CN111526770A - 用于存储外科装置的参数和状态以与基于云的分析系统共享的通信集线器和存储装置 - Google Patents
用于存储外科装置的参数和状态以与基于云的分析系统共享的通信集线器和存储装置 Download PDFInfo
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Abstract
本发明公开了各种外科集线器。外科集线器包括：存储装置；联接到所述存储装置的处理器；以及联接到所述处理器的存储器。所述存储器存储能够由所述处理器执行以进行以下操作的指令：从联接到所述外科集线器的外科器械接收数据；以及基于所述存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到基于云的远程医疗分析网络的速率。
Description
相关申请的交叉引用
本申请根据35U.S.C.119(e)要求2018年3月28日提交的标题为DATA STRIPPINGMETHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD的美国临时专利申请序列号62/649,294的优先权，该临时专利申请的公开内容全文以引用方式并入本文中。
本申请根据35U.S.C.119(e)还要求2017年12月28日提交的标题为INTERACTIVESURGICAL PLATFORM的美国临时专利申请序列号62/611,341、2017年12月28日提交的标题为CLOUD-BASED MEDICAL ANALYTICS的美国临时专利申请序列号62/611,340和2017年12月28日提交的标题为ROBOT ASSISTED SURGICAL PLATFORM的美国临时专利申请序列号62/611,339的优先权权益，这些临时专利申请中的每一者的公开内容全文以引用方式并入本文。
背景技术
本公开涉及各种外科系统。外科手术通常在医疗设施(诸如例如医院)的外科手术室(operating theaters or rooms)中执行。通常在患者周围创建无菌场。无菌场可包括被恰当地穿着的擦洗的团队构件，以及该区域中的所有家具和固定件。在执行外科手术时利用各种外科装置和系统。
发明内容
在一个大体方面，提供了一种外科集线器。所述外科集线器包括：存储装置；联接到所述存储装置的处理器；以及联接到所述处理器的存储器。所述存储器存储能够由所述处理器执行以进行以下操作的指令：从联接到所述外科集线器的外科器械接收数据；以及基于所述存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到基于云的远程医疗分析网络的速率。
在另一大体方面，提供了另一种外科集线器与传输数据的方法。所述方法将数据从外科集线器传输到基于云的远程医疗分析网络。所述外科集线器包括存储装置、联接到所述存储装置的处理器、和联接到所述处理器的存储器。所述存储器存储能够由所述处理器执行的指令。所述方法包括：由处理器从联接到所述外科集线器的外科器械接收数据；以及由所述处理器基于联接到所述外科集线器的存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的速率。
在另一大体方面，提供了一种计算机可读介质。所述计算机可读介质是非暂态计算机可读介质并且存储计算机可读指令，所述计算机可读指令在被执行时致使机器：从联接到所述外科集线器的外科器械接收数据；以及基于所述存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到基于云的远程医疗分析网络的速率。
附图说明
各种方面的特征在所附权利要求书中进行了特别描述。然而，通过参考以下结合如下附图所作的说明可最好地理解所述多个方面(有关手术组织和方法)及其进一步的目的和优点。
图1为根据本公开的至少一个方面的计算机实现的交互式外科系统的框图。
图2为根据本公开的至少一个方面的用于在手术室中执行外科手术的外科系统。
图3为根据本公开的至少一个方面的与可视化系统、机器人系统和智能器械配对的外科集线器。
图4为根据本公开的至少一个方面的外科集线器壳体和可滑动地容纳在外科集线器壳体的抽屉中的组合发生器模块的局部透视图。
图5为根据本公开的至少一个方面的具有双极、超声和单极触点以及排烟器件的组合发生器模块的透视图。
图6示出了根据本公开的至少一个方面的用于横向模块化外壳的多个横向对接端口的单个电力总线附接件，该横向模块化外壳被配置成能够容纳多个模块。
图7示出了根据本公开的至少一个方面的被配置成能够容纳多个模块的竖直模块化外壳。
图8示出了根据本公开的至少一个方面的包括模块化通信集线器的外科数据网络，该模块化通信集线器被配置成能够将位于医疗设施的一个或多个手术室中的模块化装置或专用于外科操作的医疗设施中的任何房间连接到云。
图9为根据本公开的至少一个方面的计算机实现的交互式外科系统。
图10示出了根据本公开的至少一个方面的包括联接到模块化控制塔的多个模块的外科集线器。
图11示出了根据本公开的至少一个方面的通用串行总线(USB)网络集线器装置的一个方面。
图12示出了根据本公开的至少一个方面的外科器械或工具的控制系统的逻辑图。
图13示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各个方面的控制电路。
图14示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各个方面的组合逻辑电路。
图15示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各方面的时序逻辑电路。
图16示出了根据本公开的至少一个方面的包括多个马达的外科器械或工具，多个马达可被激活以执行各种功能。
图17为根据本公开的至少一个方面的被配置成能够操作本文所述的外科工具的机器人外科器械的示意图。
图18示出了根据本公开的至少一个方面的被编程以控制位移构件的远侧平移的外科器械的框图。
图19为根据本公开的至少一个方面的被配置成能够控制各个功能的外科器械的示意图。
图20为根据本公开的至少一个方面的被配置成能够除其它益处之外还提供无电感器调谐的发生器的简化框图。
图21示出了根据本公开的至少一个方面的发生器的示例，该发生器是图20的发生器的一种形式。
图22为根据本公开的至少一个方面的示出了用于与患者电子医疗记录(EMR)数据库交互的技术的图。
图23示出了根据本公开的至少一个方面的通过用人工时间量度取代实时时钟用于存储在器械、机器人、外科集线器和/或医院计算机设备内部的所有信息来对外科手术匿名化的方法。
图24示出了根据本公开的至少一个方面的对手术室壁进行超声查验以确定外科集线器和手术室壁之间的距离。
图25示出了根据本公开的至少一个方面的描绘了导入存储在电子医疗记录(EMR)数据库中的患者数据、剥离患者数据以及标识智能装置含义的方法的图。
图26示出了根据本公开的至少一个方面的基于云的分析在编辑和剥离患者数据和独立数据对中的应用。
图27为根据本公开的至少一个方面的示出了用于将来自第一数据源和第二数据源的患者数据集相关联的控制程序或逻辑配置的方法的逻辑流程图。
图28为根据本公开的至少一个方面的描绘了用于剥离数据以提取数据的相关部分以用于对外科集线器和联接到外科集线器的模块(例如，器械)进行配置和操作的控制程序或逻辑配置的方法的逻辑流程图。
图29示出了根据本公开的至少一个方面的包括自描述数据的自描述数据分组。
图30为根据本公开的至少一个方面的描绘了用于使用包括自描述数据的数据分组的控制程序或逻辑配置的方法的逻辑流程图。
图31为根据本公开的至少一个方面的描绘了用于使用包括自描述数据的数据分组的控制程序或逻辑配置的方法的逻辑流程图。
图32为根据本公开的至少一个方面的嵌入右肺的右上后叶中的肿瘤的图。
图33为根据本公开的至少一个方面的肺肿瘤切除外科手术的图，该肺肿瘤切除外科手术包括外科缝合器的四个单独击发以密封和切割暴露在裂隙中的通向和来自图32所示的右肺的上叶和下叶的支气管血管。
图34为根据本公开的至少一个方面的表征如图32所示的装置002的第一击发的闭合力(FTC)对时间曲线和击发力(FTF)对时间曲线的图形图解。
图35为根据本公开的至少一个方面的通过在外科缝合器击发后监测脉管的出血来评估缝合线密封完整性的缝合线可视化激光多普勒的图。
图36示出了根据本公开的至少一个方面的按手术分组的配对数据集。
图37为右肺的图。
图38为包括肺的气管和支气管的支气管树的图。
图39为根据本公开的至少一个方面的描绘了用于存储按手术分组的配对匿名数据集的控制程序或逻辑配置的方法的逻辑流程图。
图40为根据本公开的至少一个方面的描绘了用于确定传输到基于云的远程分析网络的速率、频率和数据类型的控制程序或逻辑配置的方法的逻辑流程图。
图41为根据本公开的至少一个方面的描绘了外科集线器的态势感知的时间线。
具体实施方式
本专利申请的申请人拥有于2018年3月28日提交的以下美国临时专利申请，其中的每个以引用方式全文并入本文：
·标题为INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES的美国临时专利申请序列号62/649,302；
·标题为DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD的美国临时专利申请序列号62/649,294；
·标题为SURGICAL HUB SITUATIONAL AWARENESS的美国临时专利申请序列号62/649,300；
·标题为SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER的美国临时专利申请序列号62/649,309；
·标题为COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS的美国临时专利申请序列号62/649,310；
·标题为USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT的美国临时专利申请序列号62/649,291；
·标题为ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES的美国临时专利申请序列号62/649,296；
·标题为CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER的美国临时专利申请序列号62/649,333；
·标题为CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATIONTRENDS AND REACTIVE MEASURES的美国临时专利申请序列号62/649,327；
·标题为DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK的美国临时专利申请序列号62/649,315；
·标题为CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES的美国临时专利申请序列号62/649,313；
·标题为DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS的美国临时专利申请序列号62/649,320；
·美国临时专利申请序列号62/649,307，其标题为用于机器人辅助外科平台的自动工具调节(AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；以及
·标题为SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS的美国临时专利申请序列号62/649,323。
本专利申请的申请人拥有于2018年3月29日提交的以下美国专利申请，其中的每个以引用方式全文并入本文：
·标题为INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES的美国专利申请序列号____________；代理人案卷号END8499USNP/170766；
·标题为INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OFDEVICES AND DATA CAPABILITIES的美国专利申请序列号____________；代理人案卷号END8499USNP1/170766-1；
·标题为SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OFOPERATING ROOM DEVICES的美国专利申请序列号____________；代理人案卷号END8499USNP2/170766-2；
·标题为SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS的美国专利申请序列号____________；代理人案卷号END8499USNP3/170766-3；
·标题为COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARYSOURCES BY INTELLIGENT SURGICAL HUBS的美国专利申请序列号____________；代理人案卷号END8499USNP4/170766-4；
·标题为SURGICAL HUB CONTROL ARRANGEMENTS的美国专利申请序列号____________；代理人案卷号END8499USNP5/170766-5；
·标题为DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD的美国专利申请序列号____________；代理人案卷号END8500USNP/170767；
·标题为SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUINGINSTRUMENT的美国专利申请序列号____________；代理人案卷号END8500USNP2/170767-2；
·标题为DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITHAN OUTCOME的美国专利申请序列号____________；代理人案卷号END8500USNP3/170767-3；
·标题为SURGICAL HUB SITUATIONAL AWARENESS的美国专利申请序列号____________；代理人案卷号END8501USNP/170768；
·标题为SURGICAL SYSTEM DISTRIBUTED PROCESSING的美国专利申请序列号____________；代理人案卷号END8501USNP1/170768-1；
·标题为AGGREGATION AND REPORTING OF SURGICAL HUB DATA的美国专利申请序列号____________；代理人案卷号END8501USNP2/170768-2；
·标题为SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER的美国专利申请序列号____________；代理人案卷号END8502USNP/170769；
·标题为DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEARSTAPLE LINE的美国专利申请序列号____________；代理人案卷号END8502USNP1/170769-1；
·标题为STERILE FIELD INTERACTIVE CONTROL DISPLAYS的美国专利申请序列号____________；代理人案卷号END8502USNP2/170769-2；
·标题为COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS的美国专利申请序列号____________；代理人案卷号END8503USNP/170770；
·标题为USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT的美国专利申请序列号____________；代理人案卷号END8504USNP/170771；
·标题为CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OFMONO-CHROMATIC LIGHT REFRACTIVITY的美国专利申请序列号____________；代理人案卷号END8504USNP1/170771-1；以及
·标题为DUAL CMOS ARRAY IMAGING的美国专利申请序列号____________；代理人案卷号END8504USNP2/170771-2。
本专利申请的申请人拥有于2018年3月29日提交的以下美国专利申请，其中的每个以引用方式全文并入本文：
·标题为ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES的美国专利申请序列号____________；代理人案卷号END8506USNP/170773；
·标题为ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS的美国专利申请序列号____________；代理人案卷号END8506USNP1/170773-1；
·标题为CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER的美国专利申请序列号____________；代理人案卷号END8507USNP/170774；
·标题为CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGETRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET的美国专利申请序列号____________；代理人案卷号END8507USNP1/170774-1；
·标题为CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTEDINDIVIDUALIZATION OF INSTRUMENT FUNCTION的美国专利申请序列号____________；代理人案卷号END8507USNP2/170774-2；
·标题为CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATIONTRENDS AND REACTIVE MEASURES的美国专利申请序列号____________；代理人案卷号END8508USNP/170775；
·标题为DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK的美国专利申请序列号____________；代理人案卷号END8509USNP/170776；以及
·标题为CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES的美国专利申请序列号____________；代理人案卷号END8510USNP/170777。
本专利申请的申请人拥有于2018年3月29日提交的以下美国专利申请，其中的每个以引用方式全文并入本文：
·标题为DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS的美国专利申请序列号____________；代理人案卷号END8511USNP/170778；
·标题为COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS的美国专利申请序列号____________；代理人案卷号END8511USNP1/170778-1；
·标题为CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS的美国专利申请序列号____________；代理人案卷号END8511USNP2/170778-2；
·标题为AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS的美国专利申请序列号____________；代理人案卷号END8512USNP/170779；
·标题为CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS的美国专利申请序列号____________；代理人案卷号END8512USNP1/170779-1；
·标题为COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICALPLATFORMS的美国专利申请序列号____________；代理人案卷号END8512USNP2/170779-2；
·标题为DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS的美国专利申请序列号____________；代理人案卷号END8512USNP3/170779-3；以及
·标题为SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS的美国专利申请序列号____________；代理人案卷号END8513USNP/170780。
在详细说明外科装置和发生器的各个方面之前，应该指出的是，示例性示例的应用或使用并不局限于附图和具体实施方式中所示出的部件的配置和布置方式的细节。示例性示例可以单独实施，或与其它方面、变更形式和修改形式结合在一起实施，并可以通过多种方式实践或执行。此外，除非另外指明，否则本文所用的术语和表达是为了方便读者而对示例性实施例进行描述而所选的，并非为了限制性的目的。而且，应当理解，以下描述的方面中的一个或多个、方面和/或示例的表达可以与以下描述的其它方面、方面和/或示例的表达中的任何一个或多个组合。
参见图1，计算机实现的交互式外科系统100包括一个或多个外科系统102和基于云的系统(例如，可包括联接到存储装置105的远程服务器113的云104)。每个外科系统102包括与可包括远程服务器113的云104通信的至少一个外科集线器106。在一个示例中，如图1中所示，外科系统102包括可视化系统108、机器人系统110和手持式智能外科器械112，其被配置成能够彼此通信和/或与集线器106通信。在一些方面，外科系统102可包括M数量的集线器106、N数量的可视化系统108、O数量的机器人系统110和P数量的手持式智能外科器械112，其中M、N、O和P为大于或等于一的整数。
图3示出了用于对平躺在外科手术室116中的手术台114上的患者执行外科手术的外科系统102的示例。机器人系统110在外科手术中用作外科系统102的一部分。机器人系统110包括外科医生的控制台118、患者侧推车120(外科机器人)和外科机器人集线器122。当外科医生通过外科医生的控制台120观察外科部位时，患者侧推车117可通过患者体内的微创切口操纵至少一个可移除地联接的外科工具118。外科部位的图像可通过医学成像装置124获得，该医学成像装置可由患者侧推车120操纵以定向成像装置124。机器人集线器122可用于处理外科部位的图像，以随后通过外科医生的控制台118显示给外科医生。
其它类型的机器人系统可容易地适于与外科系统102一起使用。适用于本公开的机器人系统和外科工具的各种示例在2017年12月28日提交的标题为机器人辅助的外科平台(ROBOT ASSISTED SURGICAL PLATFORM)的美国临时专利申请序列号62/611,339中有所描述，该专利的公开内容全文以引用方式并入本文。
由云104执行并且适用于本公开的基于云的分析的各种示例描述于2017年12月28日提交的标题为“基于云的医疗分析(CLOUD-BASED MEDICAL ANALYTICS)”的美国临时专利申请序列号62/611,340中，其公开内容全文以引用方式并入本文。
