of surgical robots are usually made with one function. One robot was designed to count instruments and another one interacted with the surgical team in delivering and receiving instruments. Invention No. 74312 has been registered in 2011 by Mahboubeh Hassanzadeh Mahani, Raheel Hassanzadeh Mahani, and Reza Hassanzadeh Mahani as a smart surgical table for counting surgical instruments and gauze, but with the help of a human nurse, delivered or received and even recounted the instruments and gauze. In fact, it was only a desk for the availability and counting of instruments and gauze made possible with the presence of a nurse. Invention No. 97253 registered in 2017 by Hesamuddin Atashi is a three-dimensional tracer device using radio waves for surgical instruments left in the body of patients, and is a tracer device used during surgery that solely detects instruments left in the patient bodies. Many robots and devices around the world related to surgery have been designed that have been, to date, used only once or with the help of a nurse. In designing the scrub nurse robot, attempts have been made so that all the tasks of a scrub nurse can be performed. Scrubbing and sterilizing surgical instruments, counting and preventing the instruments and gauze from remaining in the body of a patient, like-human communication with the surgical team, and sterilizing the instruments after surgery without the help of a human nurse, can be realized in the robot that does everything automatically and with great accuracy.

Providing a solution for the existing technical problem with an accurate, sufficient, and integrated description of the invention

The scrub nurse robot works in the operating room with the medical team and has unique features. The power supply for this robot is electricity and a battery. This robot is used for all surgeries, including urological surgeries, orthopedics, ENT, neurology, and general surgery, and maintenance of surgical sets. The scrub nurse robot is fully automatic and has a computer with an advanced CPU or central processor unit (1) to process all required information. It also has internal default information recorded, in the form of a program, as the main data including the type of surgical set, instrument names, and instrument shapes. All automatic programs of this robot are based on an electronic kit receiving information from an electronic circuit. In this part, the circuits are divided into small blocks and the codes related to the main circuit are prepared. In fact, these codes design the hardware. The robot also has a monitor in the center and two touch-sensitive LCD screens (2) on both sides with the help of a so-smart kit and a circuit for data analysis. This screen is equipped with information on selecting the type of surgery and the number of instruments needed. There is a sterile system selection option (2-1), a screen for showing type and number of instruments delivered (2-2) by the robot, type and number of instruments received ( 2-3), a red light warning, as well as an alarm for type and number of instruments that have been delivered and not yet received (2-4). Finally, there is a count of sterile instruments and gauze. Before starting surgery, the surgical team selects the type of surgery (2-1) and the robot starts its tasks automatically. It should be noted that the lights and alarm (2-4) are activated at the end of the surgery if there is a lack of instruments and gauze, and after selecting the fulfillment button on the main screen (2-1) the final count by the robot activates automatically, but an alarm is not activated during surgery. This robot has several sensors to receive and respond accurately at the right time. These sensors work with the help of motion signals to deliver and receive instruments. Visual and auditory sensors also have the power of recognizing and analyzing information that is commanded by a computer. On this robot, visual sensors are designed by electronic eyes for recognition of instruments, auditory sensors are designed to hear surgeon requests for recognized instruments, and motion sensors are designed on the robot hands. This intelligent robot has an electronic eye that is located on a computer (3) and is used for recognition of the position of the surgeon, and is able to distinguish them with the help of a CPU and a visual sensor. It also has an auditory system (4) to hear the surgeon requests to deliver the required instruments. For the instruments and gauze to remain sterile during surgery, two separate movable arms (5) are provided for the robot to deliver and receive them. One arm has been designed to deliver the instruments and gauze and the other has been designed to receive them. Mechanical arms are designed as electrical actuators consisting of connectors (5-1) that are connected by a cable to the main circuit, which are connected by three pneumatic jacks (5-5) that make a systematic chain giving the arms five degrees of freedom. The movement of the arms is done by cables that are connected to the robot motor and computer embedded in its body. Coordinates or computer programs are used for moving the robot to make correct calculations such as moving jacks, specifying movement direction, speed, and position of the mechanical arms.