在各种方面，成像装置124包括至少一个图像传感器和一个或多个光学部件。合适的图像传感器包括但不限于电荷耦合器件(CCD)传感器和互补金属氧化物半导体(CMOS)传感器。
成像装置124的光学器件可包括一个或多个照明源和/或一个或多个透镜。一个或多个照明源可被引导以照明外科场地的多部分。一个或多个图像传感器可接收从外科场地反射或折射的光，包括从组织和/或外科器械反射或折射的光。
一个或多个照明源可被配置成能够辐射可见光谱中的电磁能以及不可见光谱。可见光谱(有时被称为光学光谱或发光光谱)是电磁光谱中对人眼可见(即，可被其检测)的那部分，并且可被称为可见光或简单光。典型的人眼将对空气中约380nm至约750nm的波长作出响应。
不可见光谱(即，非发光光谱)是电磁光谱的位于可见光谱之下和之上的部分(即，低于约380nm且高于约750nm的波长)。人眼不可检测到不可见光谱。大于约750nm的波长长于红色可见光谱，并且它们变为不可见的红外(IR)、微波和无线电电磁辐射。小于约380nm的波长比紫色光谱短，并且它们变为不可见的紫外、x射线和γ射线电磁辐射。
在各种方面，成像装置124被配置成能够用于微创手术中。适用于本公开的成像装置的示例包括但不限于关节镜、血管镜、支气管镜、胆道镜、结肠镜、细胞检查镜、十二指镜、肠窥镜、食道-十二指肠镜(胃镜)、内窥镜、喉镜、鼻咽-肾内窥镜、乙状结肠镜、胸腔镜和子宫内窥镜。
在一个方面，成像装置采用多光谱监测来辨别形貌和底层结构。多光谱图像是捕获跨电磁波谱的特定波长范围内的图像数据的图像。可通过滤波器或通过使用对特定波长敏感的器械来分离波长，特定波长包括来自可见光范围之外的频率的光，例如IR和紫外。光谱成像可允许提取人眼未能用其红色，绿色和蓝色的受体捕获的附加信息。多光谱成像的使用在2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICALPLATFORM)”的美国临时专利申请序列号62/611,341的标题“高级成像采集模块(AdvancedImaging Acquisition Module)”下更详细地描述，该专利的公开内容全文以引用方式并入本文。在完成外科任务以对处理过的组织执行一个或多个先前所述测试之后，多光谱监测可以是用于重新定位外科场地的有用工具。
不言自明的是，在任何外科期间都需要对手术室和外科设备进行严格消毒。在“外科室”(即，手术室或治疗室)中所需的严格的卫生和消毒条件需要所有医疗装置和设备的最高可能的无菌性。该灭菌过程的一部分是需要对接触患者或穿透无菌场的任何物质进行灭菌，包括成像装置124及其附接件和器件。应当理解，无菌场可被认为是被认为不含微生物的指定区域，诸如在托盘内或无菌毛巾内，或者无菌场可被认为是已准备用于外科手术的患者周围的区域。无菌场可包括被恰当地穿着的擦洗的团队构件，以及该区域中的所有家具和固定件。
在各种方面，可视化系统108包括一个或多个成像传感器、一个或多个图像处理单元、一个或多个存储阵列、以及一个或多个显示器，它们相对于无菌场进行策略布置，如图2中所示。在一个方面，可视化系统108包括用于HL7、PACS和EMR的界面。可视化系统108的各种器件在2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICALPLATFORM)”的美国临时专利申请序列号62/611,341的标题“高级成像采集模块(AdvancedImaging Acquisition Module)”下有所描述，该专利申请的公开内容全文以引用方式并入本文。
如图2中所示，主显示器119被定位在无菌场中，以对在手术台114处的操作者可见。此外，可视化塔111被定位在无菌场之外。可视化塔111包括彼此背离的第一非无菌显示器107和第二非无菌显示器109。由集线器106引导的可视化系统108被配置成能够利用显示器107、109和119来将信息流协调到无菌场内侧和外侧的操作者。例如，集线器106可致使可视化系统108在非无菌显示器107或109上显示由成像装置124记录的外科部位的快照，同时保持外科部位在主显示器119上的实时馈送。非无菌显示器107或109上的快照可允许非无菌操作者例如执行与外科手术相关的诊断步骤。
在一个方面，集线器106还被配置成能够将由非无菌操作者在可视化塔111处输入的诊断输入或反馈路由至无菌场内的主显示器119，其中可由操作台上的无菌操作员查看。在一个示例中，输入可以是对显示在非无菌显示器107或109上的快照的修改形式，该输入可通过集线器106路由到主显示器119。
参见图2，外科器械112作为外科系统102的一部分在外科手术中使用。集线器106还被配置成能够协调流向外科器械112的显示器的信息流。例如，在2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICAL PLATFORM)”的美国临时专利申请序列号62/611,341，其公开内容全文以引用方式并入本文。由非无菌操作者在可视化塔111处输入的诊断输入或反馈可由集线器106路由至无菌场内的外科器械显示器115，其中外科器械112的操作者可观察到该输入或反馈。适用于外科系统102的示例性外科器械描述于2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICAL PLATFORM)”的美国临时专利申请序列号62/611,341的标题“外科器械硬件(Surgical Instrument Hardware)”下，该专利的公开内容以引用方式全文并入本文。
现在参见图3，集线器106被描绘为与可视化系统108、机器人系统110和手持式智能外科器械112通信。集线器106包括集线器显示器135、成像模块138、发生器模块140、通信模块130、处理器模块132和存储阵列134。在某些方面，如图3中所示，集线器106还包括排烟模块126和/或抽吸/冲洗模块128。
在外科手术期间，用于密封和/或切割的对组织的能量施加通常与排烟、抽吸过量流体和/或冲洗组织相关。来自不同来源的流体管线、功率管线和/或数据管线通常在外科手术期间缠结。在外科手术期间解决该问题可丢失有价值的时间。断开管线可需要将管线与其相应的模块断开连接，这可需要重置模块。集线器模块化壳体136提供用于管理功率管线、数据管线和流体管线的统一环境，这降低了此类管线之间缠结的频率。
本公开的各方面提供了用于外科手术的外科集线器，该外科手术涉及将能量施加到外科部位处的组织。外科集线器包括集线器壳体和可滑动地容纳在集线器壳体的对接底座中的组合发生器模块。对接底座包括数据触点和功率触点。组合发生器模块包括座置在单个单元中的超声能量发生器器件、双极RF能量发生器器件和单极RF能量发生器器件中的两个或更多个。在一个方面，组合发生器模块还包括排烟器件，用于将组合发生器模块连接到外科器械的至少一根能量递送缆线、被配置成能够排出通过向组织施加治疗能量而产生的烟雾、流体和/或颗粒的至少一个排烟器件、以及从远程外科部位延伸至排烟器件的流体管线。
在一个方面，流体管线是第一流体管线，并且第二流体管线从远程外科部位延伸至可滑动地容纳在集线器壳体中的抽吸和冲洗模块。在一个方面，集线器壳体包括流体接口。
某些外科手术可需要将多于一种能量类型施加到组织。一种能量类型可更有利于切割组织，而另一种不同的能量类型可更有利于密封组织。例如，双极发生器可用于密封组织，而超声发生器可用于切割密封的组织。本公开的各方面提供了一种解决方案，其中集线器模块化壳体136被配置成能够容纳不同的发生器，并且有利于它们之间的交互式通信。集线器模块化壳体136的优点之一是能够快速地移除和/或更换各种模块。
本公开的方面提供了在涉及将能量施加到组织的外科手术中使用的模块化外科壳体。模块化外科壳体包括：第一能量发生器模块，该第一能量发生器模块被配置成能够生成用于施加到组织的第一能量；和第一对接底座，该第一对接底座包括第一对接端口，该第一对接端口包括第一数据和功率触点，其中第一能量发生器模块能够可滑动地运动成与功率和数据触点电接合，并且其中第一能量发生器模块能够可滑动地运动出与第一功率和数据触点的电接合。
对上文进行进一步描述，模块化外科壳体还包括第二能量发生器模块，该第二能量发生器模块被配置成能够生成不同于第一能量的第二能量以用于施加到组织，和第二对接底座，该第二对接底座包括第二对接端口，该第二对接端口包括第二数据和功率触点，其中第二能量发生器模块能够可滑动地运动成与功率和数据触点电接合，并且其中第二能量发生器能够可滑动地运动出与第二功率和数据触点的电接合。
此外，模块化外科壳体还包括在第一对接端口和第二对接端口之间的通信总线，其被配置成能够有利于第一能量发生器模块和第二能量发生器模块之间的通信。
参见图3-7，本公开的各方面被呈现为集线器模块化壳体136，其允许发生器模块140、排烟模块126和抽吸/冲洗模块128的模块化集成。集线器模块化壳体136还有利于模块140、126、128之间的交互式通信。如图5中所示，发生器模块140可为具有集成的单极器件、双极器件和超声器件的发生器模块，该器件被支撑在可滑动地插入到集线器模块化壳体136中的单个外壳单元139中。如图5中所示，发生器模块140可被配置成能够连接到单极装置146、双极装置147和超声装置148。另选地，发生器模块140可包括通过集线器模块化壳体136进行交互的一系列单极发生器模块、双极发生器模块和/或超声发生器模块。集线器模块化壳体136可被配置成能够有利于多个发生器的插入和对接到集线器模块化壳体136中的发生器之间的交互通信，使得发生器将充当单个发生器。
在一个方面，集线器模块化壳体136包括具有外部和无线通信接头的模块化功率和通信底板149，以实现模块140、126、128的可移除附接件以及它们之间的交互通信。
在一个方面，集线器模块化壳体136包括对接底座或抽屉151(本文也称为抽屉)，其被配置成能够可滑动地容纳模块140、126、128。图4示出了可滑动地容纳在外科集线器壳体136的对接底座151中的外科集线器壳体136和组合发生器模块145的局部透视图。在组合发生器模块145的背面上具有功率和数据触点的对接端口152被配置成能够当组合发生器模块145滑动到集线器模块壳体136的对应的对接底座151内的适当位置时，将对应的对接端口150与集线器模块化壳体136的对应对接底座151的功率和数据触点接合。在一个方面，组合发生器模块145包括一起集成到单个外壳单元139中的双极、超声和单极模块以及排烟模块，如图5中所示。
在各种方面，排烟模块126包括流体管线154，该流体管线154将捕集/收集的烟雾和/或流体从外科部位传送到例如排烟模块126。源自排烟模块126的真空抽吸可将烟雾吸入外科部位处的公用导管的开口中。联接到流体管线的公用导管可以是端接在排烟模块126处的柔性管的形式。公用导管和流体管线限定朝向容纳在集线器壳体136中的排烟模块126延伸的流体路径。
在各种方面，抽吸/冲洗模块128联接到包括吸出流体管线和抽吸流体管线的外科工具。在一个示例中，吸出流体管线和抽吸流体管线为从外科部位朝向抽吸/冲洗模块128延伸的柔性管的形式。一个或多个驱动系统可被配置成能够冲洗到外科部位的流体和从外科部位抽吸流体。
在一个方面，外科工具包括轴，该轴具有在其远侧端部处的端部执行器以及与端部执行器、吸出管和冲洗管相关联的至少一种能量处理。吸出管可在其远侧端部处具有入口，并且吸出管延伸穿过轴。类似地，吸出管可延伸穿过轴并且可具有邻近能量递送工具的入口。能量递送工具被配置成能够将超声能量和/或RF能量递送至外科部位，并且通过初始延伸穿过轴的缆线联接到发生器模块140。
冲洗管可与流体源流体连通，并且吸出管可与真空源流体连通。流体源和/或真空源可座置在抽吸/冲洗模块128中。在一个示例中，流体源和/或真空源可独立于抽吸/冲洗模块128座置在集线器壳体136中。在此类示例中，流体接口能够将抽吸/冲洗模块128连接到流体源和/或真空源。
在一个方面，集线器模块化壳体136上的模块140、126、128和/或其对应的对接底座可包括对准特征件，该对准特征件被配置成能够将模块的对接端口对准成与其在集线器模块化壳体136的对接底座中的对应端口接合。例如，如图4中所示，组合发生器模块145包括侧支架155，侧支架155被配置成能够与集线器模块化壳体136的对应的对接底座151的对应支架156可滑动地接合。支架配合以引导组合发生器模块145的对接端口触点与集线器模块化壳体136的对接端口触点电接合。
在一些方面，集线器模块化壳体136的抽屉151为相同的或大体上相同的大小，并且模块的大小被调节为容纳在抽屉151中。例如，侧支架155和/或156可根据模块的大小而更大或更小。在其它方面，抽屉151的大小不同，并且各自被设计成容纳特定模块。
此外，可对特定模块的触点进行键控以与特定抽屉的触点接合，以避免将模块插入到具有不匹配触点的抽屉中。
如图4中所示，一个抽屉151的对接端口150可通过通信链路157联接到另一个抽屉151的对接端口150，以有利于座置在集线器模块化壳体136中的模块之间的交互式通信。另选地或附加地，集线器模块化壳体136的对接端口150可有利于座置在集线器模块化壳体136中的模块之间的无线交互通信。可采用任何合适的无线通信，诸如例如Air Titan-Bluetooth。
图6示出了用于横向模块化外壳160的多个横向对接端口的单个功率总线附接件，该横向模块化外壳160被配置成能够容纳外科集线器206的多个模块。横向模块化外壳160被配置成能够横向容纳和互连模块161。模块161可滑动地插入到横向模块化外壳160的对接底座162中，该横向模块化外壳160包括用于互连模块161的底板。如图6中所示，模块161横向布置在横向模块化外壳160中。另选地，模块161可竖直地布置在横向模块化外壳中。
图7示出了被配置成能够容纳外科集线器106的多个模块165的竖直模块化外壳164。模块165可滑动地插入到竖直模块化外壳164的对接底座或抽屉167中，该竖直模块化外壳164包括用于互连模块165的底板。尽管竖直模块化外壳164的抽屉167竖直布置，但在某些情况下，竖直模块化外壳164可包括横向布置的抽屉。此外，模块165可通过竖直模块化外壳164的对接端口彼此交互。在图7的示例中，提供了用于显示与模块165的操作相关的数据的显示器177。此外，竖直模块化外壳164包括主模块178，该主模块座置可滑动地容纳在主模块178中的多个子模块。
在各种方面，成像模块138包括集成视频处理器和模块化光源，并且适于与各种成像装置一起使用。在一个方面，成像装置由可装配有光源模块和相机模块的模块化外壳构成。外壳可为一次性外壳。在至少一个示例中，一次性外壳可移除地联接到可重复使用的控制器、光源模块和相机模块。光源模块和/或相机模块可根据外科手术的类型选择性地选择。在一个方面，相机模块包括CCD传感器。在另一方面，相机模块包括CMOS传感器。在另一方面，相机模块被配置用于扫描波束成像。同样，光源模块可被配置成能够递送白光或不同的光，这取决于外科手术。
在外科手术期间，从外科场地移除外科装置并用包括不同相机或不同光源的另一外科装置替换外科装置可为低效的。暂时失去对外科场地的视线可导致不期望的后果。本公开的模块成像装置被配置成能够允许在外科手术期间中流替换光源模块或相机模块，而不必从外科场地移除成像装置。
在一个方面，成像装置包括包括多个通道的管状外壳。第一通道被配置成能够可滑动地容纳相机模块，该相机模块可被配置成能够与第一通道搭扣配合接合。第二通道被配置成能够可滑动地容纳光源模块，该光源模块可被配置成能够与第二通道搭扣配合接合。在另一个示例中，相机模块和/或光源模块可在其相应通道内旋转到最终位置。可采用螺纹接合代替搭扣配合接合。
在各种示例中，多个成像装置被放置在外科场地中的不同位置以提供多个视图。成像模块138可被配置成能够在成像装置之间切换以提供最佳视图。在各种方面，成像模块138可被配置成能够集成来自不同成像装置的图像。
适用于本公开的各种图像处理器和成像装置描述于2011年8月9日公布的标题为组合SBI和常规图像处理器(COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR)美国专利7,995,045中，该专利以引用方式全文并入本文。此外，2011年7月19日公布的标题为SBI运动伪影去除设备和方法(SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD)的美国专利7,982,776描述了用于从图像数据中去除运动伪影的各种系统，该专利以引用方式全文并入本文。此类系统可与成像模块138集成。此外，2011年12月15日公布的标题为对固定件体内设备的可控制磁源(CONTROLLABLE MAGNETIC SOURCE TO FIXTUREINTRACORPOREAL APPARATUS)的美国专利申请公布2011/0306840和2014年8月28日公布的标题为用于执行微创外科手术的系统(SYSTEM FOR PERFORMING A MINIMALLY INVASIVESURGICAL PROCEDURE)的美国专利申请公布2014/0243597，以上专利中的每个全文以引用方式并入本文。
图8示出了包括模块化通信集线器203的外科数据网络201，该模块化通信集线器203被配置成能够将位于医疗设施的一个或多个手术室中的模块化装置或专门配备用于外科操作的医疗设施中的任何房间连接到基于云的系统(例如，可包括联接到存储装置205的远程服务器213的云204)。在一个方面，模块化通信集线器203包括与网络路由器通信的网络集线器207和/或网络交换机209。模块化通信集线器203还可联接到本地计算机系统210以提供本地计算机处理和数据操纵。外科数据网络201可被配置为无源的、智能的或交换的。无源外科数据网络充当数据的管道，从而使其能够从一个装置(或区段)转移到另一个装置(或区段)以及云计算资源。智能外科数据网络包括附加特征，以使得能够监测穿过外科数据网络的流量并配置网络集线器207或网络交换器209中的每个端口。智能外科数据网络可被称为可管理的集线器或交换器。交换集线器读取每个包的目标地址，并且然后将包转发到正确的端口。
位于手术室中的模块化装置1a-1n可联接到模块化通信集线器203。网络集线器207和/或网络交换机209可联接到网络路由器211以将装置1a-1n连接至云204或本地计算机系统210。与装置1a-1n相关联的数据可经由路由器传输到基于云的计算机，用于远程数据处理和操纵。与装置1a-1n相关联的数据也可被传输至本地计算机系统210以用于本地数据处理和操纵。位于相同手术室中的模块化装置2a-2m也可联接到网络交换机209。网络交换机209可联接到网络集线器207和/或网络路由器211以将装置2a-2m连接至云204。与装置2a-2n相关联的数据可经由网络路由器211传输到云204以用于数据处理和操纵。与装置2a-2m相关联的数据也可被传输至本地计算机系统210以用于本地数据处理和操纵。
应当理解，可通过将多个网络集线器207和/或多个网络交换机209与多个网络路由器211互连来扩展外科数据网络201。模块化通信集线器203可被包含在模块化控制塔中，该模块化控制塔被配置成能够容纳多个装置1a-1n/2a-2m。本地计算机系统210也可包含在模块化控制塔中。模块化通信集线器203连接到显示器212以显示例如在外科手术期间由装置1a-1n/2a-2m中的一些获得的图像。在各种方面，装置1a-1n/2a-2m可包括例如各种模块，诸如联接到内窥镜的成像模块138、联接到基于能量的外科装置的发生器模块140、排烟模块126、抽吸/冲洗模块128、通信模块130、处理器模块132、存储阵列134、连接到显示器的外科装置、和/或可连接到外科数据网络201的模块化通信集线器203的其它模块化装置中的非接触传感器模块。
在一个方面，外科数据网络201可包括将装置1a-1n/2a-2m连接至云的(一个或多个)网络集线器、(一个或多个)网络交换机和(一个或多个)网络路由器的组合。联接到网络集线器或网络交换机的装置1a-1n/2a-2m中的任何一个或全部可实时收集数据并将数据传输到云计算机中以进行数据处理和操纵。应当理解，云计算依赖于共享计算资源，而不是使用本地服务器或个人装置来处理软件应用程序。可使用“云”一词作为“互联网”的隐喻，尽管该术语不受此限制。因此，本文可使用术语“云计算”来指“基于互联网的计算的类型”，其中将不同的服务(诸如服务器、存储装置和应用程序)递送至位于外科室(例如，固定、移动、临时或现场手术室或空间)中的模块化通信集线器203和/或计算机系统210以及通过互联网连接至模块化通信集线器203和/或计算机系统210的装置。云基础设施可由云服务提供方维护。在这种情况下，云服务提供方可以是协调位于一个或多个手术室中的装置1a-1n/2a-2m的使用和控制的实体。云计算服务可基于由智能外科器械、机器人和位于手术室中的其它计算机化装置所收集的数据来执行大量计算。集线器硬件使多个装置或连接能够连接到与云计算资源和存储器通信的计算机。
对由装置1a-1n/2a-2m所收集的数据应用云计算机数据处理技术，外科数据网络提供改善的外科结果，降低的成本和改善的患者满意度。可采用装置1a-1n/2a-2m中的至少一些来观察组织状态以评估在组织密封和切割手术之后密封的组织的渗漏或灌注。可采用装置1a-1n/2a-2m中的至少一些来识别病理学，诸如疾病的影响，使用基于云的计算检查包括用于诊断目的的身体组织样本的图像的数据。这包括组织和表型的定位和边缘确认。可采用装置1a-1n/2a-2m中的至少一些使用与成像装置和技术(诸如重叠由多个成像装置捕获的图像)集成的各种传感器来识别身体的解剖结构。由装置1a-1n/2a-2m收集的数据(包括图像数据)可被传输到云204或本地计算机系统210或两者以用于数据处理和操纵，包括图像处理和操纵。可分析数据以通过确定是否可继续进行进一步治疗(诸如内窥镜式干预、新兴技术、靶向辐射、靶向干预和精确机器人对组织特异性位点和条件的应用来改善外科手术结果。此类数据分析可进一步采用结果分析处理，并且使用标准化方法可提供有益反馈以确认外科治疗和外科医生的行为，或建议修改外科治疗和外科医生的行为。
在一个具体实施中，手术室装置1a-1n可通过有线信道或无线信道连接至模块化通信集线器203，这取决于装置1a-1n至网络集线器的配置。在一个方面，网络集线器207可被实现为在开放式系统互连(OSI)模型的物理层上工作的本地网络广播装置。该网络集线器提供与位于同一手术室网络中的装置1a-1n的连接。网络集线器207以包的形式收集数据，并以半双工模式将其发送至路由器。网络集线器207不存储用于传输装置数据的任何媒体访问控制/因特网协议(MAC/IP)。装置1a-1n中的仅一个可一次通过网络集线器207发送数据。网络集线器207没有关于在何处发送信息并在每个连接上广播所有网络数据以及通过云204向远程服务器213(图9)广播所有网络数据的路由表或智能。网络集线器207可以检测基本网络错误诸如冲突，但将所有信息广播到多个端口可带来安全风险并导致瓶颈。
在另一个具体实施中，手术室装置2a-2m可通过有线信道或无线信道连接到网络交换机209。网络交换机209在OSI模型的数据链路层中工作。网络交换机209是用于将位于相同手术室中的装置2a-2m连接到网络的多点广播装置。网络交换机209以帧的形式向网络路由器211发送数据并且以全双工模式工作。多个装置2a-2m可通过网络交换机209同时发送数据。网络交换机209存储并使用装置2a-2m的MAC地址来传输数据。
网络集线器207和/或网络交换机209联接到网络路由器211以连接到云204。网络路由器211在OSI模型的网络层中工作。网络路由器211创建用于将从网络集线器207和/或网络交换机211接收的数据包传输至基于云的计算机资源的路由，以进一步处理和操纵由装置1a-1n/2a-2m中的任一者或所有收集的数据。可采用网络路由器211来连接位于不同位置的两个或更多个不同的网络，诸如例如同一医疗设施的不同手术室或位于不同医疗设施的不同手术室的不同网络。网络路由器211以包的形式向云204发送数据并且以全双工模式工作。多个装置可以同时发送数据。网络路由器211使用IP地址来传输数据。
在一个示例中，网络集线器207可被实现为USB集线器，其允许多个USB装置连接到主机。USB集线器可以将单个USB端口扩展到多个层级，以便有更多端口可用于将装置连接到主机系统计算机。网络集线器207可包括用于通过有线信道或无线信道接收信息的有线或无线能力。在一个方面，无线USB短距离、高带宽无线无线电通信协议可用于装置1a-1n和位于手术室中的装置2a-2m之间的通信。
在其它示例中，手术室装置1a-1n/2a-2m可经由蓝牙无线技术标准与模块化通信集线器203通信，以用于在短距离(使用ISM频带中的2.4至2.485GHz的短波长UHF无线电波)从固定装置和移动装置交换数据以及构建个人局域网(PAN)。在其它方面，手术室装置1a-1n/2a-2m可经由多种无线或有线通信标准或协议与模块化通信集线器203通信，包括但不限于Wi-Fi(IEEE 802.11系列)、WiMAX(IEEE 802.16系列)、IEEE 802.20、长期演进(LTE)和Ev-DO、HSPA+、HSDPA+、HSUPA+、EDGE、GSM、GPRS、CDMA、TDMA、DECT、及其以太网衍生物、以及指定为3G、4G、5G和以上的任何其它无线和有线协议。计算模块可包括多个通信模块。例如，第一通信模块可专用于较短距离的无线通信诸如Wi-Fi和蓝牙，并且第二通信模块可专用于较长距离的无线通信，诸如GPS、EDGE、GPRS、CDMA、WiMAX、LTE、Ev-DO等。
模块化通信集线器203可用作手术室装置1a-1n/2a-2m中的一者或全部的中心连接，并且处理被称为帧的数据类型。帧携带由装置1a-1n/2a-2m生成的数据。当模块化通信集线器203接收到帧时，其被放大并传输至网络路由器211，该网络路由器211通过使用如本文所述的多个无线或有线通信标准或协议将数据传输到云计算资源。
模块化通信集线器203可用作独立装置或连接到兼容的网络集线器和网络交换机以形成更大的网络。模块化通信集线器203通常易于安装、配置和维护，使得其成为对手术室装置1a-1n/2a-2m进行联网的良好选项。
图9示出了计算机实现的交互式外科系统200。计算机实现的交互式外科系统200在许多方面类似于计算机实现的交互式外科系统100。例如，计算机实现的交互式外科系统200包括在许多方面类似于外科系统102的一个或多个外科系统202。每个外科系统202包括与可包括远程服务器213的云204通信的至少一个外科集线器206。在一个方面，计算机实现的交互式外科系统200包括模块化控制塔236，该模块化控制塔236连接到多个手术室装置，诸如例如智能外科器械、机器人和位于手术室中的其它计算机化装置。如图10中所示，模块化控制塔236包括联接到计算机系统210的模块化通信集线器203。如图9的示例中所示，模块化控制塔236联接到联接到内窥镜239的成像模块238、联接到能量装置241的发生器模块240、排烟器模块226、抽吸/冲洗模块228、通信模块230、处理器模块232、存储阵列234、任选地联接到显示器237的智能装置/器械235、和非接触传感器模块242。手术室装置经由模块化控制塔236联接到云计算资源和数据存储。机器人集线器222也可连接到模块化控制塔236和云计算资源。装置/器械235、可视化系统208等等可经由有线或无线通信标准或协议联接到模块化控制塔236，如本文所述。模块化控制塔236可联接到集线器显示器215(例如，监测器、屏幕)以显示和叠加从成像模块、装置/器械显示器和/或其它可视化系统208接收的图像。集线器显示器还可结合图像和叠加图像来显示从连接到模块化控制塔的装置接收的数据。
图10示出了包括联接到模块化控制塔236的多个模块的外科集线器206。模块化控制塔236包括模块化通信集线器203(例如，网络连接性装置)和计算机系统210，以提供例如本地处理、可视化和成像。如图10中所示，模块化通信集线器203可以分层配置连接以扩展可连接到模块化通信集线器203的模块(例如，装置)的数量，并将与模块相关联的数据传输至计算机系统210、云计算资源或两者。如图10中所示，模块化通信集线器203中的网络集线器/交换机中的每个包括三个下游端口和一个上游端口。上游网络集线器/交换机连接至处理器以提供与云计算资源和本地显示器217的通信连接。与云204的通信可通过有线或无线通信信道进行。
外科集线器206采用非接触传感器模块242来测量手术室的尺寸，并且使用超声或激光型非接触测量装置来生成外科室的标测图。基于超声的非接触传感器模块通过传输一阵超声波并在其从手术室的围墙弹回时接收回波来扫描手术室，如在2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICAL PLATFORM)”的美国临时专利申请序列号62/611,341中的标题“手术室内的外科集线器空间感知(Surgical Hub SpatialAwareness Within an Operating Room)”下所述，该专利全文以引用方式并入本文，其中传感器模块被配置成能够确定手术室的大小并调节蓝牙配对距离限制。基于激光的非接触传感器模块通过传输激光脉冲、接收从手术室的围墙弹回的激光脉冲，以及将传输脉冲的相位与所接收的脉冲进行比较来扫描手术室，以确定手术室的尺寸并调节蓝牙配对距离限制。
计算机系统210包括处理器244和网络接口245。处理器244经由系统总线联接到通信模块247、存储装置248、存储器249、非易失性存储器250和输入/输出接口251。系统总线可为若干类型的总线结构中的任一者，该总线结构包括存储器总线或存储器控制器、外围总线或外部总线、和/或使用任何各种可用总线架构的本地总线，包括但不限于9位总线、工业标准架构(ISA)、微型Charmel架构(MSA)、扩展ISA(EISA)、智能驱动电子器件(IDE)、VESA本地总线(VLB)、外围器件互连(PCI)、USB、高级图形端口(AGP)、个人计算机存储卡国际协会总线(PCMCIA)、小型计算机系统接口(SCSI)或任何其它外围总线。
控制器244可为任何单核或多核处理器，诸如由德克萨斯器械公司(TexasInstruments)提供的商品名为ARM Cortex的那些处理器。在一个方面，处理器可为购自例如德克萨斯器械公司(Texas Instruments)LM4F230H5QR ARM Cortex-M4F处理器核心，其包括256KB的单循环闪存或其它非易失性存储器(最多至40MHZ)的片上存储器、用于改善40MHz以上的性能的预取缓冲器、32KB单循环序列随机存取存储器(SRAM)、装载有
软件的内部只读存储器(ROM)、2KB电可擦除可编程只读存储器(EEPROM)、和/或一个或多个脉宽调制(PWM)模块、一个或多个正交编码器输入(QEI)模拟、具有12个模拟输入信道的一个或多个12位模数转换器(ADC)，其细节可见于产品数据表。
在一个方面，处理器244可包括安全控制器，该安全控制器包括两个基于控制器的系列(诸如TMS570和RM4x)，已知同样由德克萨斯器械公司(Texas Instruments)生产的商品名为Hercules ARM Cortex R4。安全控制器可被配置成能够专门用于IEC 61508和ISO26262安全关键应用等等，以提供先进的集成安全特征件，同时递送可定标的性能、连接性和存储器选项。
系统存储器包括易失性存储器和非易失性存储器。基本输入/输出系统(BIOS)(包含诸如在启动期间在计算机系统内的元件之间传输信息的基本例程，)存储在非易失性存储器中。例如，非易失性存储器可包括ROM、可编程ROM(PROM)、电可编程ROM(EPROM)、EEPROM或闪存。易失存储器包括充当外部高速缓存存储器的随机存取存储器(RAM)。此外，RAM可以多种形式可用，诸如SRAM、动态RAM(DRAM)、同步DRAM(SDRAM)、双数据速率SDRAM(DDRSDRAM)增强SDRAM(ESDRAM)、同步链路DRAM(SLDRAM)和直接Rambus RAM(DRRAM)。
计算机系统210还包括可移除/不可移除的、易失性/非易失性的计算机存储介质，诸如例如磁盘存储器。磁盘存储器包括但不限于诸如装置如磁盘驱动器、软盘驱动器、磁带驱动器、Jaz驱动器、Zip驱动器、LS-60驱动器、闪存存储卡或内存条。此外，磁盘存储器可包括单独地或与其它存储介质组合的存储介质，包括但不限于光盘驱动器诸如光盘ROM装置(CD-ROM)、光盘可记录驱动器(CD-R驱动器)、光盘可重写驱动器(CD-RW驱动器)或数字通用磁盘ROM驱动器(DVD-ROM)。为了有利于磁盘存储装置与系统总线的连接，可使用可移除或非可移除接口。
应当理解，计算机系统210包括充当用户与在合适的操作环境中描述的基本计算机资源之间的中介的软件。此类软件包括操作系统。可存储在磁盘存储装置上的操作系统用于控制并分配计算机系统的资源。系统应用程序利用操作系统通过存储在系统存储器或磁盘存储装置中的程序模块和程序数据来管理资源。应当理解，本文所述的各种器件可用各种操作系统或操作系统的组合来实现。
用户通过联接到I/O接口251的(一个或多个)输入装置将命令或信息输入到计算机系统210中。输入装置包括但不限于指向装置，诸如鼠标、触控球、触笔、触摸板、键盘、麦克风、操纵杆、游戏垫、卫星盘、扫描仪、电视调谐器卡、数字相机、数字摄像机、幅材相机等。这些和其它输入装置经由(一个或多个)接口端口通过系统总线连接到处理器。(一个或多个)接口端口包括例如串口、并行端口、游戏端口和USB。(一个或多个)输出装置使用与(一个或多个)输入装置相同类型的端口。因此，例如，USB端口可用于向计算机系统提供输入并将信息从计算机系统输出到输出装置。提供了输出适配器来说明在其它输出装置中存在需要特殊适配器的一些输出装置(如监测器、显示器、扬声器和打印机。输出适配器以举例的方式包括但不限于提供输出装置和系统总线之间的连接装置的视频和声卡。应当指出，其它装置或装置诸如(一个或多个)远程计算机的系统提供了输入能力和输出能力两者。
计算机系统210可使用与一个或多个远程计算机(诸如(一个或多个)云计算机)或本地计算机的逻辑连接在联网环境中操作。(一个或多个)远程云计算机可为个人计算机、服务器、路由器、网络PC、工作站、基于微处理器的器具、对等装置或其它公共网络节点等，并且通常包括相对于计算机系统所述的元件中的许多或全部。为简明起见，仅示出了具有(一个或多个)远程计算机的存储器存储装置。(一个或多个)远程计算机通过网络接口在逻辑上连接到计算机系统，并且然后经由通信连接物理连接。网络接口涵盖通信网络诸如局域网(LAN)和广域网(WAN)。LAN技术包括光纤分布式数据接口(FDDI)、铜分布式数据接口(CDDI)、以太网/IEEE 802.3、令牌环/IEEE 802.5等。WAN技术包括但不限于点对点链路、电路交换网络如综合业务数字网络(ISDN)及其变体、分组交换网络和数字用户管线(DSL)。
在各种方面，图10的计算机系统210、成像模块238和/或可视化系统208、和/或图9-图10的处理器模块232可包括图像处理器、图像处理引擎、媒体处理器、或用于处理数字图像的任何专用数字信号处理器(DSP)。图像处理器可采用具有单个指令、多数据(SIMD)或多指令、多数据(MIMD)技术的并行计算以提高速度和效率。数字图像处理引擎可执行一系列任务。图像处理器可为具有多核处理器架构的芯片上的系统。
(一个或多个)通信连接是指用于将网络接口连接到总线的硬件/软件。虽然示出了通信连接以便在计算机系统内进行示例性澄清，但其也可位于计算机系统210的外部。连接到网络接口所必需的硬件/软件仅出于示例性目的包括内部和外部技术，诸如调制解调器，包括常规的电话级调制解调器、电缆调制解调器和DSL调制解调器、ISDN适配器和以太网卡。
图11示出了根据本公开的一个方面的USB网络集线器300装置的一个方面的功能框图。在例示的方面，USB网络集线器装置300采用得克萨斯器械公司(Texas Instruments)的TUSB2036集成电路集线器。USB网络集线器300是根据USB 2.0规范提供上游USB收发器端口302和多达三个下游USB收发器端口304、306、308的CMOS装置。上游USB收发器端口302为差分根数据端口，其包括与差分数据正(DM0)输入配对的差分数据负(DP0)输入。三个下游USB收发器端口304、306、308为差分数据端口，其中每个端口包括与差分数据负(DM1-DM3)输出配对的差分数据正(DP1-DP3)输出。
USB网络集线器300装置用数字状态机而不是微控制器来实现，并且不需要固件编程。完全兼容的USB收发器集成到用于上游USB收发器端口302和所有下游USB收发器端口304、306、308的电路中。下游USB收发器端口304、306、308通过根据附接到端口的装置的速度自动设置转换速率来支持全速度装置和低速装置两者。USB网络集线器300装置可被配置成能够处于总线供电模式或自供电模式，并且包括用于管理功率的集线器功率逻辑312。
USB网络集线器300装置包括串行接口引擎310(SIE)。SIE 310是USB网络集线器300硬件的前端，并处理USB规范第8章中描述的大多数协议。SIE 310通常包括多达交易级别的信令。其处理的功能可包括：包识别、事务排序、SOP、EOP、RESET和RESUME信号检测/生成、时钟/数据分离、不返回到零反转(NRZI)数据编码/解码和数位填充、CRC生成和校验(令牌和数据)、包ID(PID)生成和校验/解码、和/或串行并行/并行串行转换。310接收时钟输入314并且联接到暂停/恢复逻辑和帧定时器316电路以及集线器中继器电路318，以通过端口逻辑电路320、322、324控制上游USB收发器端口302和下游USB收发器端口304、306、308之间的通信。SIE 310经由接口逻辑联接到命令解码器326，以经由串行EEPROM接口330来控制来自串行EEPROM的命令。
在各种方面，USB网络集线器300可将配置在多达六个逻辑层(层级)中的127功能连接至单个计算机。此外，USB网络集线器300可使用提供通信和功率分配两者的标准化四线电缆连接到所有外装置。功率配置为总线供电模式和自供电模式。USB网络集线器300可被配置成能够支持四种功率管理模式：具有单独端口功率管理或成套端口功率管理的总线供电集线器，以及具有单独端口功率管理或成套端口功率管理的自供电集线器。在一个方面，使用USB电缆、USB网络集线器300将上游USB收发器端口302插入USB主机控制器中，并且将下游USB收发器端口304、306、308暴露以用于连接USB兼容装置等。
外科器械硬件
图12示出了根据本公开的一个或多个方面的外科器械或工具的控制系统470的逻辑图。系统470包括控制电路。控制电路包括微控制器461，该微控制器包括处理器462和存储器468。例如，传感器472、474、476中的一个或多个向处理器462提供实时反馈。由马达驱动器492驱动的马达482可操作地联接到能够纵向运动的位移构件以驱动I形梁刀元件。跟踪系统480被配置成能够确定能够纵向运动的位移构件的位置。位置信息被提供给处理器462，该处理器可被编程或配置成能够确定能够纵向运动的驱动构件的位置以及击发构件、击发杆和I形梁刀元件的位置。附加马达可设置在工具驱动器接口处，以控制I形梁击发、闭合管行进、轴旋转和关节运动。显示器473显示器械的多种操作条件并且可包括用于数据输入的触摸屏功能。显示在显示器473上的信息可叠加有经由内窥镜式成像模块获取的图像。
在一个方面，微处理器461可为任何单核或多核处理器，诸如已知的由德克萨斯器械公司(Texas Instruments)生产的商品名为ARM Cortex的那些。在一个方面，微控制器461可为购自例如德克萨斯器械公司(Texas Instruments)的LM4F230H5QR ARM Cortex-M4F处理器核心，其包括256KB的单循环闪存或其它非易失性存储器(最多至40MHZ)的片上存储器、用于改善40MHz以上的性能的预取缓冲器、32KB单循环SRAM、装载有
软件的内部ROM、2KB电EEPROM、一个或多个PWM模块、一个或多个QEI模拟、具有12个模拟输入信道的一个或多个12位ADC，其细节可见于产品数据表。
在一个方面，微控制器461可包括安全控制器，该安全控制器包括两个基于控制器的系列(诸如TMS570和RM4x)，已知同样由德克萨斯器械公司(Texas Instruments)生产的商品名为Hercules ARM Cortex R4。安全控制器可被配置成能够专门用于IEC 61508和ISO26262安全关键应用等等，以提供先进的集成安全特征件，同时递送可定标的性能、连接性和存储器选项。
微控制器461可被编程为执行各种功能，诸如对刀和关节运动系统的速度和位置的精确控制。在一个方面，微控制器461包括处理器462和存储器468。电动马达482可为有刷直流(DC)马达，其具有齿轮箱以及至关节运动或刀系统的机械链路。在一个方面，马达驱动器492可为可购自Allegro微系统公司(Allegro Microsystems,Inc)的A3941。其它马达驱动器可容易地被替换以用于包括绝对定位系统的跟踪系统480中。绝对定位系统的详细描述在2017年10月19日公布的标题为用于控制外科缝合和切割器械的系统和方法(SYSTEMSAND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT)的美国专利申请公布2017/0296213中有所描述，该专利申请全文以引用方式并入本文。
微控制器461可被编程为提供对位移构件和关节运动系统的速度和位置的精确控制。微控制器461可被配置成能够计算微控制器461的软件中的响应。将计算的响应与实际系统的所测量响应进行比较，以获得“观察到的”响应，其用于实际反馈决定。观察到的响应为有利的调谐值，该值使所模拟响应的平滑连续性质与所测量响应均衡，这可检测对系统的外部影响。
在一个方面，马达482可由马达驱动器492控制并可被外科器械或工具的击发系统采用。在各种形式中，马达482可为具有大约25,000RPM的最大旋转速度的有刷DC驱动马达。在其它布置中，马达482可包括无刷马达、无绳马达、同步马达、步进马达、或任何其它合适的电动马达。马达驱动器492可包括例如包括场效应晶体管(FET)的H桥驱动器。马达482可通过可释放地安装到柄部组件或工具外壳的功率组件来供电，以用于向外科器械或工具供应控制功率。功率组件可包括电池，该电池可以包括串联连接的、可用作功率源以为外科器械或工具提供电力的多个电池单元。在某些情况下，功率组件的电池单元可以是可替换的和/或可再充电的。在至少一个示例中，电池单元可为锂离子电池，其可联接到功率组件并且可与功率组件分离。
马达驱动器492可为可购自Allegro微系统公司(Allegro Microsystems,Inc)的A3941。A3941 492为全桥控制器，其用于与针对电感负载(诸如有刷DC马达)特别设计的外部N信道功率金属氧化物半导体场效应晶体管(MOSFET)一起使用。驱动器492包括独特的电荷泵调节器，其为低至7V的电池电压提供完整的(>10V)栅极驱动并且允许A3941在低至5.5V的减小的栅极驱动下操作。可采用自举电容器来提供N信道MOSFET所需的上述电池供电电压。高边驱动装置的内部电荷泵允许直流(100％占空比)操作。可使用二极管或同步整流在快衰减模式或慢衰减模式下驱动全桥。在慢衰减模式下，电流再循环可穿过高边或低边FET。通过电阻器可调式空载时间保护功率FET不被击穿。整体诊断提供欠压、过热和功率桥故障的指示，并且可被配置成能够在大多数短路条件下保护功率MOSFET。其它马达驱动器可容易地被替换以用于包括绝对定位系统的跟踪系统480中。
跟踪系统480包括根据本公开的一个方面的包括位置传感器472的受控马达驱动电路布置方式。用于绝对定位系统的位置传感器472提供对应于位移构件的位置的独特位置信号。在一个方面，位移构件表示能够纵向运动的驱动构件，其包括用于与齿轮减速器组件的对应驱动齿轮啮合接合的驱动齿的齿条。在其它方面，位移构件表示击发构件，该击发构件可被适配和配置成能够包括驱动齿的齿条。在另一方面，位移构件表示击发杆或I形梁，它们中的每一者可被适配和配置成能够包括驱动齿的齿条。因此，如本文所用，术语位移构件通常用于指外科器械或工具的任何可运动构件诸如驱动构件、击发构件、击发杆、I形梁或可进行位移的任何元件。在一个方面，能够纵向运动的驱动构件联接到击发构件、击发杆和I形梁。因此，绝对定位系统实际上可通过跟踪能够纵向运动的驱动构件的线性位移来跟踪I形梁的线性位移。在各种其它方面，位移构件可联接到适于测量线性位移的任何位置传感器472。因此，能够纵向运动的驱动构件、击发构件、击发杆或I形梁或它们的组合可联接到任何合适的线性位移传感器。线性位移传感器可包括接触式位移传感器或非接触式位移传感器。线性位移传感器可包括线性可变差分变压器(LVDT)、差分可变磁阻换能器(DVRT)、滑动电位计、包括可运动磁体和一系列线性布置的霍尔效应传感器的磁感测系统、包括固定磁体和一系列可运动的线性布置的霍尔效应传感器的磁感测系统、包括可运动光源和一系列线性布置的光电二极管或光电检测器的光学感测系统、包括固定光源和一系列可运动的线性布置的光电二极管或光电检测器的光学感测系统、或它们的任何组合。
电动马达482可包括可操作地与齿轮组件交接的可旋转轴，该齿轮组件与驱动齿的组或齿条啮合接合安装在位移构件上。传感器元件可以可操作地联接到齿轮组件，使得位置传感器472元件的单次旋转对应于位移构件的一些线性纵向平移。齿轮传动装置和传感器的布置方式可经由齿条和小齿轮布置方式连接至线性致动器，或者经由直齿齿轮或其它连接连接至旋转致动器。功率源为绝对定位系统供电，并且输出指示器可显示绝对定位系统的输出。位移构件表示能够纵向运动的驱动构件，该能够纵向运动的驱动构件包括形成于其上的驱动齿的齿条，以用于与齿轮减速器组件的对应驱动齿轮啮合接合。位移构件表示能够纵向运动的击发构件、击发杆、I形梁或它们的组合。
与位置传感器472相关联的传感器元件的单次旋转等同于位移构件的纵向线性位移d1，其中d1为在联接到位移构件的传感器元件的单次旋转之后位移构件从点“a”运动到点“b”的纵向线性距离。可经由齿轮减速连接传感器布置方式，该齿轮减速使得位置传感器472针对位移构件的全行程仅完成一次或多次旋转。位置传感器472可针对位移构件的全行程完成多次旋转。
可单独或结合齿轮减速采用一系列开关(其中n为大于一的整数)以针对位置传感器472的多于一次旋转提供独特位置信号。开关的状态被馈送回微控制器461，该微控制器应用逻辑以确定对应于位移构件的纵向线性位移d1+d2+…dn的独特位置信号。位置传感器472的输出被提供给微控制器461。该传感器布置方式的位置传感器472可包括磁性传感器、模拟旋转传感器(如电位差计)、模拟霍尔效应元件的阵列，该霍尔效应元件的阵列输出位置信号或值的独特组合。
位置传感器472可包括任何数量的磁性感测元件，诸如例如根据它们是否测量磁场的总磁场或矢量分量而被分类的磁性传感器。用于产生上述两种类型磁性传感器的技术涵盖物理学和电子学的多个方面。用于磁场感测的技术包括探查线圈、磁通门、光泵、核旋、超导量子干涉仪(SQUID)、霍尔效应、各向异性磁电阻、巨磁电阻、磁性隧道结、巨磁阻抗、磁致伸缩/压电复合材料、磁敏二极管、磁敏晶体管、光纤、磁光，以及基于微机电系统的磁性传感器等等。
在一个方面，用于包括绝对定位系统的跟踪系统480的位置传感器472包括磁性旋转绝对定位系统。位置传感器472可被实现为购自Austria Microsystems,AG的AS5055EQFT单片磁旋转位置传感器。位置传感器472与微控制器461交接，以提供绝对定位系统。位置传感器472为低电压和低功率器件，并且包括位于磁体上的位置传感器472的区域中的四个霍尔效应元件。在芯片上还提供了高分辨率ADC和智能功率管理控制器。提供了坐标旋转数字计算机(CORDIC)处理器(也被称为逐位法和Volder算法)以执行简单有效的算法来计算双曲线函数和三角函数，其仅需要加法、减法、数位位移和表格查找操作。角位置、报警位和磁场信息通过标准串行通信接口(诸如串行外围接口(SPI)接口)传输到微控制器461。位置传感器472提供12或14位分辨率。位置传感器472可以是以小型QFN 16引脚4×4×0.85mm封装提供的AS5055芯片。