An electronic eye (6) is provided on each moving arm that is for robot recognition of the instruments. These electronic eyes are directly connected to the computer where all the information about the instruments is recorded. The electronic eye distinguishes and identifies the instruments using the basic data in the computer, and finally removes it with the help of its fingers and provides them to the surgeon. Each arm is also equipped with cables that are connected to the circuit (5-1) and the body of the robot and has several separate rotary joints (5-2), signals, and motion sensors to communicate with the outside environment. The joints are also connected to the electronic circuit by attachments. The connection point of the arm parts, cables and screws, joints, pneumatic jacks, and a number of servers are designed for each arm. The servers are also connected to the robot engine. All arm parts are connected by screws and cables. One end of the cables (5-1) is connected to the electronic circuit to enable controlling and moving. A separate cable also connects the electronic eye (6) on each arm to the main circuit. Therefore, signals are sent to move the arms from the circuit to the motion sensors, thereby allowing the arms to do automatic tasks. The robotic arm circuit is designed for efficient routing of various wires and motion signals. In this robot, a rotary joint (5-2) has been designed for better movement of both parts of the arm, which is able to deliver and receive instruments from the surgeon. These rotary joints make the rotational movement between the parts of the arm easier. With the help of jacks, the movement is embedded for the arm to open and close or move up and down, as well as for the fingers and their opening and closing to remove instruments in the compartment that can be used during surgery. Each arm has four fingers (5- 3), and several sensors and a jack to move them. The fingers are connected by short cables and several servers, which are connected to the motor and electronic circuit. The tips of this robot fingers are made of small and flexible sponge (jelly) TacheS (5-4) that prevent instruments from falling. These small sponges facilitate the delivery and receipt of the tools during surgery. To keep the robot arms sterile, a plastic cover is on each arm and the fingers keeping the robot from being washed. After the delivery of the instruments, a symbol representing the tool type and its number is displayed as a number on the computer screen (2-2), and after receiving the surgical instruments, the alarm sign (2-4) automatically turns off. This part is related to the robot automatic counting system and is done through the computer mechanism of the robot. This robot acts like a human, but with more accuracy. In fact, when the surgeon requests scissors, it is enough to say the word ‘scissors’ that the language embedded in the robot electronic system allows a quick response. The robot uses an electronic kit, which initially has an image, name, type, and number display. The instrument is recorded and recognized by electronic eyes on the arms (6) and provided to the surgeon. Electronic information of all instruments of each surgical set has been entered as primary data, is recognized by the robot and when the surgeon requests the instruments, picks them up with the actuator arm, and delivers to the surgeon. After delivering the instruments and gauze to the surgeon, it records and displays the type and number of tools and gauze on the screen (2-2). The robot nurse has several compartments for scrubbing and sterilizing surgical instruments. On the top level, a surgical set plate (7) is designed to maintain and control the weight of each surgical set after selection. This allows a person to choose, from the monitor, a suitable set encased in a sterile cloth and then directs the plate to the top level automatically. The person installs the set on the surgical set plate (7). Surgery begins then the instrument is unloaded completely and the empty tray returns to its previous location. The robot also consists of separate classes of surgical instruments, each designed for a surgical set (8). By selecting the type of surgery, located on the center of the LCD monitor (2-1), the robot intelligence system receives the information, moves upwards the desired tray (which comes out as a drawer) with the help of two designed gears that are around each tray. On either side of the outer wall of each level (on the body of the robot), there is a vertical rail from top to bottom (9) on which the two gears of each tray are placed on the rail (when the desired drawer ejects after selection). The station is now ready for performance of surgery. The selected instrument tray stands ready at the top, and then the designed top weight control plate of the surgical set (7) comes out horizontally for holding instruments and the controlling of their weight. The surgery begins when the robot hears the surgeon requests to receive the pertinent instruments, thereby interacting and delivering them to the surgeon. When surgery has been completed and selection of the ‘end’ button, located in the center of the monitor (2-1), has been made the robot will make the final count of all tools and gauze received. After the tool has been delivered, a final count is made and when the robot finds that it has not received an instrument or gauze, it automatically sounds a light and alarm (2-4) on the monitor screen (2-3). It will continue the alert until the desired instrument is delivered to it. Only if the instrument is delivered are all lights and alarms deactivated simultaneously and automatically. The importance of this matter is found in that the surgical team is informed that the robot has not received all instruments or gauze. It should be noted that the surgical team must select the ‘End’ button before the body of the patient is sutured so that the robot can count the instruments and gauze. After counting the gauze, the robot places them into the used gauze disposable bag bin (10) located next to the robot. This bin can be separated from the main body of the robot, washed, reused, and re-installed after it is emptied. Finally, with the delivery of all the instruments again on the surgical set plate (7), the plate is automatically placed on the rails (9) and led to the bottom by two gears that are on both sides of the tray. At the bottom of this robot is a compartment that is equipped with a sterilization system (11) and is designed to be waterproof similar to a dishwasher. This part is equipped with a thermal sensor for washing and sterilizing tools at a temperature of 25 to 30 degrees Celsius. It also has a drain valve (13), a brush for better washing the top of the sterile tray (14), water jets all around (15) for washing the instruments, and a water outlet pipe (16)all designed for better sterilization. There is a horizontal plate (12) under the robot to protect the sterilization compartment. When the set plate (7) used is moved to the bottom, the protective plate moves at the bottom to open the sterile tray door, and the set plate is moved by gears into the sterile tray. Finally, the lower protective plate (12) leads the tray up and locks it starting the sterilization process. At this point, water located in the operating room enters the sterilization compartment from the water supply inlet (13), and then moves the water to the jets through a pipe (15) and water pumps through water jet holes (15-1). In the drainage phase, it directs water to the outlet pipe. Dewatering is received from the water source, rinses at a temperature of 25-30 degrees, then, at the appropriate time, a sterile solution consisting of Sidex or DecoSpace is added (17). This solution spread over the floor of the tray where it has been pre placed in a special container for the solution by a nurse. (It opens and closes in a drawer and is easy to use). The solution container is equipped with a precise timer, which is added to the sterile tray in the second stage of washing, after rinsing and initial unloading. In this way, with a special washing brush (14) which moves from top to bottom by a pressurized spring lever (14-1) and by a rotation lever (14-2) located in the center. The brush rotates on the tools for a more thorough washing, and by the water jets pressure (15) streaming through the inlet holes (15-1), the instruments are thoroughly washed and rinsed. Conclusion of the sterilization operation happens in two stages ejecting all the fluids by way of the outlet pipe (16) extending from the lower part of the robot body (16-1); one end being placed in the path of the outlet pipe in the surgery room.