包括绝对定位系统的跟踪系统480可包括和/或可被编程以实现反馈控制器，诸如PID、状态反馈和自适应控制器。功率源将来自反馈控制器的信号转换为对系统的物理输入：在这种情况下为电压。其它示例包括电压、电流和力的PWM。除了由位置传感器472所测量的位置之外，可提供(一个或多个)其它传感器来测量物理系统的物理参数。在一些方面，(一个或多个)其它传感器可包括传感器布置方式，诸如在2016年5月24日发布的标题为钉仓组织厚度传感器系统(STAPLE CARTRIDGE TISSUE THICKNESS)的美国专利9,345,481中所述的那些，该专利全文以引用方式并入本文；2014年9月18日公布的标题为钉仓组织厚度传感器系统(STAPLE CARTRIDGE TISSUE THICKNESS)的美国专利申请公布2014/0263552，该专利全文以引用方式并入本文；以及2017年6月20日提交的标题为用于外科缝合和切割器械的马达速度的自适应控制的技术(TECHNIQUES FOR ADAPTIVE CONTROL OF MOTORVELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT)的美国专利申请序列号15/628,175，该专利申请全文以引用方式并入本文。在数字信号处理系统中，绝对定位系统联接到数字数据采集系统，其中绝对定位系统的输出将具有有限分辨率和采样频率。绝对定位系统可包括比较和组合电路，以使用算法(诸如加权平均和理论控制环路)将计算响应与测量响应进行组合，该算法驱动计算响应朝向所测量的响应。物理系统的计算响应将特性如质量、惯性、粘性摩擦、电感电阻考虑在内，以通过得知输入预测物理系统的状态和输出。
因此，绝对定位系统在器械上电时提供位移构件的绝对位置，并且不使位移构件回缩或推进至如常规旋转编码器可需要的复位(清零或本位)位置，这些编码器仅对马达482采取的向前或向后的步骤数进行计数以推断装置致动器、驱动棒、刀等等的位置。
传感器474(诸如，例如应变仪或微应变仪)被配置成能够测量端部执行器的一个或多个参数，诸如例如在夹持操作期间施加在砧座上的应变的幅值，该幅值可以指示施加到砧座的闭合力。测得的应变被转换为数字信号并提供给处理器462。另选地或除了传感器474之外，传感器476诸如例如负荷传感器可测量由闭合驱动系统施加到砧座的闭合力。传感器476诸如例如负荷传感器可测量在外科器械或工具的击发行程中施加到I形梁的击发力。I形梁被配置成能够接合楔形滑动件，该楔形滑动件被配置成能够使钉驱动器向上凸轮运动以将钉推出以与砧座变形接触。I形梁还包括锋利切割刃，当通过击发杆向远侧推进I形梁时，该切割刃可用于切断组织。另选地，可以采用电流传感器478来测量由马达482消耗的电流。推进击发构件所需的力可对应于例如由马达482消耗的电流。测得的力被转换为数字信号并提供给处理器462。
在一种形式中，应变仪传感器474可用于测量由端部执行器施加到组织的力。应变计可联接到端部执行器以测量被端部执行器处理的组织上的力。用于测量施加到由端部执行器抓握的组织的力的系统包括应变仪传感器474，诸如例如微应变仪，其被配置成能够测量例如端部执行器的一个或多个参数。在一个方面，应变仪传感器474可测量在夹持操作期间施加到端部执行器的钳口构件上的应变的振幅或量值，这可指示组织压缩。将测得的应变转换成数字信号并将其提供到微控制器461的处理器462。负载传感器476可测量用于操作刀元件例如以切割被捕获在砧座和钉仓之间的组织的力。可采用磁场传感器来测量捕集的组织的厚度。磁场传感器的测量值也可被转换成数字信号并提供给处理器462。
微控制器461可使用分别由传感器474、476测量的组织压缩、组织厚度和/或闭合端部执行器所需的力的测量来表征击发构件的所选择的位置和/或击发构件的速度的对应值。在一个实例中，存储器468可存储可由微控制器461在评估中所采用的技术、公式和/或查找表。
外科器械或工具的控制系统470还可包括有线或无线通信电路以与模块化通信集线器通信，如图8-11中所示。
图13示出了控制电路500，该控制电路500被配置成能够控制根据本公开的一个方面的外科器械或工具的各方面。控制电路500可被配置成能够实现本文所述的各种方法。电路500可以包括微控制器，该微控制器包括联接到至少一个存储器电路504的一个或多个处理器502(例如，微处理器、微控制器)。存储器电路504存储在由处理器502执行时使处理器502执行机器指令以实现本文所述的各种过程的机器可执行指令。处理器502可为本领域中已知的多种单核或多核处理器中的任一种。存储器电路504可包括易失性存储介质和非易失性存储介质。处理器502可包括指令处理单元506和运算单元508。该指令处理单元可被配置成能够从本公开的存储器电路504接收指令。
图14示出了组合逻辑电路510，该组合逻辑电路510被配置成能够控制根据本公开的一个方面的外科器械或工具的各方面。组合逻辑电路510可被配置成能够实现本文所述的各种方法。组合逻辑电路510可包括有限状态机，该有限状态机包括组合逻辑512，该组合逻辑512被配置成能够在输入514处接收与外科器械或工具相关联的数据，通过组合逻辑512处理数据并提供输出516。
图15示出了根据本公开的一个方面的被配置成能够控制外科器械或工具的各个方面的时序逻辑电路520。时序逻辑电路520或组合逻辑522可被配置成能够实现本文所述的各种方法。时序逻辑电路520可包括有限状态机。时序逻辑电路520可包括例如组合逻辑522、至少一个存储器电路524和时钟529。至少一个存储器电路524可存储有限状态机的当前状态。在某些情况下，时序逻辑电路520可以是同步的或异步的。组合逻辑522被配置成能够从输入526接收与外科器械或工具相关联的数据，通过组合逻辑522处理数据并提供输出528。在其它方面，电路可包括处理器(例如，处理器502，图13)和有限状态机的组合以实现本文的各种过程。在其它实施方案中，有限状态机可以包括组合逻辑电路(例如，组合逻辑电路510，图14)和时序逻辑电路520的组合。
图16示出了包括可被激活以执行各种功能的多个马达的外科器械或工具。在某些情况下，第一马达可被激活以执行第一功能，第二马达可被激活以执行第二功能，并且第三马达可被激活以执行第三功能。在某些情况下，机器人外科器械600的多个马达可被单独地激活以导致端部执行器中的击发运动、闭合运动、和/或关节运动。击发运动、闭合运动、和/或关节运动可例如通过轴组件传输到端部执行器。
在某些情况下，外科器械系统或工具可包括击发马达602。击发马达602可以可操作地联接到击发马达驱动组件604，该击发马达驱动组件可被配置成能够将由马达602产生的击发运动传输到端部执行器，具体地用于使I形梁元件位移。在某些情况下，由马达602产生的击发运动可例如致使钉从钉仓部署到由端部执行器捕获的组织中和/或致使I形梁元件的切割刃被推进以切割所捕获组织。I形梁元件可通过反转马达602的方向而回缩。
在某些情况下，外科器械或工具可包括闭合马达603。闭合马达603可以可操作地联接到闭合马达驱动组件605，该闭合马达驱动组件605被配置成能够将由马达603生成的闭合运动传输到端部执行器，具体地用于移置闭合管以闭合砧座并且压缩砧座和钉仓之间的组织。闭合运动可使例如端部执行器从打开配置转变成接近配置以捕获组织。端部执行器可通过反转马达603的方向而转变到打开位置。
在某些情况下，外科器械或工具可包括例如一个或多个关节运动马达606a、606b。马达606a、606b可以可操作地联接到相应的关节运动马达驱动组件608a、608b，该关节运动马达驱动组件可被配置成能够将由马达606a、606b生成的关节运动传输到端部执行器。在某些情况下，关节运动可使端部执行器相对于轴进行关节运动，例如。
如上所述，外科器械或工具可包括多个马达，该多个马达可被配置成能够执行各种独立功能。在某些情况下，外科器械或工具的多个马达可被单独地或独立地激活以执行一个或多个功能，而其它马达保持非活动的。例如，关节运动马达606a、606b可被激活以使端部执行器进行关节运动，而击发马达602保持非活动的。另选地，击发马达602可被激活以击发多个钉和/或推进切割边缘，而关节运动马达606保持非活动的。此外，闭合马达603可与击发马达602同时激活，以致使闭合管和I形梁元件朝远侧推进，如下文更详细地描述。
在某些情况下，外科器械或工具可包括公共控制模块610，该公共控制模块610可与外科器械或工具的多个马达一起使用。在某些情况下，公共控制模块610每次可调节多个马达中的一个。例如，公共控制模块610可单独地联接到外科器械的多个马达并且可从外科器械的多个马达分离。在某些情况下，外科器械或工具的多个马达可共用一个或多个公共控制模块诸如公共控制模块610。在某些情况下，外科器械或工具的多个马达可独立地和选择性地接合公共控制模块610。在某些情况下，公共控制模块610可从与外科器械或工具的多个马达中的一个交接切换到与外科器械或工具的多个马达中的另一个交接。
在至少一个示例中，公共控制模块610可在可操作地接合关节运动马达606a、606b与可操作地接合击发马达602或闭合马达603之间选择性地切换。在至少一个示例中，如图16中所示，开关614可在多个位置和/或状态之间运动或转变。在第一位置616中，开关614可以将公共控制模块610电联接到击发马达602；在第二位置617中，开关614可以将公共控制模块610电联接到闭合马达603；在第三位置618a中，开关614可以将公共控制模块610电联接到第一关节运动马达606a；并且在第四位置618b中，开关614可以将公共控制模块610电联接到例如第二关节运动马达606b。在某些情况下，单独的公共控制模块610可同时电联接到击发马达602、闭合马达603和关节运动马达606a、606b。在某些情况下，开关614可为机械开关、机电开关、固态开关、或任何合适的开关机构。
马达602、603、606a、606b中的每个可包括扭矩传感器以测量马达的轴上的输出扭矩。可以任何常规方式感测端部执行器上的力，诸如通过钳口的外侧上的力传感器或通过用于致动钳口的马达的扭矩传感器来感测端部执行器上的力。
在各种情况下，如图16中所示，公共控制模块610可包括马达驱动器626，该马达驱动器626可包括一个或多个H桥场效应FET。马达驱动器626可例如基于得自微控制器620(“控制器”)的输入来调节从功率源628传输到联接到公共控制模块610的马达的功率。在某些情况下，当马达联接到公共控制模块610时，可例如采用微控制器620来确定由马达消耗的电流，如上所述。
在某些情况下，微控制器620可包括微处理器622(“处理器”)和一个或多个非暂态计算机可读介质或存储单元624(“存储器”)。在某些情况下，存储器624可存储各种程序指令，这些程序指令在被执行时可致使处理器622执行本文所述的多个功能和/或计算。在某些情况下，存储器单元624中的一个或多个可例如联接到处理器622。
在某些情况下，功率源628可例如用于为微控制器620供电。在某些情况下，功率源628可包括电池(或者“电池组”或“功率组”)，诸如锂离子电池，例如。在某些情况下，电池组可被配置成能够可释放地安装到柄部以用于给外科器械600供电。可将串联连接的多个电池单元用作功率源628。在某些情况下，功率源628可以是例如可替换的和/或可再充电的。
在各种情况下，处理器622可控制马达驱动器626以控制联接到公共控制器610的马达的位置、旋转方向、和/或速度。在某些情况下，处理器622可发信号通知马达驱动器626，以停止和/或停用联接到公共控制器610的马达。应当理解，如本文所用的术语“处理器”包括任何合适的微处理器、微控制器、或将计算机的中央处理单元(CPU)的功能结合在一个集成电路或至多几个集成电路上的其它基础计算装置。处理器是多用途的可编程装置，该装置接收数字数据作为输入，根据其存储器中存储的指令来处理输入，然后提供结果作为输出。因为处理器具有内部存储器，所以是顺序数字逻辑的示例。处理器的操作对象是以二进制数字系统表示的数字和符号。
在一个实例中，处理器622可为任何单核或多核处理器，诸如已知的由德克萨斯器械公司(Texas Instruments)生产的商品名为ARM Cortex的那些。在某些情况下，微控制器620可以是例如购自Texas Instruments的LM 4F230H5QR。在至少一个示例中，TexasInstruments LM4F230H5QR为ARM Cortex-M4F处理器芯，其包括：256KB的单循环闪存或其它非易失性存储器(最多至40MHZ)的片上存储器、用于改善40MHz以上的性能的预取缓冲器、32KB的单循环SRAM、装载有
软件的内部ROM、2KB的EEPROM、一个或多个PWM模块、一个或多个QEI模拟、具有12个模拟输入信道的一个或多个12位ADC、以及产品数据表易得的其它特征。可容易地换用其它微控制器，以与模块4410一起使用。因此，本公开不应限于这一上下文。
在某些情况下，存储器624可包括用于控制可联接到公共控制器610的外科器械600的马达中的每个的程序指令。例如，存储器624可包括用于控制击发马达602、闭合马达603和关节运动马达606a、606b的程序指令。此类程序指令可使得处理器622根据来自外科器械或工具的算法或控制程序的输入来控制击发、闭合和关节运动功能。
在某些情况下，一个或多个机构和/或传感器诸如例如传感器630可用于警示处理器622应当在特定设定中使用的程序指令。例如，传感器630可警示处理器622使用与击发、闭合和关节运动端部执行器相关联的程序指令。在某些情况下，传感器630可包括例如可用于感测开关614的位置的位置传感器。因此，处理器622可在例如通过传感器630检测到开关614处于第一位置616时使用与击发端部执行器的I形梁相关联的程序指令；处理器622可以在例如通过传感器630检测到开关614处于第二位置617时使用与闭合砧座相关联的程序指令；并且处理器622可以在例如通过传感器630检测到开关614处于第三位置618a或第四位置618b时使用与使端部执行器进行关节运动相关联的程序指令。
图17是根据本公开的一个方面的被配置成能够操作本文所述的外科工具的机器人外科器械700的示意图。机器人外科器械700可被编程或配置成能够控制位移构件的远侧/近侧平移、闭合管的远侧/近侧位移、轴旋转、以及具有单个或多个关节运动驱动连杆的关节运动。在一个方面，外科器械700可被编程或配置成能够单独地控制击发构件、闭合构件、轴构件、和/或一个或多个关节运动构件。外科器械700包括控制电路710，该控制电路被配置成能够控制马达驱动的击发构件、闭合构件、轴构件、和/或一个或多个关节运动构件。
在一个方面，机器人外科器械700包括控制电路710，该控制电路被配置成能够经由多个马达704a-704e来控制端部执行器702的砧座716和I形梁714(包括锋利切割刃)部分、可移除钉仓718、轴740、以及一个或多个关节运动构件742a、742b。位置传感器734可被配置成能够向控制电路710提供I形梁714的位置反馈。其它传感器738可被配置成能够向控制电路710提供反馈。定时器/计数器731向控制电路710提供定时和计数信息。可提供能量源712以操作马达704a-704e，并且电流传感器736向控制电路710提供马达电流反馈。马达704a-704e可通过控制电路710在开环或闭环反馈控制中单独地操作。
在一个方面，控制电路710可包括用于执行使得一个或多个处理器执行一个或多个任务的指令的一个或多个微控制器、微处理器或其它合适的处理器。在一个方面，定时器/计数器731向控制电路710提供输出信号诸如实耗时间或数字计数，以将如由位置传感器734确定的I形梁714的位置与定时器/计数器731的输出相关联，使得控制电路710可确定I形梁714在相对于起始位置的特定时间(t)处或I形梁714处于相对于起始位置的特定位置时的时间(t)处的位置。定时器/计数器731可被配置成能够测量所耗用的时间、计数外部事件或时间外部事件。
在一个方面，控制电路710可被编程为基于一个或多个组织状况来控制端部执行器702的功能。控制电路710可被编程为直接或间接地感测组织状况诸如厚度，如本文所述。控制电路710可被编程为基于组织状况来选择击发控制程序或闭合控制程序。击发控制程序可以描述位移构件的远侧运动。可以选择不同的击发控制程序以更好地处理不同的组织状况。例如，控制电路710可被编程为当存在较厚组织时，以较低速度和/或以较低功率平移位移构件。控制电路710可被编程为当存在较薄组织时，以较高速度和/或以较高功率平移位移构件。闭合控制程序可控制由砧座716施加到组织的闭合力。其它控制程序控制轴740和关节运动构件742a、742b的旋转。
在一个方面，控制电路710可生成马达设定点信号。马达设定点信号可以被提供给各种马达控制器708a-708e。马达控制器708a-708e可以包括一个或多个电路，这些电路被配置成能够向马达704a-704e提供马达驱动信号，以驱动马达704a-704e，如本文所述。在一些示例中，马达704a-704e可为有刷DC电动马达。例如，马达704a-704e的速度可与相应的马达驱动信号成比例。在一些示例中，马达704a-704e可为无刷DC马达，并且相应的马达驱动信号可包括提供给马达704a-704e的一个或多个定子绕组的PWM信号。而且，在一些示例中，可以省略马达控制器708a-708e，并且控制电路710可以直接生成马达驱动信号。
在一个方面，控制电路710可以针对位移构件的行程的第一开环部分初始以开环配置操作马达704a-704e中的每个。基于在行程的开环部分期间机器人外科器械700的响应，控制电路710可以选择处于闭环配置的击发控制程序。器械的响应可以包括在开环部分期间位移构件的平移距离、在开环部分期间耗用的时间、在开环部分期间提供给马达704a-704e中的一者的能量、马达驱动信号的脉冲宽度之和等。在开环部分之后，控制电路710可以对位移构件行程的第二部分实现所选择的击发控制程序。例如，在行程的闭环部分期间，控制电路710可以基于以闭环方式描述位移构件的位置的平移数据来调制马达704a-704e中的一者，以使位移构件以恒定速度平移。
在一个方面，马达704a-704e可从能量源712接收电力。能量源712可为由主交流功率源、电池、超级电容器或任何其它合适的能量源驱动的DC功率源。马达704a-704e可经由相应的传输装置706a-706e机械地联接到单独的可运动机械元件，诸如I形梁714、砧座716、轴740、关节运动742a和关节运动742b。传输装置706a-706e可以包括一个或多个齿轮或其它连杆器件，以将马达704a-704e联接到可运动机械元件。位置传感器734可感测I形梁714的位置。位置传感器734可以是或包括能够生成指示I形梁714的位置的位置数据的任何类型的传感器。在一些示例中，位置传感器734可包括编码器，该编码器被配置成能够在I形梁714朝远侧和朝近侧平移时向控制电路710提供一系列脉冲。控制电路710可跟踪脉冲以确定I形梁714的位置。可使用其它合适的位置传感器，包括例如接近传感器。其它类型的位置传感器可提供指示I形梁714的运动的其它信号。而且，在一些示例中，可省略位置传感器734。在马达704a-704e中的任一个是步进马达的情况下，控制电路710可通过汇总马达704已被命令执行的步骤的数量和方向来跟踪I形梁714的位置。位置传感器734可位于端部执行器702中或器械的任何其它部分处。马达704a-704e中的每个的输出包括用于感测力的扭矩传感器744a-744e，并且具有用于感测驱动轴的旋转的编码器。
在一个方面，控制电路710被配置成能够驱动击发构件诸如端部执行器702的I形梁714部分。控制电路710向马达控制708a提供马达设定点，该马达控制向马达704a提供驱动信号。马达704a的输出轴联接到扭矩传感器744a。扭矩传感器744a联接到传输装置706a，该传输装置联接到I形梁714。传输装置706a包括可运动机械元件诸如旋转元件和击发构件，以控制I形梁714沿端部执行器702的纵向轴线朝远侧和朝近侧的运动。在一个方面，马达704a可联接到刀齿轮组件，该刀齿轮组件包括刀齿轮减速组，该刀齿轮减速组包括第一刀驱动齿轮和第二刀驱动齿轮。扭矩传感器744a向控制电路710提供击发力反馈信号。击发力信号表示击发I形梁714或使其位移所需的力。位置传感器734可被配置成能够将I形梁714沿击发行程的位置或击发构件的位置作为反馈信号提供给控制电路710。端部执行器702可包括被配置成能够向控制电路710提供反馈信号的附加传感器738。当准备好使用时，控制电路710可向马达控制708a提供击发信号。响应于击发信号，马达704a可沿端部执行器702的纵向轴线将击发构件从近侧行程开始位置朝远侧驱动至行程开始位置远侧的行程结束位置。当击发构件朝远侧平移时，具有定位在远侧端部处的切割元件的I形梁714朝远侧推进以切割位于钉仓718和砧座716之间的组织。
在一个方面，控制电路710被配置成能够驱动闭合构件，诸如端部执行器702的砧座716部分。控制电路710向马达控制708b提供马达设定点，该马达控制708b向马达704b提供驱动信号。马达704b的输出轴联接到扭矩传感器744b。扭矩传感器744b联接到传输装置706b，该传输装置联接到砧座716。传输装置706b包括可运动机械元件诸如旋转元件和闭合构件，以控制砧座716从打开位置和闭合位置的运动。在一个方面，马达704b联接到闭合齿轮组件，该闭合齿轮组件包括被支撑成与闭合正齿轮啮合接合的闭合减速齿轮组。扭矩传感器744b向控制电路710提供闭合力反馈信号。闭合力反馈信号表示施加到砧座716的闭合力。位置传感器734可被配置成能够将闭合构件的位置作为反馈信号提供给控制电路710。端部执行器702中的附加传感器738可向控制电路710提供闭合力反馈信号。可枢转砧座716与钉仓718相对地定位。当准备好使用时，控制电路710可向马达控制708b提供闭合信号。响应于闭合信号，马达704b推进闭合构件以抓握砧座716和钉仓718之间的组织。
在一个方面，控制电路710被配置成能够使轴构件诸如轴740旋转，以使端部执行器702旋转。控制电路710向马达控制708c提供马达设定点，该马达控制708c向马达704c提供驱动信号。马达704c的输出轴联接到扭矩传感器744c。扭矩传感器744c联接到联接到轴740的传输装置706c。传输装置706c包括可运动机械元件诸如旋转元件，以控制轴740顺时针或逆时针旋转360°以上。在一个方面，马达704c联接到旋转传输装置组件，该旋转传输装置组件包括管齿轮区段，该管齿轮区段形成于(或附接到)近侧闭合管的近侧端部上，以通过可操作地支撑在工具安装板上的旋转齿轮组件可操作地接合。扭矩传感器744c向控制电路710提供旋转力反馈信号。旋转力反馈信号表示施加到轴740的旋转力。位置传感器734可被配置成能够将闭合构件的位置作为反馈信号提供给控制电路710。附加传感器738诸如轴编码器可向控制电路710提供轴740的旋转位置。
在一个方面，控制电路710被配置成能够使端部执行器702进行关节运动。控制电路710向马达控制708d提供马达设定点，该马达控制708d向马达704d提供驱动信号。马达704d的输出轴联接到扭矩传感器744d。扭矩传感器744d联接到联接到关节运动构件742a的传输装置706d。传输装置706d包括可运动的机械元件诸如关节运动元件，以控制端部执行器702±65°的关节运动。在一个方面，马达704d联接到关节运动螺母，该关节运动螺母可旋转地轴颈连接在远侧脊部的近侧端部部分上并且通过关节运动齿轮组件在其上可旋转地驱动。扭矩传感器744d向控制电路710提供关节运动力反馈信号。关节运动力反馈信号表示施加到端部执行器702的关节运动力。传感器738(诸如关节运动编码器)可向控制电路710提供端部执行器702的关节运动位置。
在另一方面，机器人外科系统700的关节运动功能可包括两个关节运动构件或连杆742a、742b。这些关节运动构件742a、742b由机器人接口(齿条)上的由两个马达708d、708e驱动的单独盘驱动。当提供单独的击发马达704a时，关节运动连杆742a、742b中的每个可相对于另一个连杆进行拮抗驱动，以便在头部未运动时向头部提供阻力保持运动和负载，并且在头部进行关节运动时提供关节运动。当头部旋转时，关节运动构件742a、742b以固定的半径附接到头部。因此，当头部旋转时，推拉连杆的机械优点发生变化。机械优点的该变化对于其它关节运动连杆驱动系统可更明显。
在一个方面，一个或多个马达704a-704e可包括具有齿轮箱的有刷DC马达和与击发构件、闭合构件或关节运动构件的机械链路。另一个示例包括操作可运动机械元件诸如位移构件、关节运动连杆、闭合管和轴的电动马达704a-704e。外部影响是事物如组织、周围身体和摩擦对物理系统的未测量的、不可预测的影响。此类外部影响可被称为曳力，其相对电动马达704a-704e中的一个作用。外部影响诸如曳力可导致物理系统的操作偏离物理系统的期望操作。
在一个方面，位置传感器734可被实现为绝对定位系统。在一个方面，位置传感器734可包括磁旋转绝对定位系统，该磁旋转绝对定位系统被实现为购自AustriaMicrosystems,AG的AS5055EQFT单片磁旋转位置传感器。位置传感器734可与控制电路710进行交互，以提供绝对定位系统。位置可包括位于磁体上方并联接到CORDIC处理器的霍尔效应元件，该CORDIC处理器也被已知为逐位方法和Volder算法，提供该CORDIC处理器以实现用于计算双曲线函数和三角函数的简单有效的算法，双曲线函数和三角函数仅需要加法操作、减法操作、数位位移操作和表格查找操作。
在一个方面，控制电路710可与一个或多个传感器738通信。传感器738可定位在端部执行器702上并且适于与机器人外科器械700一起操作以测量各种衍生参数，诸如间隙距离对时间、组织压缩与时间、以及砧座应变与时间。传感器738可包括磁传感器、磁场传感器、应变仪、负荷传感器、压力传感器、力传感器、扭矩传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器、和/或用于测量端部执行器702的一个或多个参数的任何其它合适的传感器。传感器738可包括一个或多个传感器。传感器738可位于钉仓718平台上，以使用分段电极来确定组织位置。扭矩传感器744a-744e可被配置成能够感测力诸如击发力、闭合力和/或关节运动力等。因此，控制电路710可感测：(1)远侧闭合管所经受的闭合负荷及其位置，(2)在齿条处的击发构件及其位置，(3)钉仓718在其上具有组织的部分，以及(4)两个关节运动杆上的负荷和位置。
在一个方面，一个或多个传感器738可包括应变仪诸如微应变仪，该应变仪被配置成能够在夹持条件期间测量砧座716中的应变的量值。应变仪提供电信号，该电信号的幅值随着应变量值而变化。传感器738可包括压力传感器，该压力传感器被配置成能够检测因砧座716和钉仓718之间的压缩组织的存在产生的压力。传感器738可被配置成能够检测位于砧座716和钉仓718之间的组织区段的阻抗，该阻抗指示位于其间的组织的厚度和/或完全性。
在一个方面，传感器738可实现为一个或多个限位开关、机电装置、固态开关、霍尔效应装置、磁阻(MR)装置、巨磁电阻(GMR)装置、磁力计等等。在其它具体实施中，传感器738可被实现为在光的影响下操作的固态开关，诸如光学传感器、IR传感器、紫外线传感器等等。同样，开关可为固态装置，诸如晶体管(例如，FET、结型FET、MOSFET、双极型晶体管等)。在其它具体实施中，传感器738可包括无电导体开关、超声开关、加速度计和惯性传感器等等。
在一个方面，传感器738可被配置成能够测量由闭合驱动系统施加在砧座716上的力。例如，一个或多个传感器738可位于闭合管和砧座716之间的交互点处，以检测由闭合管施加到砧座716的闭合力。施加在砧座716上的力可表示捕获在砧座716和钉仓718之间的组织区段所经受的组织压缩。一个或多个传感器738可定位在沿闭合驱动系统的各种交互点处，以检测由闭合驱动系统施加到砧座716的闭合力。一个或多个传感器738可在夹持操作期间由控制电路710的处理器实时取样。控制电路710接收实时样本测量结果以提供和分析基于时间的信息，并实时估计施加到砧座716的闭合力。
在一个方面，电流传感器736可用于测量由马达704a-704e中的每个所消耗的电流。推进可运动机械元件中的任一者诸如I形梁714所需的力对应于由马达704a-704e中的一个消耗的电流。将力转换为数字信号并将其提供给控制电路710。控制电路710可被配置成能够模拟器械的实际系统在控制器的软件中的响应。可致动位移构件以使端部执行器702中的I形梁714以目标速度或接近目标速度运动。机器人外科系统700可包括反馈控制器，该反馈控制器可为任何反馈控制器中的一者，包括但不限于例如PID、状态反馈、线性平方(LQR)和/或自适应控制器。机器人外科器械700可包括功率源，以例如将来自反馈控制器的信号转换成物理输入，诸如外壳电压、PWM电压、频率调制电压、电流、扭矩和/或力。附加细节公开于2017年6月29日提交的标题为用于机器人外科器械的闭环速度控制技术(CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT)的美国专利申请序列号15/636,829中，该专利全文以引用方式并入本文。
图18示出了根据本公开的一个方面的被编程为控制位移构件的远侧平移的外科器械750的框图。在一个方面，外科器械750被编程为控制位移构件诸如I形梁764的远侧平移。外科器械750包括端部执行器752，该端部执行器可包括砧座766、I形梁764(包括锋利切割刃)、和可移除钉仓768。
线性位移构件诸如I形梁764的位置、运动、位移和/或平移可通过绝对定位系统、传感器布置和位置传感器784来测量。由于I形梁764联接到能够纵向运动的驱动构件，因此I形梁764的位置可通过采用位置传感器784测量能够纵向运动的驱动构件的位置来确定。因此，在以下描述中，I形梁764的位置、位移和/或平移可通过如本文所述的位置传感器784来实现。控制电路760可被编程为控制位移构件诸如I形梁764的平移。在一些示例中，控制电路760可包括一个或多个微控制器、微处理器或其它合适的处理器，以用于执行致使一个或多个处理器以所述方式控制位移构件(例如，I形梁764)的指令。在一个方面，定时器/计数器781向控制电路760提供输出信号诸如实耗时间或数字计数，以将如由位置传感器784确定的I形梁764的位置与定时器/计数器781的输出相关联，使得控制电路760可确定I形梁764在相对于起始位置的特定时间(t)处的位置。定时器/计数器781可被配置成能够测量实耗时间、计数外部事件或时间外部事件。
控制电路760可生成马达设定点信号772。马达设定点信号772可提供给马达控制器758。马达控制器758可包括一个或多个电路，该一个或多个电路被配置成能够向马达754提供马达驱动信号774以驱动马达754，如本文所述。在一些示例中，马达754可为有刷DC电动马达。例如，马达754的速度可与马达驱动信号774成比例。在一些示例中，马达754可为无刷DC电动马达，并且马达驱动信号774可以包括提供给马达754的一个或多个定子绕组的PWM信号。而且，在一些示例中，可以省略马达控制器758，并且控制电路760可以直接生成马达驱动信号774。
马达754可从能量源762接收电力。能量源762可以是或包括电池、超级电容器或任何其它合适的能量源。马达754可经由传输装置756机械地联接到I形梁764。传输装置756可包括一个或多个齿轮或其它连杆部件，以将马达754联接到I形梁764。位置传感器784可感测I形梁764的位置。位置传感器784可以是或包括能够生成指示I形梁764的位置的位置数据的任何类型的传感器。在一些示例中，位置传感器784可包括编码器，该编码器被配置成能够在I形梁764朝远侧和朝近侧平移时向控制电路760提供一系列脉冲。控制电路760可跟踪脉冲以确定I形梁764的位置。可使用其它合适的位置传感器，包括例如接近传感器。其它类型的位置传感器可提供指示I形梁764的运动的其它信号。而且，在一些示例中，可省略位置传感器784。在马达754是步进马达的情况下，控制电路760可通过汇总马达754已被命令执行的步骤的数量和方向来跟踪I形梁764的位置。位置传感器784可位于端部执行器752中或器械的任何其它部分处。
控制电路760可与一个或多个传感器788通信。传感器788可定位在端部执行器752上并且适于与外科器械750一起操作以测量各种衍生参数，诸如间隙距离对时间、组织压缩对时间、和砧座应变对时间。传感器788可包括例如磁传感器、磁场传感器、应变仪、压力传感器、力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器、和/或用于测量端部执行器752的一个或多个参数的任何其它合适的传感器。传感器788可包括一个或多个传感器。
一个或多个传感器788可包括应变仪诸如微应变仪，该应变仪被配置成能够在夹持条件期间测量砧座766中的应变的量值。应变仪提供电信号，该电信号的幅值随着应变量值而变化。传感器788可包括压力传感器，该压力传感器被配置成能够检测因砧座766和钉仓768之间的压缩组织的存在产生的压力。传感器788可被配置成能够检测位于砧座766和钉仓768之间的组织区段的阻抗，该阻抗指示位于其间的组织的厚度和/或完全性。
传感器788可被配置成能够测量由闭合驱动系统施加在砧座766上的力。例如，一个或多个传感器788可位于闭合管和砧座766之间的交互点处，以检测由闭合管施加到砧座766的闭合力。施加在砧座766上的力可表示捕获在砧座766和钉仓768之间的组织区段所经受的组织压缩。一个或多个传感器788可定位在沿闭合驱动系统的各种交互点处，以检测由闭合驱动系统施加到砧座766的闭合力。一个或多个传感器788可在夹持操作期间由控制电路760的处理器实时取样。控制电路760接收实时样本测量结果以提供和分析基于时间的信息，并实时估计施加到砧座766的闭合力。
可采用电流传感器786来测量由马达754消耗的电流。推进I形梁764所需的力对应于由马达754消耗的电流。力被转换为数字信号并提供给控制电路760。
控制电路760可被配置成能够模拟器械的实际系统在控制器的软件中的响应。可致动位移构件以将端部执行器752中的I形梁764以目标速度或接近目标速度运动。外科器械750可包括反馈控制器，该反馈控制器可为任何反馈控制器中的一者，包括但不限于例如PID、状态反馈、LQR和/或自适应控制器。外科器械750可包括功率源，以例如将来自反馈控制器的信号转换为物理输入，诸如外壳电压、PWM电压、频率调制电压、电流、扭矩和/或力。
外科器械750的实际驱动系统被配置成能够通过具有齿轮箱和与关节运动和/或刀系统连接的机械连接件的有刷DC马达来驱动位移构件、切割构件或I形梁764。另一示例是操作例如可互换轴组件的位移构件和关节运动驱动器的电动马达754。外部影响是事物如组织、周围身体和摩擦对物理系统的未测量的、不可预测的影响。这种外部影响可称为与电动马达754相反地作用的曳力。外部影响诸如曳力可导致物理系统的操作偏离物理系统的期望操作。
各种示例性方面涉及外科器械750，该外科器械包括具有马达驱动的外科缝合和切割工具的端部执行器752。例如，马达754可沿着端部执行器752的纵向轴线朝远侧和朝近侧驱动位移构件。端部执行器752可包括可枢转砧座766，并且当被配置用于使用时，钉仓768与砧座766相对地定位。临床医生可将组织抓握在砧座766和钉仓768之间，如本文所述。当准备好使用器械750时，临床医生可例如通过按下器械750的触发器来提供击发信号。响应于击发信号，马达754可沿着端部执行器752的纵向轴线将位移构件从近侧行程开始位置朝远侧驱动到行程开始位置远侧的行程结束位置。当位移构件朝远侧平移时，具有定位在远侧端部处的切割元件的I形梁764可切割钉仓768和砧座766之间的组织。
在各种示例中，外科器械750可包括控制电路760，该控制电路被编程为例如基于一个或多个组织状况来控制位移构件诸如I形梁764的远侧平移。控制电路760可被编程为直接或间接地感测组织状况诸如厚度，如本文所述。控制电路760可被编程为基于组织状况来选择击发控制程序。击发控制程序可以描述位移构件的远侧运动。可以选择不同的击发控制程序以更好地处理不同的组织状况。例如，控制电路760可被编程为当存在较厚组织时，以较低速度和/或以较低功率平移位移构件。控制电路760可被编程为当存在较薄组织时，以较高速度和/或以较高功率平移位移构件。
在一些示例中，控制电路760可针对位移构件的行程的第一开环部分初始以开环配置操作马达754。基于在行程的开环部分期间器械750的响应，控制电路760可选择击发控制程序。器械的响应可包括在开环部分期间位移构件的平移距离、在开环部分期间实耗的时间、在开环部分期间提供给马达754的能量、马达驱动信号的脉冲宽度之和等。在开环部分之后，控制电路760可对位移构件行程的第二部分实施所选择的击发控制程序。例如，在行程的闭环部分期间，控制电路760可基于以闭环方式描述位移构件的位置的平移数据来调节马达754，以使位移构件以恒定速度平移。附加细节公开于2017年9月29日提交的标题为用于控制外科器械的显示器的系统和方法(SYSTEM AND METHODS FOR CONTROLLING ADISPLAY OF A SURGICAL INSTRUMENT)的美国专利申请序列号15/720,852中，该专利申请全文以引用方式并入本文。
图19为根据本公开的一个方面的被配置成能够控制各种功能的外科器械790的示意图。在一个方面，外科器械790被编程为控制位移构件诸如I形梁764的远侧平移。外科器械790包括端部执行器792，该端部执行器可包括砧座766、I形梁764和可移除钉仓768，该可移除钉仓可与RF仓796(以虚线示出)互换。
在一个方面，传感器788可被实现为限位开关、机电装置、固态开关、霍尔效应装置、MR装置、GMR装置、磁力计等等。在其它具体实施中，传感器638可被实现为在光的影响下操作的固态开关，诸如光学传感器、IR传感器、紫外线传感器等等。同样，开关可为固态装置，诸如晶体管(例如，FET、结型FET、MOSFET、双极型晶体管等)。在其它具体实施中，传感器788可包括无电导体开关、超声开关、加速度计和惯性传感器等等。
在一个方面，位置传感器784可被实现为绝对定位系统，该绝对定位系统包括被实现为购自Austria Microsystems,AG的AS5055EQFT单片磁旋转位置传感器的磁旋转绝对定位系统。位置传感器784可与控制电路760进行交互，以提供绝对定位系统。位置可包括位于磁体上方并联接到CORDIC处理器的霍尔效应元件，该CORDIC处理器也被已知为逐位方法和Volder算法，提供该CORDIC处理器以实现用于计算双曲线函数和三角函数的简单有效的算法，双曲线函数和三角函数仅需要加法操作、减法操作、数位位移操作和表格查找操作。
在一个方面，I形梁764可被实现为刀构件，该刀构件包括在其上可操作地支撑组织切割刀片的刀主体，并且该I形梁还可包括砧座接合突片或特征和通道接合特征或底脚。在一个方面，钉仓768可被实现为标准的(机械)外科紧固件仓。在一个方面，RF仓796可被实现为RF仓。这些和其它传感器布置在2017年6月20日提交的标题为TECHNIQUES FORADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTINGINSTRUMENT的共同拥有的美国专利申请序列号15/628,175中有所描述，该专利申请全文以引用方式并入本文。
线性位移构件诸如I形梁764的位置、运动、位移和/或平移可通过绝对定位系统、传感器布置和表示为位置传感器784的位置传感器来测量。因为I形梁764联接到能够纵向运动的驱动构件，所以I形梁764的位置可通过采用位置传感器784测量能够纵向运动的驱动构件的位置来确定。因此，在以下描述中，I形梁764的位置、位移和/或平移可通过如本文所述的位置传感器784来实现。控制电路760可被编程为控制位移构件诸如I形梁764的平移，如本文所述。在一些示例中，控制电路760可包括一个或多个微控制器、微处理器或其它合适的处理器，以用于执行致使一个或多个处理器以所述方式控制位移构件(例如，I形梁764)的指令。在一个方面，定时器/计数器781向控制电路760提供输出信号诸如实耗时间或数字计数，以将如由位置传感器784确定的I形梁764的位置与定时器/计数器781的输出相关联，使得控制电路760可确定I形梁764在相对于起始位置的特定时间(t)处的位置。定时器/计数器781可被配置成能够测量实耗时间、计数外部事件或时间外部事件。
控制电路760可生成马达设定点信号772。马达设定点信号772可提供给马达控制器758。马达控制器758可包括一个或多个电路，该一个或多个电路被配置成能够向马达754提供马达驱动信号774以驱动马达754，如本文所述。在一些示例中，马达754可为有刷DC电动马达。例如，马达754的速度可与马达驱动信号774成比例。在一些示例中，马达754可为无刷DC电动马达，并且马达驱动信号774可以包括提供给马达754的一个或多个定子绕组的PWM信号。而且，在一些示例中，可以省略马达控制器758，并且控制电路760可以直接生成马达驱动信号774。
马达754可从能量源762接收电力。能量源762可以是或包括电池、超级电容器或任何其它合适的能量源。马达754可经由传输装置756机械地联接到I形梁764。传输装置756可包括一个或多个齿轮或其它连杆部件，以将马达754联接到I形梁764。位置传感器784可感测I形梁764的位置。位置传感器784可以是或包括能够生成指示I形梁764的位置的位置数据的任何类型的传感器。在一些示例中，位置传感器784可包括编码器，该编码器被配置成能够在I形梁764朝远侧和朝近侧平移时向控制电路760提供一系列脉冲。控制电路760可跟踪脉冲以确定I形梁764的位置。可使用其它合适的位置传感器，包括例如接近传感器。其它类型的位置传感器可提供指示I形梁764的运动的其它信号。而且，在一些示例中，可省略位置传感器784。在马达754是步进马达的情况下，控制电路760可通过汇总马达已被命令执行的步骤的数量和方向来跟踪I形梁764的位置。位置传感器784可位于端部执行器792中或器械的任何其它部分处。
控制电路760可与一个或多个传感器788通信。传感器788可定位在端部执行器792上并且适于与外科器械790一起操作以测量各种衍生参数，诸如间隙距离对时间、组织压缩对时间、和砧座应变对时间。传感器788可包括例如磁性传感器、磁场传感器、应变仪、压力传感器、力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器、和/或用于测量端部执行器792的一个或多个参数的任何其它合适的传感器。传感器788可包括一个或多个传感器。
一个或多个传感器788可包括应变仪诸如微应变仪，该应变仪被配置成能够在夹持条件期间测量砧座766中的应变的量值。应变仪提供电信号，该电信号的幅值随着应变量值而变化。传感器788可包括压力传感器，该压力传感器被配置成能够检测因砧座766和钉仓768之间的压缩组织的存在产生的压力。传感器788可被配置成能够检测位于砧座766和钉仓768之间的组织区段的阻抗，该阻抗指示位于其间的组织的厚度和/或完全性。
传感器788可被配置成能够测量由闭合驱动系统施加在砧座766上的力。例如，一个或多个传感器788可位于闭合管和砧座766之间的交互点处，以检测由闭合管施加到砧座766的闭合力。施加在砧座766上的力可表示捕获在砧座766和钉仓768之间的组织区段所经受的组织压缩。一个或多个传感器788可定位在沿闭合驱动系统的各种交互点处，以检测由闭合驱动系统施加到砧座766的闭合力。一个或多个传感器788可在夹持操作期间由控制电路760的处理器部分实时取样。控制电路760接收实时样本测量结果以提供和分析基于时间的信息，并实时估计施加到砧座766的闭合力。
可采用电流传感器786来测量由马达754消耗的电流。推进I形梁764所需的力对应于由马达754消耗的电流。力被转换为数字信号并提供给控制电路760。
当RF仓796代替钉仓768被装载在端部执行器792中时，RF能量源794联接到端部执行器792，并且该RF能量源被施加到RF仓796。控制电路760控制RF能量到RF仓796的递送。
附加细节公开于2017年6月28日提交的美国专利申请序列号15/636,096，其标题为可与钉仓和射频仓联接的外科系统及其使用方法(SURGICAL SYSTEM COUPLABLE WITHSTAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE,AND METHOD OF USING SAME)，该专利全文以引用方式并入本文。
发生器硬件
图20为被配置成能够除其它益处之外还提供无电感器调谐的发生器800的简化框图。发生器800的附加细节在2015年6月23日提交的标题为SURGICAL GENERATOR FORULTRASONIC AND ELECTROSURGICAL DEVICES的美国专利号9,060,775中有所描述，该专利申请全文以引用方式并入本文。发生器800可包括患者隔离级802，该患者隔离级经由电力变压器806与非隔离级804通信。电力变压器806的次级绕组808包含在隔离级802中，并且可包括抽头配置(例如，中心抽头或非中心抽头配置)以限定驱动信号输出端810a、810b、810c，这些驱动信号输出端用于将驱动信号递送到不同的外科器械，诸如例如超声外科器械、RF电外科器械、和包括可单独或同时递送的超声能量模式和RF能量模式的多功能外科器械。具体地，驱动信号输出端810a、810c可将超声驱动信号(例如，420V均方根(RMS)驱动信号)输出到超声外科器械，并且驱动信号输出端810b、810c可将RF电外科驱动信号(例如，100V RMS驱动信号)输出到RF电外科器械，其中驱动信号输出端810b对应于电力变压器806的中心抽头。
在某些形式中，超声驱动信号和电外科驱动信号可同时提供到不同的外科器械和/或具有将超声能量和电外科能量两者递送到组织的能力的单个外科器械诸如多功能外科器械。应当理解，提供到专用电外科器械和/或组合的多功能超声/电外科器械的电外科信号可以是治疗水平信号或亚治疗水平信号，其中亚治疗信号可用于例如监测组织或器械状况并向发生器提供反馈。例如，超声信号和RF信号可从具有单个输出端口的发生器单独地或同时地递送，以便向外科器械提供期望的输出信号，如将在下文更详细地讨论。因此，发生器可组合超声能量和电外科RF能量并且将组合的能量递送到多功能超声/电外科器械。双极电极可被放置在端部执行器的一个或两个钳口上。除了电外科RF能量之外，一个钳口可由超声能量同时驱动。超声能量可用于解剖组织，而电外科RF能量可用于脉管密封。
非隔离级804可包括功率放大器812，该功率放大器具有连接到电力变压器806的初级绕组814的输出端。在某些形式中，功率放大器812可包括推挽放大器。例如，非隔离级804还可包括逻辑装置816，该逻辑装置用于向数字模拟转换器(DAC)电路818供应数字输出，该DAC电路进而将对应的模拟信号供应到功率放大器812的输入端。在某些形式中，例如除其它逻辑电路之外，逻辑装置816可包括可编程门阵列(PGA)、FPGA、可编程逻辑装置(PLD)。因此，通过经由DAC电路818控制功率放大器812的输入，逻辑装置816可控制在驱动信号输出端810a、810b、810c处出现的驱动信号的多个参数(例如，频率、波形形状、波形振幅)中的任一个。在某些形式中且如下文所讨论，逻辑装置816结合处理器(例如，下文所讨论的DSP)可实现多个基于DSP的算法和/或其它控制算法，以控制由发生器800输出的驱动信号的参数。
可通过开关模式调节器820(例如，功率转换器)将功率供应到功率放大器812的功率轨。在某些形式中，开关模式调节器820可包括例如可调式降压调节器。例如，非隔离级804还可包括第一处理器822，该第一处理器在一种形式中可包括DSP处理器，诸如例如购自Analog Devices(Norwood,MA)的Analog Devices ADSP-21469SHARC DSP，但可在各种形式中采用任何合适的处理器。在某些形式中，DSP处理器822可响应于由DSP处理器822经由ADC电路824从功率放大器812接收的电压反馈数据来控制开关模式调节器820的操作。在一种形式中，例如，DSP处理器822可经由ADC电路824接收由功率放大器812放大的信号(例如，RF信号)的波形包络作为输入。然后，DSP处理器822可控制开关模式调节器820(例如，经由PWM输出)，使得供应到功率放大器812的干线电压跟踪经放大信号的波形包络。通过基于波形包络动态地调节功率放大器812的干线电压，功率放大器812的效率相对于固定干线电压放大器方案可得到显著提高。