After sterilization, the robot automatically directs the bottom plate (12) to lock the sterile tray and directs the sterilized plate moving outwards and upwards. Finally, the nurse places them orderly in a sterile cloth and in a drawer or in their own compartment, which can be used again at another time. The tasks of the scrub nurse are now finished. This robot has four running wheels (18) which allow the robot to be easily moved by any person to any surgery room. It is worth mentioning that all the mechanisms of this robot are located inside it and in the back of the levels of the surgical set from the top to the bottom of the robot.

Explanation of shapes, maps and diagrams

Number 1 : Robot Computer Number 2: Robot Monitor

2- 1 : Monitor center to select the type of surgery and other functions

2-2: Screen for delivery of tools and gauze

2-3: Screen for receiving tools and gauze

2-4: Warning sign with lights and alarm

Number 3: Electronic robot eye

Number 4: Robot auditory system

Number 5: Robot arms

5-1: Connections and cables that can be connected to the robot circuit

5-2: Joints of arms

5-3: Fingers (grips) of each arm

5-4: Sponge balls (jelly) 5-5: Pneumatic jacks of arms Number 6: Electronic eyes on robot hands Number 7 : Control plate of surgical set weight Number 8: Separate classes of surgical sets

Number 9: Rails around the body of the robot to move trays up and down

Number 10: Collection bin of used gauze after counting

Number 11 : Sterile floor of tools

Number 12: Protection plate of sterile level and lock

Number 13: Water inlet pipe

Number 14: Washing brush for surgical instruments

14-1: Lever of up and down movement of brush

14-2: Lever for rotation on the tools Number 15: Water jets

15-1: Water pressure inlets on water jets

Number 16: Water outlet pipe after sterilization process

16-1: Path of water outlet in bottom of sterilization compartment Number 17: Protection tank of sterilization solution

Number 18: Robot wheels for ease of movement

Clear and precise statement of the advantages of the claimed invention over previous inventions