在某些形式中，逻辑装置816结合DSP处理器822可实现数字合成电路诸如直接数字合成器控制方案，以控制由发生器800输出的驱动信号的波形形状、频率和/或振幅。在一种形式中，例如，逻辑装置816可通过调用存储在动态更新的查找表(LUT)诸如RAM LUT中的波形样本来实现DDS控制算法，该动态更新的LUT可嵌入FPGA中。该控制算法尤其可用于如下超声应用：其中超声换能器诸如超声换能器可由其谐振频率下的纯正弦电流驱动。因为其它频率可激发寄生谐振，因此最小化或降低动态支路电流的总畸变可相应地最小化或降低不利的谐振效应。因为由发生器800输出的驱动信号的波形形状受输出驱动电路(例如，电力变压器806、功率放大器812)中所存在的各种畸变源的影响，因此基于驱动信号的电压和电流反馈数据可被输入到算法诸如由DSP处理器822实现的误差控制算法中，该算法通过适当地在动态、正在进行的基础上(例如实时)对存储在LUT中的波形样本进行预先畸变或修改来补偿畸变。在一种形式中，对LUT样本所施加的预先畸变量或程度可根据所计算的动态支路电流与期望的电流波形形状之间的误差而定，其中所述误差可基于逐一样本确定。以该方式，预先畸变的LUT样本在通过驱动电路进行处理时，可使动态支路驱动信号具有所期望的波形形状(例如，正弦形状)，以最佳地驱动超声换能器。因此，在此类形式中，当考虑到畸变效应时，LUT波形样本将不呈现驱动信号的期望波形形状，而是呈现要求最终产生动态支路驱动信号的期望波形形状的波形形状。
非隔离级804还可包括第一ADC电路826和第二ADC电路828，它们经由相应的隔离变压器830、832联接到电力变压器806的输出端，以分别用于对由发生器800输出的驱动信号的电压和电流进行采样。在某些形式中，ADC电路826、828可被配置成能够以高速(例如，80兆样本每秒(MSPS))进行采样，以实现对驱动信号的过采样。在一种形式中，例如，ADC电路826、828的采样速度可实现对驱动信号的约200x(根据频率而定)过采样。在某些形式中，可通过使单个ADC电路经由双向多路复用器接收输入电压和电流信号来执行ADC电路826、828的采样操作。在发生器800的形式中使用高速采样除其它事项之外还可实现对流过动态支路的复杂电流的计算(这在某些形式中可用于实现上述基于DDS的波形形状控制)、对采样信号的精确数字滤波、以及以高精度计算实际功耗。由ADC电路826、828输出的电压和电流反馈数据可由逻辑装置816接收和处理(例如，先进先出(FIFO)缓冲、多路复用器)并被存储在数据存储器中，以供例如DSP处理器822后续检索。如上所述，电压和电流反馈数据可用作算法的输入用于以动态行进方式使LUT波形样本预先畸变或修改。在某些形式中，当采集到电压和电流反馈数据对时，可能需要基于由逻辑装置816输出的对应LUT样本对每个所存储电压和电流反馈数据对进行索引或以其它方式将其与该对应LUT样本相关联。以此方式使LUT样本和电压和电流反馈数据同步有助于预畸变算法的准确计时和稳定性。
在某些形式中，可使用电压和电流反馈数据来控制驱动信号的频率和/或振幅(例如，电流振幅)。在一种形式中，例如，可使用电压和电流反馈数据来确定阻抗相位。随后，可控制驱动信号的频率以最小化或减小所确定阻抗相位与阻抗相位设定点(例如，0°)之间的差值，从而最小化或减小谐波畸变的影响，并相应地提高阻抗相位测量精确度。相位阻抗和频率控制信号的确定可在DSP处理器822中实现，例如，其中将频率控制信号作为输入供应给逻辑装置816所实现的DDS控制算法。
在另一形式中，例如可监测电流反馈数据，以便将驱动信号的电流振幅保持在电流振幅设定点。电流振幅设定点可被直接指定或基于特定的电压振幅和功率设定点而间接地确定。在某些形式中，可通过DSP处理器822中的控制算法诸如例如比例积分微分(PID)控制算法来实现对电流振幅的控制。由控制算法控制以适当地控制驱动信号的电流振幅的变量可包括：例如，存储在逻辑装置816中的LUT波形样本的标度和/或经由DAC电路834的DAC电路818(其向功率放大器812供应输入)的满刻度输出电压。
非隔离级804还可包括第二处理器836，该第二处理器用于除其它事项之外还提供用户接口(UI)功能。在一种形式中，UI处理器836可包括例如购自Atmel Corporation(SanJose,California)的具有ARM 926EJ-S核心的Atmel AT91SAM9263处理器。UI处理器836所支持的UI功能的示例可包括听觉和视觉用户反馈、与外围装置(例如，经由USB接口)的通信、与脚踏开关的通信、与输入装置(例如，触摸屏显示器)的通信以及与输出装置(例如，扬声器)的通信。UI处理器836可(例如，经由SPI总线)与DSP处理器822和逻辑装置816通信。尽管UI处理器836可主要支持UI功能，但在某些形式中，它也可与DSP处理器822协作以实现风险减缓。例如，UI处理器836可被编程为监测用户输入和/或其它输入(例如，触摸屏输入、脚踏开关输入、温度传感器输入)的各个方面，并且可在检测到错误状况时停用发生器800的驱动输出。
在某些形式中，例如DSP处理器822和UI处理器836两者可确定并监测发生器800的操作状态。对于DSP处理器822，发生器800的操作状态可指示例如由DSP处理器822实施哪些控制和/或诊断过程。对于UI处理器836，发生器800的操作状态可指示例如向用户呈现UI的哪些元素(例如，显示屏、声音)。相应的DSP处理器822和UI处理器836可独立地保持发生器800的当前操作状态并识别和评估当前操作状态的可能转变。DSP处理器822可充当该关系中的主体并且确定何时发生操作状态间的转变。UI处理器836可知道操作状态间的有效转变并且可确认特定转变是否适当。例如，当DSP处理器822命令UI处理器836转变到特定状态时，UI处理器836可验证所要求的转变是有效的。如果UI处理器836确定所要求的状态间转变是无效的，则UI处理器836可致使发生器800进入失效模式。
非隔离级804还可包括控制器838，该控制器用于监测输入装置(例如，用于接通和断开发生器800的电容触摸传感器、电容触摸屏)。在某些形式中，控制器838可包括至少一个处理器和/或与UI处理器836通信的其它控制器装置。在一种形式中，例如，控制器838可包括处理器(例如，购自Atmel的Meg168 8位控制器)，该处理器被配置成能够监测经由一个或多个电容触摸传感器提供的用户输入。在一种形式中，控制器838可包括触摸屏控制器(例如购自Atmel的QT5480触摸屏控制器)，以控制和管理从电容触摸屏对触摸数据的采集。
在某些形式中，当发生器800处于“功率关”状态时，控制器838可继续接收操作功率(例如，经由来自发生器800的功率源诸如下文所讨论的功率源854的线)。以此方式，控制器838可继续监测输入装置(例如，位于发生器800的前面板上的电容式触摸传感器)，以用于接通和断开发生器800。当发生器800处于功率关状态时，如果检测到用户“接通/断开”输入装置的激活，则控制器838可唤醒功率源(例如，启用功率源854的一个或多个DC/DC电压转换器856的操作)。因此，控制器838可发起用于将发生器800转变到“功率开”状态的序列。相反，当发生器800处于功率开状态时，如果检测到“接通/断开”输入装置的激活，则控制器838可发起用于将发生器800转变到功率关状态的序列。在某些形式中，例如，控制器838可向UI处理器836报告“接通/断开”输入装置的激活，该UI处理器进而实施必要过程序列以将发生器800转变到功率关状态。在此类形式中，控制器838可能不具有在已经建立发生器800的功率开状态之后从该发生器去除功率的独立能力。
在某些形式中，控制器838可致使发生器800提供听觉或其它感观反馈，以用于警示用户已经发起功率开或功率关序列。可在功率开或功率关序列开始时以及在与序列相关联的其它过程开始之前提供此类警示。
在某些形式中，隔离级802可包括器械接口电路840，例如以在外科器械的控制电路(例如，包括手持件开关的控制电路)和非隔离级804的部件(诸如例如，逻辑装置816、DSP处理器822和/或UI处理器836)之间提供通信接口。器械接口电路840可经由保持隔离级802和非隔离级804之间的合适的电气隔离程度的通信链路诸如例如基于IR的通信链路与非隔离级804的部件交换信息。例如，可使用由隔离变压器供电的低压降电压调节器向器械接口电路840供应电力，该低压降电压调节器从非隔离级804被驱动。
在一种形式中，器械接口电路840可包括与信号调节电路844通信的逻辑电路842(例如，逻辑电路、可编程逻辑电路、PGA、FPGA、PLD)。信号调节电路844可被配置成能够从逻辑电路842接收周期性信号(例如，2kHz方波)，以生成具有相同频率的双极性询问信号。例如，可使用由差分放大器馈送的双极电流源生成询问信号。询问信号可传送到外科器械控制电路(例如，通过使用将发生器800连接到外科器械的缆线中的导电对)并被监测，以确定控制电路的状态或配置。控制电路可包括多个开关、电阻器和/或二极管，以修改询问信号的一个或多个特性(例如，振幅、整流)，使得可基于该一个或多个特性唯一地辨别控制电路的状态或配置。在一种形式中，例如，信号调节电路844可包括ADC电路，该ADC电路用于产生由于询问信号通过控制电路而出现在控制电路输入中的电压信号的样本。然后，逻辑电路842(或非隔离级804的部件)可基于ADC电路样本来确定控制电路的状态或配置。
在一种形式中，器械接口电路840可包括第一数据电路接口846，以实现逻辑电路842(或器械接口电路840的其它元件)和设置于外科器械中或以其它方式与外科器械相关联的第一数据电路之间的信息交换。在某些形式中，例如，第一数据电路可设置于整体附接到外科器械手持件的缆线中，或设置于用于使特定外科器械类型或模型与发生器800交接的适配器中。第一数据电路可以任何合适的方式实施，并且可根据包括例如本文关于第一数据电路所述的任何合适的协议与发生器通信。在某些形式中，第一数据电路可包括非易失性存储装置，诸如EEPROM装置。在某些形式中，第一数据电路接口846可与逻辑电路842分开实施，并且包括合适的电路(例如，离散逻辑装置、处理器)，以实现逻辑电路842和第一数据电路之间的通信。在其它形式中，第一数据电路接口846可与逻辑电路842形成一体。
在某些形式中，第一数据电路可存储与其所相关联的特定外科器械相关的信息。此类信息可包括例如型号、序列号、其中已使用外科器械的多个操作、和/或任何其它类型的信息。该信息可由器械接口电路840(例如，通过逻辑电路842)读取、被传输到非隔离级804的部件(例如，到逻辑装置816、DSP处理器822和/或UI处理器836)，以用于经由输出装置呈现给用户和/或控制发生器800的功能或操作。另外，任何类型的信息均可经由第一数据电路接口846(例如，使用逻辑电路842)传送到第一数据电路以存储于其中。此类信息例如可包括已经使用外科器械的操作的更新数目和/或外科器械的使用日期和/或时间。
如先前所讨论，外科器械可从手持件拆卸(例如，多功能外科器械可从手持件拆卸)以促进器械可互换性和/或处置性。在此类情形中，常规发生器的识别所使用特定器械配置和相应地优化控制和诊断过程的能力可受限。然而，从兼容性角度来看，通过对外科器械添加可读数据电路来解决该问题是有问题的。例如，设计外科器械来保持与缺少必备数据读取功能的发生器的向后兼容可能由于例如不同的信号方案、设计复杂性和成本而不切实际。本文所讨论的器械的形式通过使用数据电路来解决这些问题，这些数据电路可经济地实施于现有外科器械中并且具有最小的设计变化，以保持外科器械与当前发生器平台的兼容性。
另外，发生器800的形式可实现与基于器械的数据电路的通信。例如，发生器800可被配置成能够与器械(例如，多功能外科器械)中所包含的第二数据电路通信。在一些形式中，第二数据电路可以类似于本文所述的第一数据电路的方式实施。器械接口电路840可包括用于实现该通信的第二数据电路接口848。在一种形式中，第二数据电路接口848可包括三态数字接口，但也可使用其它接口。在某些形式中，第二数据电路通常可为用于传输和/或接收数据的任何电路。在一种形式中，例如第二数据电路可存储与相关联的特定外科器械相关的信息。此类信息可包括例如型号、序列号、其中已使用外科器械的多个操作、和/或任何其它类型的信息。
在一些形式中，第二数据电路可存储关于相关联的超声换能器、端部执行器或超声驱动系统的电性能和/或超声性能的信息。例如，第一数据电路可指示老化频率斜率，如本文所述。附加地或另选地，任何类型的信息均可经由第二数据电路接口848(例如，使用逻辑电路842)传送到第二数据电路以存储于其中。此类信息例如可包括其中使用外科器械的操作的更新数目和/或其使用的日期和/或时间。在某些形式中，第二数据电路可传输由一个或多个传感器(例如，基于器械的温度传感器)采集的数据。在某些形式中，第二数据电路可从发生器800接收数据，并且基于所接收的数据向用户提供指示(例如，发光二极管指示或其它可视指示)。
在某些形式中，第二数据电路和第二数据电路接口848可被配置成使得可实现逻辑电路842和第二数据电路之间的通信而无需为此提供附加导体(例如，将手持件连接至发生器800的缆线的专用导体)。在一种形式中，例如，可使用实施于现有缆线上的单总线通信方案诸如用于将询问信号从信号调节电路844传输到手持件中的控制电路的导体中的一者来将信息传送到第二数据电路并从第二数据电路发送信息。以此方式，可使原本可能必要的外科器械的设计变化或修改最小化或减少。此外，因为在公共物理通道上实施的不同类型的通信可以是频带分离的，因此第二数据电路的存在对于不具有必备数据读取功能的发生器可以是“隐形的”，从而实现外科器械的向后兼容性。
在某些形式中，隔离级802可包括至少一个阻挡电容器850-1，该至少一个阻挡电容器连接到驱动信号输出端810b以防止DC电流流向患者。例如，可要求信号阻挡电容器符合医疗规则或标准。尽管相对而言单电容器设计中很少出现错误，然而此类错误可造成不良后果。在一种形式中，可设置与阻挡电容器850-1串联的第二阻挡电容器850-2，其中例如通过ADC电路852来监测来自阻挡电容器850-1和850-2之间的点的电流泄漏，以对泄漏电流所感应的电压进行采样。这些样本例如可由逻辑电路842接收。基于泄漏电流的变化(如电压样本所指示)，发生器800可确定阻挡电容器850-1、850-2中的至少一者何时已失效，从而提供优于具有单个失效点的单电容器设计的益处。
在某些形式中，非隔离级804可包括功率源854，该功率源用于在适当的电压和电流下递送DC功率。功率源可包括例如用于递送48VDC系统电压的400W功率源。功率源854还可包括一个或多个DC/DC电压转换器856，该一个或多个DC/DC电压转换器用于接收功率源的输出以在发生器800的各种部件所需的电压和电流下产生DC输出。如上文结合控制器838所讨论，当控制器838检测到用户激活“接通/断开”输入装置以启用DC/DC电压转换器856的操作或唤醒DC/DC电压转换器856时，DC/DC电压转换器856中的一个或多个可从控制器838接收输入。
图21示出了发生器900的示例，该发生器是发生器800(图20)的一种形式。发生器900被配置成能够将多个能量模态递送至外科器械。发生器900提供用于独立地或同时将能量递送至外科器械的RF信号和超声信号。RF信号和超声信号可单独或组合提供，并且可同时提供。如上所述，至少一个发生器输出可通过单个端口递送多种能量模态(例如，超声、双极或单极RF、不可逆和/或可逆电穿孔和/或微波能量等等)，并且这些信号可分开或同时被递送到端部执行器以处理组织。
发生器900包括联接到波形发生器904的处理器902。处理器902和波形发生器904被配置成能够基于存储在联接到处理器902的存储器中的信息来生成各种信号波形，为了本公开清楚起见而未示出该存储器。与波形相关联的数字信息被提供给波形发生器904，该波形发生器904包括一个或多个DAC电路以将数字输入转换成模拟输出。模拟输出被馈送到放大器1106用于信号调节和放大。放大器906的经调节和放大的输出联接到电力变压器908。信号通过电力变压器908联接到患者隔离侧中的次级侧。第一能量模态的第一信号被提供给被标记为ENERGY1和RETURN的端子之间的外科器械。第二能量模态的第二信号联接到电容器910两端并被提供给标记为ENERGY2和RETURN的端子之间的外科器械。应当理解，可输出超过两种能量模态，并且因此下标“n”可被用来指定可提供多至n个ENERGYn端子，其中n是大于1的正整数。还应当理解，在不脱离本公开的范围的情况下，可提供多至“n”个返回路径RETURNn。
第一电压感测电路912联接到标记为ENERGY1和RETURN路径的端子的两端，以测量其间的输出电压。第二电压感测电路924联接到标记为ENERGY2和RETURN路径的端子的两端，以测量其间的输出电压。如图所示，电流感测电路914与电力变压器908的次级侧的RETURN支路串联设置，以测量任一能量模态的输出电流。如果为每种能量模态提供不同的返回路径，则应在每个返回支路中提供单独的电流感测电路。第一电压感测电路912和第二电压感测电路924的输出被提供给相应的隔离变压器916、922，并且电流感测电路914的输出被提供给另一隔离变压器918。电力变压器908(非患者隔离侧)的初级侧上的隔离变压器916、928、922的输出被提供给一个或多个ADC电路926。ADC电路926的数字化输出被提供给处理器902用于进一步处理和计算。可采用输出电压和输出电流反馈信息来调整提供给外科器械的输出电压和电流，并且计算输出阻抗等参数。处理器902和患者隔离电路之间的输入/输出通信通过接口电路920提供。传感器也可通过接口920与处理器902电气通信。
在一个方面，阻抗可由处理器902通过将联接在标记为ENERGY1/RETURN的端子两端的第一电压感测电路912或联接在标记为ENERGY2/RETURN的端子两端的第二电压感测电路924的输出除以与电力变压器908的次级侧的RETURN支路串联设置的电流感测电路914的输出来确定。第一电压感测电路912和第二电压感测电路924的输出被提供给单独的隔离变压器916、922，并且电流感测电路914的输出被提供给另一隔离变压器916。来自ADC电路926的数字化电压和电流感测测量值被提供给处理器902以用于计算阻抗。例如，第一能量模态ENERGY1可以是超声能量，并且第二能量模态ENERGY2可以是RF能量。然而，除了超声和双极或单极RF能量模态之外，其它能量模态还包括不可逆和/或可逆电穿孔和/或微波能量等。而且，虽然图21所示的示例示出了可为两种或更多种能量模态提供单个返回路径RETURN，但在其它方面，可为每种能量模态ENERGYn提供多个返回路径RETURNn。因此，如本文所述，超声换能器阻抗可通过将第一电压感测电路912的输出除以电流感测电路914的输出来测量，并且组织阻抗可通过将第二电压感测电路924的输出除以电流感测电路914的输出来测量。
如图21中所示，包括至少一个输出端口的发生器900可包括具有单个输出和多个抽头的电力变压器908，以例如根据正在执行的组织处理类型以一种或多种能量模态(诸如超声、双极或单极RF、不可逆和/或可逆电穿孔和/或微波能量等等)的形式向端部执行器提供功率。例如，发生器900可用较高电压和较低电流递送能量以驱动超声换能器，用较低电压和较高电流递送能量以驱动RF电极以用于密封组织，或者用凝固波形递送能量以用于使用单极或双极RF电外科电极。来自发生器900的输出波形可被操纵、切换或滤波，以向外科器械的端部执行器提供频率。超声换能器与发生器900输出端的连接将优选地位于被标记为ENERGY1和RETURN的输出端之间，如图21所示。在一个示例中，RF双极电极与发生器900输出端的连接将优选地位于被标记为ENERGY2和RETURN的输出端之间。在单极输出的情况下，优选的连接将是ENERGY2输出端的有源电极(例如，铅笔或其他探头)以及连接至RETURN输出端的合适的返回垫。
附加细节公开于2017年3月30日公布的标题为用于操作用于数字地生成电信号波形的发生器和外科器械的技术(TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLYGENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS)的美国专利申请公布2017/0086914中，该专利申请全文以引用方式并入本文。
如本说明书通篇所用，术语“无线”及其衍生物可用于描述可通过使用经调制的电磁辐射通过非固体介质来传送数据的电路、装置、系统、方法、技术、通信信道等。该术语并不意味着相关联的组织不包含任何电线，尽管在一些方面它们可能不包含。通信模块可实现多种无线或有线通信标准或协议中的任一种，包括但不限于Wi-Fi(IEEE802.11系列)、WiMAX(IEEE 802.16系列)、IEEE 802.20、长期演进(LTE)、Ev-DO、HSPA+、HSDPA+、HSUPA+、EDGE、GSM、GPRS、CDMA、TDMA、DECT、蓝牙、及其以太网衍生物、以及被指定为3G、4G、5G和以上的任何其它无线和有线协议。计算模块可包括多个通信模块。例如，第一通信模块可专用于较短距离的无线通信诸如Wi-Fi和蓝牙，并且第二通信模块可专用于较长距离的无线通信诸如GPS、EDGE、GPRS、CDMA、WiMAX、LTE、Ev-DO等。
如本文所用，处理器或处理单元是对一些外部数据源(通常为存储器或一些其它数据流)执行操作的电子电路。本文所用术语是指组合多个专门的“处理器”的一个或多个系统(尤其是片上系统(SoC))中的中央处理器(中央处理单元)。
如本文所用，片上系统或芯片上系统(SoC或SOC)为集成了计算机或其它电子系统的所有器件的集成电路(也被称为“IC”或“芯片”)。它可以包含数字、模拟、混合信号以及通常射频功能—全部在单个基板上。SoC将微控制器(或微处理器)与高级外围装置如图形处理单元(GPU)、Wi-Fi模块或协处理器集成。SoC可以包含或可不包含内置存储器。
如本文所用，微控制器或控制器为将微处理器与外围电路和存储器集成的系统。微控制器(或微控制器单元的MCU)可被实现为单个集成电路上的小型计算机。其可类似于SoC；SoC可包括作为其器件之一的微控制器。微控制器可包含一个或多个核心处理单元(CPU)以及存储器和可编程输入/输出外围装置。以铁电RAM、NOR闪存或OTP ROM形式的程序存储器以及少量RAM也经常包括在芯片上。与个人计算机或由各种分立芯片组成的其它通用应用中使用的微处理器相比，微控制器可用于嵌入式应用。
如本文所用，术语控制器或微控制器可为与外围装置交接的独立式IC或芯片装置。这可为计算机的两个部件或用于管理该装置的操作(以及与该装置的连接)的外部装置上的控制器之间的链路。
如本文所述的处理器或微控制器中的任一者可为任何单核或多核处理器，诸如由德克萨斯器械公司(Texas Instruments)提供的商品名为ARM Cortex的那些。在一个方面，处理器可为例如购自德克萨斯器械公司(Texas Instruments)的LM4F230H5QR ARMCortex-M4F处理器内核，其包括：256KB的单循环闪存或其它非易失性存储器(最多至40MHZ)的片上存储器、用于使性能改善超过40MHz的预取缓冲器、32KB的单循环串行随机存取存储器(SRAM)、装载有
软件的内部只读存储器(ROM)、2KB的电可擦除可编程只读存储器(EEPROM)、一个或多个脉宽调制(PWM)模块、一个或多个正交编码器输入(QEI)模拟、具有12个模拟输入信道的一个或多个12位模数转换器(ADC)、以及产品数据表易得的其它特征。
在一个示例中，处理器可包括安全控制器，该安全控制器包括两个基于控制器的系列，诸如同样由德克萨斯器械公司(Texas Instruments)提供的商品名为Hercules ARMCortex R4的TMS570和RM4x。安全控制器可被配置成能够专门用于IEC 61508和ISO 26262安全关键应用等等，以提供先进的集成安全特征件，同时递送可定标的性能、连接性和存储器选项。
模块化装置包括可容纳在外科集线器内的模块(如结合图3和图9所述)和外科装置或器械，该外科装置或器械可连接到各种模块以便与对应的外科集线器连接或配对。模块化装置包括例如智能外科器械、医学成像装置、抽吸/冲洗装置、排烟器、能量发生器、呼吸机、吹入器和显示器。本文所述的模块化装置可通过控制算法来控制。控制算法可在模块化装置自身上、在与特定模块化装置配对的外科集线器上或在模块化装置和外科集线器两者上执行(例如，经由分布式计算架构)。在一些示例中，模块化装置的控制算法基于由模块化装置自身感测到的数据来控制装置(即，通过模块化装置之中、之上或连接到模块化装置的传感器)。该数据可与正在手术的患者(例如，组织特性或吹入压力)或模块化装置本身相关(例如，刀被推进的速率、马达电流或能量水平)。例如，外科缝合和切割器械的控制算法可根据刀在其前进时遇到的阻力来控制器械的马达驱动其刀穿过组织的速率。
数据管理和收集
在一个方面，外科集线器提供数据存储能力。数据存储包括创建和使用包括标识特征的自描述数据、管理冗余数据集和以配对数据集的方式存储数据，这些配对数据集可按手术分组但不一定键控到实际外科手术日期和外科医生以保持数据匿名性。以下描述以引用方式并入所有“集线器”和“云”分析系统硬件和软件处理技术以实现下文所述的特定数据管理和收集技术，如以引用方式并入本文的。将在交互式外科系统100的环境的背景下描述图22-图41，该交互式外科系统100的环境包括结合图1-图11描述的外科集线器106、206和结合图12-图21描述的智能器械和发生器。
电子医疗记录(EMR)交互
图22为根据本公开的一个方面的示出了用于与患者电子医疗记录(EMR)数据库4002交互的技术的图4000。在一个方面，本公开提供了一种将密钥4004嵌入位于医院或医疗设施内的EMR数据库4002内的方法。提供数据屏障4006来保护患者数据隐私，并且允许从外科集线器106、206或云104、204重新整合如下文所述的剥离和隔离数据对以进行重新汇编。图1-图11并且特别是图9-图10中大体描述了外科集线器206的示意图。因此，在图22的描述中，针对外科集线器206的任何实施细节，将读者引导至图1-图11，并且特别是图9-图10；为了公开的简洁和清楚，这里可省略这些细节。返回到图22，该方法允许用户完全访问在外科手术期间收集的所有数据和以电子医疗记录4012的形式存储的患者信息。重新汇编的数据可显示在联接到外科集线器206的监测器4010或次级监测器上，但不永久地存储在任何外科集线器存储装置248上。重新汇编的数据暂时存储在位于外科集线器206或云204中的存储装置248中，并且在使用结束时被删除并重写以确保其不能恢复。EMR数据库4002中的密钥4004用于将匿名化集线器数据重新整合回全整合患者电子医疗记录4012数据中。
如图22所示，EMR数据库4002位于医院数据屏障4006内。EMR数据库4002可被配置用于存储、检索和管理关联阵列或今天称为字典或哈希的其它数据结构。字典包含对象或记录的集合，这些对象或记录在其中又具有许多不同的字段，每个字段均包含数据。可使用密钥4004来存储和检索患者电子医疗记录4012，该密钥唯一地标识患者电子医疗记录4012并且用于在EMR数据库4002内快速找到数据。密钥值EMR数据库4002系统将数据视为单个不透明集合，其中每个记录可具有不同的字段。
可将来自EMR数据库4002的信息传输到外科集线器206，并且在将患者电子医疗记录4012数据发送到基于集线器206或云204的分析系统之前对其进行编辑和剥离。通过对个人患者数据进行编辑并从患者电子医疗记录4012剥离相关患者数据4018来创建匿名数据文件4016。如本文所用，编辑过程包括从患者电子医疗记录4012删除或去除个人患者信息以创建仅包括匿名患者数据的编辑记录。编辑记录是已经从中清除敏感患者信息的记录。可删除4019未编辑数据。相关患者数据4018在本文中可称为剥离/提取数据4018。相关患者数据4018由外科集线器206或云204的处理引擎用于分析目的，并且可存储在外科集线器206的存储装置248上或者可存储在基于云204的分析系统存储装置205上。可使用存储在EMR数据库4002中的密钥4004来重建外科集线器匿名数据文件4016，以将外科集线器匿名数据文件4016重新整合回全整合患者电子医疗记录4012中。分析过程中使用的相关患者数据4018可包括以下信息：诸如患者的肺气肿诊断、术前治疗(例如，化学治疗、放射、血液稀释剂、血压药物等)、通常的血压或不能单独用于确定患者身份的任何数据。待编辑的数据4020包括从患者电子医疗记录4012去除的个人信息，这些个人信息可包括年龄、工作单位、体质指数(BMI)或可用于确定患者身份的任何数据。外科集线器206创建唯一的匿名手术ID号(例如，380i4z)，例如，如图23所述。在位于医院数据屏障4006中的EMR数据库4002内，外科集线器206可将存储在外科集线器206存储装置248上的匿名数据文件4016中的数据与存储在EMR数据库4002上的患者电子医疗记录4012中的数据重新组合，以供外科医生查看。外科集线器206将组合的患者电子医疗记录4012显示在联接到外科集线器206的显示器或监测器4010上。最终，从外科集线器206的存储装置248删除4019未编辑数据。
创建医院数据屏障，在医院数据屏障内可使用非匿名化数据比较来自集线器的数
据并且在医院数据屏障外必须剥离数据
在一个方面，本公开提供了一种如图9和图10所述的外科集线器206，例如，其中外科集线器206包括处理器244；以及联接到处理器244的存储器249。存储器249存储能够由处理器244执行以进行以下操作的指令：询问外科器械235，从外科器械235检索第一数据集，询问医学成像装置238，从医学成像装置238检索第二数据集，通过密钥将第一数据集和第二数据集相关联，以及将相关联的第一数据集和第二数据集传输到外科集线器206外部的远程网络(例如，云204)。外科器械235是患者数据的第一源，并且第一数据集与外科手术相关联。医学成像装置238是患者数据的第二源，并且第二数据集与外科手术的效果相关联。第一数据记录和第二数据记录由密钥唯一地标识。
在另一方面，外科集线器206提供存储器249，该存储器存储能够由处理器244执行以进行以下操作的指令：使用密钥来检索第一数据集，对第一数据集匿名化，使用密钥来检索第二数据集，对第二数据集匿名化，将匿名化的第一数据集和第二数据集配对，以及基于匿名化的配对第一数据集和第二数据集来确定按外科手术分组的外科手术的成功率。
在另一方面，外科集线器206提供存储器249，该存储器存储能够由处理器244执行以进行以下操作的指令：检索匿名化的第一数据集，检索匿名化的第二数据集，以及使用密钥来重新整合匿名化的第一数据集和第二数据集。
在另一方面，第一数据集和第二数据集定义相应的第一数据分组和第二数据分组中的第一数据有效载荷和第二数据有效载荷。
在各个方面，本公开提供了一种用于通过如上所述的密钥来将第一数据集和第二数据集相关联的控制电路。在各个方面，本公开提供了一种非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，这些计算机可读指令在被执行时致使机器通过如上所述的密钥将第一数据集和第二数据集相关联。
在外科手术期间，将期望监测与外科手术相关联的数据，以使得能够对在手术期间使用的器械进行配置和操作，从而改善外科效果。技术挑战是以保持患者的匿名性从而保持与患者相关联的数据隐私的方式检索数据。数据可用于与其它数据聚集，而不对数据进行个体化。
一种解决方案提供了一种外科集线器206，该外科集线器用于针对患者电子医疗记录4012的数据询问电子医疗记录数据库4002，从患者电子医疗记录4012剥离所需的或相关的患者数据4018，并且编辑可用于标识患者的任何个人信息。编辑技术去除可用于将所剥离的相关患者数据4018与特定患者、手术或时间相关联的任何信息。然后，可基于所剥离的相关患者数据4018对外科集线器206和联接到外科集线器206的器械235进行配置和操作。
如结合图22所公开，从患者电子医疗记录4012提取(或剥离)相关患者数据4018，同时编辑可用于将患者与手术或手术的预定时间相关联的任何信息，使得相关患者数据4018能够被匿名化。然后，可将匿名数据文件4016发送到云204以用于汇总、处理和操纵。匿名数据文件4016可用于基于所提取匿名数据文件4016，在手术期间对外科器械235或图9和图10所示的模块中的任一者或外科集线器206进行配置。
在一个方面，创建医院数据屏障4006，以使得在数据屏障4006内，可使用非匿名化的未编辑数据来比较来自各种外科集线器206的数据，并且在数据屏障4006外，剥离来自各种外科集线器206的数据以保持匿名性并保护患者和外科医生的隐私。结合图26进一步描述该方面。
在一个方面，来自外科集线器206的数据可在外科集线器206之间(例如，集线器到集线器、交换机到交换机或路由器到路由器)交换，以提供医院内分析和数据显示。图1示出了彼此通信且与云104通信的多个集线器106的示例。还结合图26进一步描述了该方面。
在另一方面，用人工时间量度取代实时时钟用于内部存储在器械235、位于机器人集线器222中的机器人、外科集线器206和/或医院计算机设备内的所有信息。将匿名化的数据(其可包括匿名化的患者和外科医生数据)传输到云204中的服务器213，并且将其存储在联接到服务器213的云存储装置205中。人工实时时钟的取代使得能够对患者数据和外科医生数据匿名化，同时保持数据连续性。在一个方面，器械235、机器人集线器222、外科集线器206和/或云204被配置成能够在保持数据连续性的同时隐藏患者身份(ID)。结合图23进一步描述该方面。
在外科集线器206内，本地解密密钥4004允许从外科集线器206自身检索的信息恢复为来自位于匿名数据文件4016中的匿名化数据集的实时信息。然而，存储在集线器206或云204上的数据不能恢复为来自匿名数据文件4016中的匿名化数据集的实时信息。密钥4004以加密格式本地保存在外科集线器206的计算机/存储装置248中。外科集线器206的网络处理器ID是解密机构的一部分，使得如果密钥4004和数据移除，则匿名数据文件4016中的匿名化数据集在不在原始外科集线器206的计算机/存储装置248上的情况下无法恢复。
用人工时间量度取代实时时钟用于所有内部存储的信息，以及将信息发送到云作
为对患者和外科医生数据匿名化的手段
图23示出了根据本公开的一个方面的通过用人工时间量度取代实时时钟用于内部存储在器械、机器人、外科集线器和/或医院计算机设备内的所有信息来对外科手术匿名化的方法4030。如图23所示，外科手术设置启动时间4032被预定为在基于实时时钟的实际时间11:31:14(EST)开始。在所述手术设置启动时间4032处，外科集线器206在人工实时07:36:00启动4034人工随机化实时时钟定时方案。然后，在人工实时07:36:01，外科集线器206超声查验4036手术室(例如，发出超声脉冲串并在其从手术室(例如，固定的、移动的、临时的或现场的手术室)的围墙弹回时侦听回波)(如结合图24所述)，以验证手术室的大小并调整短程无线(例如，蓝牙)配对距离限制。在人工实时07:36:03，外科集线器206剥离4038相关数据并将时间戳应用于所剥离数据。在人工实时07:36:05，外科集线器206唤醒仅位于如使用超声查验4036过程所验证的手术室内的装置并开始对其进行配对4040。
图24示出了根据本公开的至少一个方面的对手术室壁进行超声查验以确定外科集线器和手术室壁之间的距离。还参见图2，外科集线器206的空间感知及其针对外科系统的潜在部件对手术室进行标测的能力允许外科集线器206做出关于是否包括此类潜在部件作为外科系统的一部分或排除此类潜在部件的自主决定，这使外科人员免于处理此类任务。此外，外科集线器206被配置成能够基于在执行外科手术之前、期间和/或之后收集的信息来做出关于例如将在手术室中执行的外科手术的类型的推断。所收集信息的示例包括带入手术室中的装置的类型、将此类装置引入手术室中的时间和/或装置激活序列。
在一个方面，外科集线器206采用手术室标测模块诸如例如非接触式传感器模块242，以使用超声非接触式测量装置或激光非接触式测量装置来确定外科手术室(例如，固定的、移动的或临时的手术室或空间)的边界。
现在参见图24，基于超声的非接触式传感器3002可用于通过以下方式扫描手术室：传输超声脉冲串并在其从手术室的围墙3006弹回时接收回波，来确定手术室的大小并调整短程无线(例如，蓝牙)配对距离限制。在一个示例中，非接触式传感器3002可为Ping超声距离传感器，如图24所示。
图24示出了超声传感器3002如何利用其超声扬声器3003发送短暂的啁啾并使手术室标测模块的微控制器3004可测量回波返回到超声传感器的超声麦克风3005所花费的时间。微控制器3004必须向超声传感器3002发送脉冲以开始测量。然后，超声传感器3002等待足够长的时间以便微控制器程序启动脉冲输入命令。然后，大约在超声传感器3002发出40kHz音调的啁啾的同时，超声传感器向微控制器3004发送高信号。当超声传感器3002利用其超声麦克风3005检测到回波时，其将该高信号改变回低信号。微控制器的脉冲输入命令测量高变化和低变化之间的时间，并将测量结果存储在变量中。该值可与空气中声音的速度一起用于计算外科集线器106和手术室壁3006之间的距离。
在一个示例中，外科集线器206可配备有四个超声传感器3002，其中这四个超声传感器中的每一者均被配置成能够估计外科集线器206和手术室3000的壁之间的距离。外科集线器206可配备有多于或少于四个超声传感器3002，以用于确定手术室的边界。
手术室标测模块可采用其它距离传感器来确定手术室的边界。在一个示例中，手术室标测模块可配备有一个或多个光电传感器，该一个或多个光电传感器可用于估计手术室的边界。在一个示例中，还可采用合适的激光距离传感器来估计手术室的边界。基于激光的非接触式传感器可通过以下方式扫描手术室：传输激光脉冲，接收从手术室的围墙弹回的激光脉冲，并将所传输脉冲的相位与所接收脉冲进行比较，来确定手术室的大小并调整短程无线(例如，蓝牙)配对距离限制。
从图像和连接智能器械数据剥离数据以允许聚集但不进行个体化
在一个方面，本公开提供了一种数据剥离方法，该数据剥离方法询问所提供的电子患者记录，提取相关部分以对外科集线器和联接到外科集线器的器械进行配置和操作，同时对手术、患者和所有标识参数匿名化以保持患者隐私性。
现在重新参见图23并且还参见图1-图11以示出与包括外科集线器106、206的交互式外科系统100的环境的交互，一旦已经验证手术室的大小且蓝牙配对完成，基于人工实时，外科集线器206的计算机处理器244开始剥离4038从联接到外科集线器206的模块接收的数据。在一个示例中，处理器244开始剥离4083例如从成像模块238和连接的智能器械235接收的图像。剥离4038数据允许数据的聚集，但不允许数据的个体化。这使得能够剥离4038数据标识符，链接数据，并且监测事件，同时通过对数据匿名化来保持患者隐私性。
参见图1-图24，在一个方面，提供了一种数据剥离4038方法。根据数据剥离4038方法，外科集线器206的处理器244询问存储在外科集线器数据库238中的患者记录，并且提取患者记录的相关部分以对外科集线器206及其器械235、机器人和其它模块化装置(例如，模块)进行配置和操作。数据剥离4038方法对外科手术、患者以及与外科手术相关联的所有标识参数匿名化。剥离4038在飞行中的数据确保数据在任何时候都不与特定患者、外科手术、外科医生、时间或可用于关联数据的其它可能标识符相关联。
数据可被剥离4038以用于在联接到远程服务器213的远程云204的数据库存储装置205处编译基本信息。存储在数据库存储装置248中的数据可用于如在2017年12月28日提交的标题为CLOUD-BASED MEDICAL ANALYTICS的美国临时专利申请序列号62/611,340中所述的基于云的高级分析，该专利申请全文以引用方式并入本文。数据链路完整的信息的副本也可存储到患者EMR数据库4002(图22)中。例如，外科集线器206可导入患者组织不规则或并存病以添加到数据库248中所存储的现有数据集。可在手术之前剥离4038数据和/或可在数据被传输到联接至远程服务器213的云204的数据库存储装置205时剥离4038数据。
继续参见图1-图11和图22-图24，图25是根据本公开的一个方面的描绘了以下过程的图4050：导入包含外科手术和存储在EMR数据库4002中的相关患者数据4018的患者电子医疗记录4012，从所导入医疗记录4012剥离4038相关患者数据4018，以及标识4060智能装置含义4062或推断。如图25所示，从EMR数据库4002检索包含患者EMR数据库4002中所存储的信息的患者电子医疗记录4012，将其导入外科集线器206中并存储在外科集线器206的存储装置248中。在将未编辑数据作为匿名数据文件4016(图22)存储在外科集线器206存储装置248中之前将其从患者电子医疗记录4012去除或删除4019。然后，从医疗记录4012剥离4038相关患者数据4018以去除所需的相关患者数据4018，并删除4019未编辑数据以保持患者匿名性。在所示的示例中，所剥离数据4058包括肺气肿、高血压、小肺癌、华法林/血液稀释剂和/或放射预治疗。如下文所述，采用所剥离数据4058来标识4060智能装置含义，同时保持患者匿名性。
虽然外科手术数据和相关患者数据4018被描述为从存储在EMR数据库4002中的患者电子医疗记录4012导入，但在各个方面，外科手术数据和相关患者数据4018可在存储在EMR数据库4002中之前从联接到外科集线器206的模块化装置检索得到。例如，外科集线器206可询问模块以从模块检索外科手术数据和相关患者数据4018。如本文所述，模块包括联接到内窥镜239的成像模块238、联接到能量装置241的发生器模块240、排烟器模块226、抽吸/冲洗模块228、通信模块230、处理器模块232、存储阵列234、任选地联接到显示器237的智能装置/器械235、和非接触式传感器模块242、以及如图3和图8-图10所示的其它模块。
例如，匿名化的剥离数据4058可用于标识4060器械和其它智能装置的重大故障，并且可发起数据的自动存档过程和提交以用于进一步的含义分析。例如，在原始设备制造商(OEM)装置上检测到伪造部件或适配器的含义将是发起对该部件的记载及对其使用结果和效果的记录。例如，外科集线器206可执行如结合图41所述的态势感知算法。在一个方面，外科集线器206可初始地接收或标识从匿名化剥离数据4058导出的多种含义4062。外科集线器206被配置成能够控制器械235或其它模块，使得它们对应于所导出含义4062进行操作。在一个示例中，外科集线器206的控制逻辑标识以下内容：(i)肺组织可能比正常情况更脆弱(例如，由于肺气肿)，(ii)更可能发生止血问题(例如，由于高血压和/或患者正在接受血液稀释剂诸如华法林治疗)，(iii)癌症可能更具有侵袭性(例如，由于手术的目标是小细胞肺癌)，以及(iv)肺组织可能更硬并且更易于破裂(例如，由于患者已经接受放射预治疗)。然后，外科集线器206的控制逻辑或处理器244解译该数据如何影响器械235或其它模块使得器械235与数据一致地操作，并且然后将对应的调整传送到器械235中的每一者。
在涉及外科器械235的缝合器类型的一个示例中，基于从匿名化剥离数据4058标识4060的含义4062，外科集线器206的控制逻辑或处理器244可进行以下操作：(i)通知缝合器调整压缩率阈值参数，(ii)调整外科集线器206可视化阈值以量化出血和内部参数，(iii)向组合发生器模块240通知肺组织和脉管组织类型，使得相应地调整功率和发生器模块240的控制算法，(iv)向成像模块238通知侵袭性癌症标签以相应地调整裕度范围，(v)向缝合器通知所需的裕度参数调整(裕度参数对应于将切除的癌周围组织的距离或量)，以及(vi)向缝合器通知组织是可能易碎的。此外，含义40602所基于的匿名化剥离数据4058由外科集线器206标识并且被馈送到态势感知算法中(参见图41)。示例包括但不限于胸肺切除术，例如节段切除术等。
图26为根据本公开的一个方面的示出了将基于云的分析应用于未编辑数据、剥离相关患者数据4018和独立数据对的图4070。如图所示，多个外科集线器(集线器#1 4072、集线器#3 4074和集线器#44076)位于医院数据屏障4006内(也参见图22)。包括患者数据和手术相关数据的未编辑患者电子医疗记录4012可在位于医院数据屏障4006内的外科集线器(集线器#1 4072、集线器#3 4074和集线器#44076)之间使用和交换。然而，在于医院数据屏障4006之外传输包含患者数据和手术相关数据的未编辑患者电子医疗记录4012之前，对患者电子医疗记录4012的患者数据进行编辑和剥离以创建包含匿名化信息的匿名数据文件4016，以用于在云204中通过基于云的分析过程进一步分析和处理所编辑/剥离的数据。
图27为根据本公开的一个方面的示出了用于将来自第一数据源和第二数据源的患者数据集相关联的控制程序或逻辑配置的方法的逻辑流程图4080。参见图27并且还参见图1-图11以示出与包括外科集线器106、206的交互式外科系统100的环境的交互，在一个方面，本公开提供了一种外科集线器206，该外科集线器包括：处理器244；以及联接到处理器244的存储器249。存储器249存储能够由处理器244执行以进行以下操作的指令：询问4082外科器械235，从外科器械235检索4084第一数据集，询问4086医学成像装置238，从医学成像装置238检索4088第二数据集，通过密钥将第一数据集和第二数据集相关联4090，以及将相关联的第一数据集和第二数据集传输到外科集线器206外部的远程网络。外科器械235是患者数据的第一源，并且第一数据集与外科手术相关联。医学成像装置238是患者数据的第二源，并且第二数据集与外科手术的效果相关联。第一数据记录和第二数据记录由密钥唯一地标识。
在另一方面，外科集线器206提供存储器249，该存储器存储能够由处理器244执行以进行以下操作的指令：使用密钥来检索第一数据集，对第一数据集匿名化，使用密钥来检索第二数据集，对第二数据集匿名化，将匿名化的第一数据集和第二数据集配对，以及基于匿名化的配对第一数据集和第二数据集来确定按外科手术分组的外科手术的成功率。
在另一方面，外科集线器206提供存储器249，该存储器存储能够由处理器244执行以进行以下操作的指令：检索匿名化的第一数据集，检索匿名化的第二数据集，以及使用密钥来重新整合匿名化的第一数据集和第二数据集。
图28为根据本公开的一个方面的描绘了用于剥离数据以提取数据的相关部分以便对外科集线器206和联接到外科集线器206的模块(例如，器械235)进行配置和操作的控制程序或逻辑配置的方法4400的逻辑流程图。参见图28并且还参见图1-图11以示出与包括外科集线器106、206的交互式外科系统100的环境的交互，在一个方面，外科集线器206可被配置成能够询问联接到外科集线器206的模块以获取数据，并且剥离数据以提取数据的相关部分以便对外科集线器206和联接到外科集线器206的模块(例如，器械235)进行配置和操作，并且对手术、患者和可用于标识患者的其它参数匿名化以保持患者隐私性。根据方法4400，在一个方面，本公开提供了一种外科集线器206，该外科集线器包括处理器244、联接到处理器244的模块化通信集线器203，其中模块化通信集线器203被配置成能够将位于一个或多个手术室中的模块化装置连接到外科集线器206。处理器244联接到存储器249，其中存储器249存储能够由处理器244执行以致使处理器询问4402经由模块化通信集线器203联接到处理器244的模块化装置的指令。模块化装置是包括患者身份数据和外科手术数据的数据集的源。处理器244从模块化装置接收4404数据集。处理器244从数据集丢弃4406患者身份数据和外科手术数据的标识患者的任何部分。处理器244从数据集提取4408匿名数据并创建4410匿名化数据集。处理器244基于匿名化数据集来对外科集线器206或模块化装置的操作进行配置4412。