One of the advantages of this invention, compared to previous inventions, is the existence of a robot with a more complete function, in other words, a robot that has been designed with several applications. In the past, robots have been designed, in this field, not having all the features in one robot that are present in this scrub nurse robot. At present, the robot is not designed to do all the tasks related to the scrub section without the need for a human scrub nurse for the initial counting, delivery of tools and gauze, receiving tools and gauze, secondary counting, and final washing of the instruments with more precision than a human nurse. To make the surgery as easy as possible and to ensure surgical fidelity, including counting, the existence of such robots for surgery use is inevitable. Unlike previous inventions, in which devices are designed for only instrument counting, this robot provides the unique features more than previous inventions for the surgical teams. In the past, a counting device, before and after surgery, was designed by Iranian researchers in the form of a desk with a specific location for each instrument in the surgical set. This desk had a monitor on which the type of set had to be selected first, and finally, after the operation, its task was finished by counting each instrument. However, this desk was only used for counting and required a human scrub nurse to deliver, receive, and check the number of instruments. In fact, the previous design was able to provide services in a rudimentary way. Another design had been made to prevent the instruments from remaining in the body of a patient and was detected by radio waves after counting the instruments remaining and before suturing the body of the patient. Other designs, with relatively similar methods, had been presented by foreign researchers, which counted instruments and had different applications. Many of the designs were in the form of a device that only did the work of counting instruments and gauze. A robot has also been designed that only delivers and receives instruments and communicates with the surgical team in the operating room. There are also devices that sterilize the instruments. While the scrub nurse robot, in addition to counting the surgical instruments and gauze, establishes a relationship similar to a human nurse with the surgical team by delivering the instruments to the surgeon and receiving them when not needed by the surgeon. At the end of surgery, the robot is also responsible for washing and sterilizing the instruments (11); all operations being performed without demand of a human nurse. In fact, this robot does all the robot tasks and has all the devices related to the responsibility of a scrub nurse. In other words, all the applications of a scrub nurse and the sterilization process are performed by one robot. At the beginning of surgery, it is enough to select the surgical set on the robot monitor (2). In this way, each set is selected that is related to a corresponding category (8). The information is pre-recorded on the monitor about each surgical set and in which tray they are found. Finally, by selecting the surgical set, the robot received the information with the help of the smart kit and according to the relevant class of each set, that class was removed with the help of the robot engine, in the form of a slider intended for each class. Two gears are designed around each tray to lead the tray to the highest level of the robot compartments.

At the end of surgery and before suturing the body of the patient, it is enough to select the finalization of the operation on the monitor (2) to give the robot the task of safely counting the instruments and gauze. If the number of tools and gauze, which are received and are delivered, are equal, then the count is correct. If one of the instruments or gauze has not been received, a symbol (2-4) of the type and number of instruments or gauze will be displayed on the receiving screen (2-3) and the robot will then notify with a warning light and an alarm. For the purpose of prevention of misplacing instruments and gauze inside the body of a patient, two types of lights and alarms in the robot have been used. At the end of counting, the robot automatically places the dirty gauze in a bin (10). In order to sterilize the instruments, it is enough to select the option on the main monitor for sterilizing the instruments (2), which the robot will automatically direct the used instruments to the bottom sterilization part of the robot. In the sterilization stage, Sidex or DecoSpace solution (17), washing brush (14) and water jets (15) are used, in two stages, for washing the instruments. At the end of the sterilization, the robot automatically guides the sterilized tray to its own place, which can be used again and ready for the next surgery. With this robot, all surgeons will perform surgery without worrying about sterilization and the accurate counting of instruments.

Explanation of at least one practical method for using the invention

This invention was designed as an intelligent robot able to hear, see, diagnose, analyze information, and deliver and receive surgical instruments to communicate well with the surgical team like a human. In addition, it is able to count and sterilize instruments after surgery. In fact, human error in counting instruments and gauze at each surgery is reduced to zero. This robot has no usage restrictions and is applicable for all types of surgeries, including urology, orthopedics, ENT, neurology, and general surgery. In addition, with such robots, the confidence increases of patients in the correct counting of instruments and gauze for every surgery and the patients are treated with more security.

Explicit explanation of the industrial application of the invention

The application of this invention is related to the field of electronics and robotics. This robot communicates with the surgical team in the operating room like a human and performs all activities solely related to a scrub nurse. With the electronic kit, monitor, and smart screens in this robot, all the basic information is recorded for accurate diagnosis and can easily be used. All basic information about the tools and classes of surgical sets is recorded in the robot, which is activated by the user by selecting the set. The robot is also able to sterilize the instrument without the need for a human scrub nurse. The scrub nurse robot accurately diagnoses the instruments and can deliver them at surgeon request, registers their type and number, and if the robot receives the instruments and gauze, then their symbol is automatically deleted for the final count after surgery.

The robot is equipped with warning lights and alarms at the end of surgery if there is a compromise in the number of instruments and gauze that should remain. Following the surgery, the robot directs the instruments to the sterile compartment and begins rinsing. In fact, this robot is able to do several important tasks at once without the need for a human nurse. Accurate counting of instruments and gauze, as well as the accurate sterilization of instruments, has always played a vital role in patient surgery, which doubles the importance of the application of this invention. The scrub nurse robot communicates with the surgical team at every surgery, and counts instruments and gauze (before and after surgery), as well as sterilizes the instruments more accurately than humans can, all designed in one robot.

Summary of the invention

The scrub nurse robot and surgical instrument sterilization is an innovative idea and has no precedent. In other words, in this invention several robots are designed in one robot. Often errors occur that are unjustifiable and irreparable due to forgetfulness and hurried performance. This is especially noticeable in very important matters, including the surgery of patients, which must be performed with great accuracy. If instruments or gauze accidentally or carelessly were left in the body of the patient during surgery, irreparable dangers for all persons involved would occur. This robot is useful for urological surgeries, orthopedics, ENT, neurology, and general surgery. In addition to accurately counting instruments, from the beginning to the end of surgery, the scrub nurse robot is able to interact properly with the surgical team to deliver and receive tools and gauze. In the case of any shortage in number and type of instrument or gauze, by alerting the lights and alarm, the surgical team will be informed by the robot of that shortage. Alerts are automatically deactivated when the instrument is delivered to the robot. The robot is also able to sterilize all instruments after surgery. This intelligent robot is able to work like humans, and even more accurately than humans can, in important surgical tasks.

Claims

Assertion

That which is claimed:

Claim No. 1: It is claimed that the robot nurse, for scrubbing and sterilizing surgical instruments, has a motor to move different parts and is equipped with a computer and a monitor that analyzes information with the help of circuits and electronic kits. It also has hearing and vision sensors that are designed at the top to detect the position in order to deliver and receive instruments to and from the surgeon. All parts of the information analysis and movements of different parts of the robot are controlled by a computer. This robot is powered by a power pack and battery.

Claim No. 2: According to Claim No. 1, several separate classes of surgical sets have been considered for the robot, which have been selected with the help of the robot computer and from the monitor of the relevant set, and finally the drawers move up and are ready to use automatically with the help of electricity.

Claim No. 3: According to Claim No. 1, two separate mechanical arms are designed to communicate between the surgical team and the robot to deliver and receive instruments and sterile gauze during surgery. Each arm has electronic joints, fingers, and eyes to detect and remove instruments, and motion sensors, which receive information from the computer. Each arm also has screws that connect to the joints.

Claim No. 4: According to Claim No. 3, on the wrist of each arm an electronic eye is installed to inform the robot computer by detecting tools and gauze regarding accurate preliminary data concerning the type, shape, and number of instruments and gauze present. This robot can easily recognize these data. On each finger, there are sponges (jelly) TacheS to prevent the instruments from falling from the robots hands, making it easy for the robot to deliver and receive effortlessly. Claim 5: According to Claim 1, the aseptic robot is able to count instruments and gauze accurately and automatically. The robot does this during surgery with the help of a central monitor and two screens (related to the delivery and receipt of instruments and gauze). The final count is also done by selecting the ‘End’ option, which counts the instruments and gauze automatically before the body of the patient is sutured by the surgical team.

Claim No. 6: According to Claim No. 5, for further assurance that no instrument or gauze is left in the body of the patient in case of non-compliance with delivery and receipt (type and number of instruments and gauze), alarms and lights appear on the screen. The robot reveals the number and type of instruments remaining, informing the surgical team of the situation.

Claim No. 7: According to Claim No. 1, the scrubbing and sterilizing nurse robot has a separate compartment for sterilizing instruments, which is equipped with a washing timer and is directly connected to the computer and electricity working with the help of a motor. This compartment washes the instruments in two steps. The sterilization part is equipped with water jets and a brush for better washing of instruments. It also has a storage encasement for sterile solution added to the sterilization instruments in the second step, housing a specific timer and connected to the electrical circuit.