在另一方面，在匿名化数据集包括模块化装置的重大故障的情况下，存储器249存储能够由处理器244执行以基于模块化装置的重大故障发起数据的自动存档和提交以用于含义分析的指令。在另一方面，存储器249存储能够由处理器244执行以从匿名化数据集检测伪造部件信息的指令。在另一方面，存储器249存储能够由处理器244执行以从匿名化数据集导出模块化装置的含义的指令，并且存储器249存储能够由处理器244执行以将模块化装置配置为基于所导出含义来操作或者基于所导出含义来对外科集线器进行配置的指令。在另一方面，存储器249存储能够由处理器244执行以聚集匿名化数据的指令。在另一方面，存储器249存储能够由处理器244执行以在将所接收数据存储在联接到外科集线器的存储装置中之前提取匿名化数据的指令。在另一方面，存储器249存储能够由处理器执行以进行以下操作的指令：将匿名化数据传输到外科集线器外部的远程网络，在远程网络处编译匿名化数据，以及将来自模块化装置的数据集的副本存储在患者电子医疗记录数据库中。
数据创建的存储和包括标识特征的自描述数据的使用
在一个方面，本公开提供了自描述数据分组，这些自描述数据分组在发布器械处生成并且包括处理分组的所有装置的标识符。自描述允许处理器解译自描述分组中的数据而无需在接收自描述分组之前提前知道数据类型。数据适用于每个数据点或数据串，并且包括数据类型、自描述分组的源、生成分组的装置标识、单元、分组的生成时间、以及包含在分组中的数据未被改变的认证。当(装置或外科集线器中的)处理器接收到意外分组并且验证了分组的源时，处理器改变收集技术以便为来自该源的任何后续分组做好准备。
还参见图1-图11以示出与包括外科集线器106、206的交互式外科系统100的环境的交互，在于外科集线器206的环境中执行的外科手术期间，由联接到外科集线器206的外科装置235生成的数据的大小和数量可变得相当大。而且，在外科装置235和/或外科集线器206之间交换的数据也可变得相当大。
一种解决方案提供了一种用于通过生成自描述分组来使数据大小和在外科集线器206内处理数据最小化的技术。初始地，自描述分组由生成它的器械235汇编。然后，对分组进行排序和加密b，从而生成对于每个数据分组是唯一的加密证书。然后，从器械235经由加密的有线或无线协议传送该数据并将其存储在外科集线器206上以用于处理和传输到云204的分析引擎。每个自描述数据分组包括用于标识生成数据分组的特定器械和生成数据分组的时间的标识符。当分组被外科集线器206接收时，将外科集线器206的标识符添加到分组。
在一个方面，本公开提供了一种外科集线器206，该外科集线器包括处理器244和联接到处理器244的存储器249。存储器249存储能够由处理器244执行以进行以下操作的指令：从第一源接收第一数据分组，从第二源接收第二数据分组，将第一数据分组和第二数据分组相关联，以及生成包括第一数据有效载荷和第二数据有效载荷的第三数据分组。第一数据分组包括第一前导码、第一数据有效载荷、第一数据有效载荷的源和第一加密证书。第一前导码定义第一数据有效载荷，并且第一加密证书验证第一数据分组的真实性。第二数据分组包括第二前导码、第二数据有效载荷、第二数据有效载荷的源和第二加密证书。第二前导码定义第二数据有效载荷，并且第二加密证书验证第二数据分组的真实性。
在另一方面，存储器249存储能够由处理器244执行以进行以下操作的指令：确定数据有效载荷来自新的源，验证数据有效载荷的新的源，以及改变外科集线器处的数据收集过程以接收来自新的源的后续数据分组。
在另一方面，存储器249存储能够由处理器244执行以基于密钥将第一数据分组和第二数据分组相关联的指令。在另一方面，存储器249存储能够由处理器244执行以对第三数据分组的数据有效载荷匿名化的指令。在另一方面，存储器249存储能够由处理器244执行以接收匿名化的第三数据分组并且使用该密钥将匿名化的第三数据分组重新整合到第一数据分组和第二数据分组中的指令。
在各个方面，本公开提供了一种用于接收和处理如上所述的数据分组的控制电路。在各个方面，本公开提供了一种非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，这些计算机可读指令在被执行时致使机器接收和处理如上所述的数据分组。
在其它方面，本公开提供了一种生成包括自描述数据的数据分组的方法。在一个方面，外科器械包括处理器和联接到该处理器的存储器、控制电路和/或计算机可读介质，该计算机可读介质被配置成能够生成包括前导码、数据有效载荷、数据有效载荷的源和加密证书的数据分组。前导码定义数据有效载荷，并且加密证书验证数据分组的真实性。在各个方面，数据分组可由联接到外科集线器的任何模块生成。自描述数据分组使数据大小和在外科集线器中的数据处理最小化。
在一个方面，本公开提供了一种在发布装置(例如，器械、工具、机器人)处生成的自描述数据分组。该自描述数据分组包括：沿通信路径处理数据分组的所有装置的标识符；自描述，该自描述使得处理器能够解译包含在数据分组中的数据而无需提前被告知沿路径对数据分组的接收；用于每个数据点或数据串的数据；以及数据类型、数据源、生成数据的装置ID、数据单元、生成时间以及数据分组未被改变的认证。在另一方面，当处理器从意外的源接收到数据分组并且验证了数据源时，处理器改变数据收集技术以便为来自该源的任何后续数据分组做好准备。
在创建和使用包括自描述数据的数据分组时，外科集线器包括标识特征结构。集线器和智能装置使用自描述数据分组来使数据大小和数据处理最小化。在生成大量数据的外科集线器中，自描述数据分组使数据大小和数据处理最小化，从而节省时间并且使得手术室能够更有效地运行。
图29示出了根据本公开的一个方面的包括自描述数据的自描述数据分组4100。还参见图1-图11以示出与包括外科集线器106、206的交互式外科系统100的环境的交互，在一个方面，如图29所示的自描述数据分组4100在发布器械235或位于手术室中或与手术室通信的装置或模块处生成，并且包括沿通信路径处理分组的所有装置235的标识符。自描述允许处理器244在于接收自描述数据分组4100之前没有提前知道数据有效载荷的定义的情况下解译分组4100的数据有效载荷。处理器244可通过在接收到传入的自描述分组4100时对其进行解析并且标识数据有效载荷来解译数据有效载荷，而无需提前被通知已接收自描述分组4100。数据用于每个数据点或数据串。数据有效载荷包括数据类型、数据源、生成数据的装置ID、数据单元、生成数据的时间以及自描述数据分组4100未被改变的认证。一旦可位于装置或外科集线器206中的处理器244接收到意外的自描述数据分组4100并且验证了自描述数据分组4100的源，处理器244就改变数据收集装置以便为来自该源的任何后续自描述数据分组4100做好准备。在一个示例中，自描述分组4100中所包含的信息可在结合图31-图35所述的肺肿瘤切除外科手术中的第一击发4172期间记录。
自描述数据分组4100不仅包括数据，而且包括定义数据是什么和数据来自何处的前导码、以及验证每个数据分组4100的真实性的加密证书。如图29所示，当自描述数据报头4102包括FTF(击发力)时，数据分组4100可包括自描述数据报头4102(例如，击发力[FTF]、闭合力[FTC]、能量振幅、能量频率、能量脉冲宽度、击发速度等)、装置ID 4104(例如，002)、轴ID 4106(例如，W30)、仓ID 4108(例如，ESN736)、唯一时间戳4110(例如，09:35:15)、击发力值4112(例如，85)，否则，数据分组4100中的该位置包括闭合力值、能量振幅、能量频率、能量脉冲宽度、击发速度等。数据分组4100还包括组织厚度值4114(例如，1.1mm)和对于每个数据分组4100是唯一的数据值4116(例如，01101010001001)的标识证书。一旦自描述数据分组4100被另一器械235、外科集线器206、云204等接收，接收器就解析自描述数据报头4102并基于其值知道自描述数据分组4100中包含什么数据类型。下表1列出了自描述数据报头4102的值和对应的数据值。
| 自描述数据报头(4102) | 数据类型 |
| FTF | 击发力(N) |
| FTC | 闭合力(N) |
| EA | 能量振幅(J) |
| EF | 能量频率(Hz) |
| EPW | 能量脉冲宽度(S) |
| SOF | 击发速度(mm/s) |
表1
初始地，包括自描述数据的每个自描述数据分组4100由生成自描述数据分组4100的器械235、装置或模块汇编。随后，对包括自描述数据的自描述数据分组4100进行排序和加密，以生成加密证书。加密证书对于每个自描述数据分组4100是唯一的。然后，经由加密的有线或无线协议传送该数据并将其存储在外科集线器206上以用于处理和传输到云204的分析引擎。
包括自描述数据的每个自描述数据分组4100包括用于标识生成自描述数据分组4100的特定器械235的装置ID 4104、用于指示生成数据分组4100的时间和自描述数据分组4100何时被外科集线器206接收的时间戳4110。外科集线器206的ID也可添加到自描述数据分组4100。
包括自描述数据的自描述数据分组4100中的每一者可包括分组封装器，该分组封装器定义数据分组4100的开始和数据分组4100的结束，包括预测自描述数据分组中的位的数量和顺序所必需的任何标识符。
外科集线器206还管理冗余数据集。当装置235起作用并与其它外科集线器206互连时，可创建多组相同的数据并将其存储在各种装置235上。因此，外科集线器206管理冗余数据的多个图像以及数据的匿名化和安全性。外科集线器206还提供临时可视化和通信、事件管理、对等处理或分布式处理、以及数据的存储备份和保护。
图30为根据本公开的一个方面的描绘了用于使用包括自描述数据的数据分组的控制程序或逻辑配置的方法的逻辑流程图4120。参见图1-图29，在一个方面，本公开提供了一种外科集线器206，该外科集线器包括处理器244和联接到处理器244的存储器249。存储器249存储能够由处理器244执行以进行以下操作的指令：从第一源接收第一数据分组，从第二源接收第二数据分组，将第一数据分组和第二数据分组相关联，以及生成包括第一数据有效载荷和第二数据有效载荷的第三数据分组。第一数据分组包括第一前导码、第一数据有效载荷、第一数据有效载荷的源和第一加密证书。第一前导码定义第一数据有效载荷，并且第一加密证书验证第一数据分组的真实性。第二数据分组包括第二前导码、第二数据有效载荷、第二数据有效载荷的源和第二加密证书。第二前导码定义第二数据有效载荷，并且第二加密证书验证第二数据分组的真实性。
在另一方面，存储器249存储能够由处理器244执行以进行以下操作的指令：确定数据有效载荷来自新的源，验证数据有效载荷的新的源，以及改变外科集线器处的数据收集过程以接收来自新的源的后续数据分组。
在另一方面，存储器249存储能够由处理器244执行以基于密钥将第一数据分组和第二数据分组相关联的指令。在另一方面，存储器249存储能够由处理器244执行以对第三数据分组的数据有效载荷匿名化的指令。在另一方面，存储器244存储能够由处理器244执行以接收匿名化的第三数据分组并且使用该密钥将匿名化的第三数据分组重新整合到第一数据分组和第二数据分组中的指令。
图31为根据本公开的一个方面的描绘了用于使用包括自描述数据的数据分组的控制程序或逻辑配置的方法的逻辑流程图4130。参见图31并且还参见图1-图11以示出与包括外科集线器106、206的交互式外科系统100的环境的交互，在一个方面，本公开提供了一种外科集线器206，该外科集线器包括处理器244和联接到处理器244的存储器249。存储器249存储能够由处理器244执行以从第一数据源接收4132第一自描述数据分组的指令，该第一自描述数据分组包括第一前导码、第一数据有效载荷、第一数据有效载荷的源和第一加密证书。第一前导码定义第一数据有效载荷，并且第一加密证书验证第一数据分组的真实性。存储器249存储能够由处理器244执行以解析4134所接收的第一前导码并且基于第一前导码解译4136第一数据有效载荷的指令。
在各个方面，存储器249存储能够由处理器244执行以从第二数据源接收第二自描述数据分组的指令，该第二自描述数据分组包括第二前导码、第二数据有效载荷、第二数据有效载荷的源和第二加密证书。第二前导码定义第二数据有效载荷，并且第二加密证书验证第二数据分组的真实性。存储器249存储能够由处理器244执行以进行以下操作的指令：解析所接收的第二前导码，基于第二前导码来解译第二数据有效载荷、将第一自描述数据分组和第二自描述数据分组相关联，以及生成包括第一数据有效载荷和第二数据有效载荷的第三自描述数据分组。在一个方面，存储器存储能够由处理器执行以对第三自描述数据分组的数据有效载荷匿名化的指令。
在各个方面，存储器存储能够由处理器执行以进行以下操作的指令：确定数据有效载荷由新数据源生成，验证数据有效载荷的新数据源，并且改变外科集线器处的数据收集过程以接收来自新数据源的后续数据分组。在一个方面，存储器存储能够由处理器执行以基于密钥将第一自描述数据分组和第二自描述数据分组相关联的指令。在另一方面，存储器存储能够由处理器执行以进行以下操作的指令：接收匿名化的第三自描述数据分组，以及使用密钥将匿名化的第三自描述数据分组重新整合回第一自描述数据分组和第二自描述数据分组中。
以配对数据集的方式存储数据，配对数据集可按手术分组但不一定键控到实际手
术日期和外科医生
在一个方面，本公开提供了一种数据配对方法，该数据配对方法允许外科集线器将装置测量参数与外科效果互连。数据对包括所有的相关外科数据或患者限定符，而没有任何患者标识符数据。数据对在两个分开且不同的时间生成。本公开还提供了以使得能够重建一系列时序事件或仅重建一系列联接但不受约束的数据集的方式配置和存储数据。本公开还提供以加密形式存储数据并且使其具有预定义备份和到云的镜像。
为了确定外科手术的成功或失败，存储在外科器械中的数据应与外科手术的效果相关联，同时将数据匿名化以保护患者的隐私。一种解决方案是将外科手术期间由外科器械记录的与外科手术相关联的数据与估计手术功效的数据配对。数据在没有与手术、患者或时间相关联的标识符的情况下配对，以保持匿名性。配对数据在两个分开且不同的时间生成。
在一个方面，本公开提供了一种被配置成能够与外科器械通信的外科集线器。该外科集线器包括处理器和联接到处理器的存储器。存储器存储能够由处理器执行以进行以下操作的指令：接收与外科手术相关联的第一数据集，接收与外科手术的功效相关联的第二数据集，通过去除标识患者、手术或手术的预定时间的信息来将第一数据集和第二数据集匿名化，以及存储第一匿名化数据集和第二匿名化数据集以生成按手术分组的数据对。第一数据集在第一时间生成，第二数据集在第二时间生成，并且第二时间与第一时间是分开且不同的。
在另一方面，存储器存储能够由处理器执行以基于数据对重建一系列时序事件的指令。在另一方面，存储器存储能够由处理器执行以基于数据对重建一系列联接但不受约束的数据集的指令。在另一方面，存储器存储能够由处理器执行以进行以下操作的指令：对数据对进行加密，定义用于数据对的备份格式，以及将数据对镜像到云存储装置。
在各个方面，本公开提供了一种用于接收和处理如上所述的数据集的控制电路。在各个方面，本公开提供了一种非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，这些计算机可读指令在被执行时致使机器接收和处理如上所述的数据集。
配对匿名数据的存储使得医院或外科医生能够在本地使用数据对以将其链接到特定手术或者能够存储数据对以在没有以时间顺序方式提取特定事件的情况下分析总体趋势。
在一个方面，外科集线器提供用户定义的数据存储和配置。数据的存储可以配对数据集的方式进行，这些配对数据集可按手术分组但不一定键控到实际手术日期和外科医生。该技术提供了关于患者和外科医生的数据匿名性。
在一个方面，本公开提供了一种数据配对方法。该数据配对方法包括使得外科集线器能够将装置测量参数与效果互连，其中数据对包括所有的相关组织或患者限定符而没有任何标识符，其中该数据对在两个不同且分开的时间生成。在另一方面，本公开提供了一种数据配置，该数据配置包括数据是否以使得能够重建一系列时序事件或仅重建一系列联接但不受约束的数据集的方式存储。在另一方面，数据可以加密形式存储。所存储数据可包括预定义的备份和到云的镜像。
数据可本地加密到装置。数据备份对于集成负载辅助存储装置可以是自动的。装置和/或外科集线器可被配置成能够保持数据的存储时间，并且编译数据并将其传输到另一位置(例如，另一外科集线器或云存储装置)以用于存储。数据可分组在一起并键控以用于传输到云分析位置。基于云的分析系统在2017年12月28日提交的标题为CLOUD-BASEDMEDICAL ANALYTICS的共同拥有的美国临时专利申请序列号62/611,340中有所描述，该专利申请全文以引用方式并入本文。
在另一方面，集线器提供用于存储数据的用户可选择选项。在一种技术中，集线器使得医院或外科医生能够选择数据是否应该以使得数据可在外科集线器中本地使用以链接到特定手术的方式存储。在另一种技术中，外科集线器使得数据能够存储为数据对，使得可在没有以时间顺序方式提取特定事件的情况下分析总体趋势。
图32为根据本公开的一个方面的嵌入右肺4156的右上后叶4154中的肿瘤4152的图4150。为了去除肿瘤4152，外科医生沿着通常称为边缘4158的周边围绕肿瘤4152进行切割。裂隙4160将右肺4156的上叶4162和中叶4164分开。为了围绕边缘4158切出肿瘤4152，外科医生必须切割通向和来自右肺4156的中叶4164和上叶4162的支气管血管4166。支气管血管4166必须使用在本文中通常表示为联接到外科集线器206的器械/装置235的装置诸如外科缝合器、电外科器械、超声器械、组合电外科/超声器械和/或组合缝合器/电外科装置来密封和切割。装置235被配置成能够记录如上所述的数据，该数据被形成为数据分组、被加密、存储和/或传输到远程数据存储装置105并且由服务器113在云104中处理。图37和图38为示出了右肺4156和嵌入肺的软组织内的支气管树4250的图。
在一个方面，数据分组可以是结合图29-图31所述的自描述数据4100的形式。自描述数据分组4100将包含在手术期间由装置235记录的信息。此类信息可包括例如基于特定变量的自描述数据报头4102(例如，击发力[FTF]、闭合力[FTC]、能量振幅、能量频率、能量脉冲宽度、击发速度等)。手术中使用的器械/装置235的装置ID 4104(例如，002)包括器械/装置235的部件，诸如轴ID 4106(例如，W30)和仓ID 4108(例如，ESN736)。当自描述数据报头4102包括FTF(击发力)时，自描述分组4100还记录唯一时间戳4110(例如，09:35:15)和过程变量诸如击发力值4112(例如，85)，否则，数据分组4100中的该位置包括闭合力(FTC)值、能量振幅、能量频率、能量脉冲宽度、击发速度等，例如，如表1所示。数据分组4100还可包括组织厚度值4114(例如，1.1mm)，其在该示例中是指被密封和切割的暴露在裂隙4160中的支气管血管4166的厚度。最后，每个自描述分组4100包括数据值4116(例如，01101010001001)的标识证书，该标识证书唯一地标识每个数据分组4100，该每个数据分组由装置/器械235传输到外科集线器206、进一步从外科集线器206传输到云204并存储在联接到服务器213的存储装置205上和/或进一步传输到机器人集线器222并存储。
通过自描述数据分组4100传输的数据由器械装置235以预定采样速率采样。每个样本被形成为自描述数据分组4100，该自描述数据分组被传输到外科集线器206并且最终从外科集线器206传输到云204。样本可在分组之前本地存储在器械装置235中，或者可在飞行中传输。预定采样速率和传输速率由外科集线器206中的通信流量决定，并且可动态地调整以适应当前带宽限制。因此，在一个方面，器械装置235可记录在手术期间取得的所有样本，并且在手术结束时，将每个样本分组成自描述分组4100并将自描述分组4100传输到外科集线器206。在另一方面，采样数据可在记录时分组并在飞行中传输到外科集线器206。
图33为根据本公开的一个方面的肺肿瘤切除外科手术的图4170，该肺肿瘤切除外科手术包括外科缝合器装置235的四个单独击发以密封和切割暴露在裂隙4160中的通向和来自图32所示的右肺4156的上叶4162和下叶4164的支气管血管4166。外科缝合器装置235以装置ID“002”标识。记录来自外科缝合器装置235的每个击发的数据并将其形成为如图30所示的包括自描述数据的数据分组4100。图30所示的自描述数据分组4100表示例如具有钉仓序列号ESN736的装置“002”的第一击发。在以下描述中，还参见图12-图19以便描述器械/装置235的各种架构，这些器械/装置包括联接到存储器以用于记录(例如，保存或存储)在外科手术期间收集的数据的处理器或控制电路。
在匿名时间09:35:15记录第一击发4172。第一击发4172将通向和来自右肺4156的中叶4164和上叶4162的第一支气管血管4166密封并切断成第一部分4166a和第二部分4166b，其中每个部分4166a、4166b由相应的第一缝合线4180a和第二缝合线4180b密封。与第一击发4172相关联的信息(例如，结合图30所述的信息)记录在外科缝合器装置235的存储器中，并且用于构建结合图29-图31所述的第一自描述数据分组4100。第一自描述分组4100可在第一击发4172完成时被传输，或者可保持存储在外科缝合器装置235的存储器中，直到外科手术完成为止。一旦被外科缝合器装置235传输，第一自描述数据分组4100就由外科集线器206接收。第一自描述数据分组4100通过对数据进行剥离和加时间戳4038来匿名化，如例如结合图23所讨论的。在肺切除外科手术完成之后，例如将如图34所示的那样评估第一缝合线4182a和第二缝合线4182b的密封完整性，并且评估结果将与和第一击发4172相关联的信息配对。
第二击发4174将通向和来自右肺4156的中叶4164和上叶4162的支气管血管的第二支气管血管4166密封并切断成第一部分4166c和第二部分4166d，其中每个部分4166c、4166d由第一缝合线4180c和第二缝合线4180d密封。与第二击发4174相关联的信息(例如，结合图29-图31所述的信息)记录在外科缝合器装置235的存储器中，并且用于构建结合图29-图31所述的第二自描述数据分组4100。第二自描述数据分组4100可在第二击发4174完成时被传输，或者可保持存储在外科缝合器装置235的存储器中，直到外科手术完成为止。一旦被外科缝合器装置235传输，第二自描述数据分组4100就由外科集线器206接收。第二自描述数据分组4100通过对数据进行剥离和加时间戳4038来匿名化，如例如结合图23所讨论的。在肺切除外科手术完成之后，例如将如图34所示的那样评估第一缝合线4182c和第二缝合线4182d的密封完整性，并且评估结果将与和第二击发4174相关联的信息配对。
在匿名时间09:42:12记录第三击发4176。第三击发4176将右肺4156的上叶4162和中叶4164的外部部分密封并切断。第一缝合线4182a和第二缝合线4182b用于密封上叶4162和中叶4162的外部部分。与第三击发4176相关联的信息(例如，结合图29-图31所述的信息)记录在外科缝合器装置235的存储器中，并且用于构建结合图29-图31所述的第三自描述数据分组4100。第三自描述分组4100可在第三击发4176完成时被传输，或者可保持存储在外科缝合器装置235的存储器中，直到外科手术完成为止。一旦被外科缝合器装置235传输，第三自描述数据分组4100就由外科集线器206接收。第三自描述数据分组4100通过对数据进行剥离和加时间戳4038来匿名化，如例如结合图23所讨论的。在肺切除外科手术完成之后，例如将如图34所示的那样评估第一缝合线4180a和第二缝合线4180b的密封完整性，并且评估结果将与和第三击发4172相关联的信息配对。
第四击发4178将右肺4156的上叶4162和中叶4162的内部部分密封并切断。第一缝合线4182c和第二缝合线4182d用于密封上叶4162和中叶4164的内部部分。与第四击发4178相关联的信息(例如，结合图30所述的信息)记录在外科缝合器装置235的存储器中，并且用于构建结合图29-图31所述的第四自描述数据分组4100。第四自描述分组4100可在第四击发4178完成时被传输，或者可保持存储在外科缝合器装置235的存储器中，直到外科手术完成为止。一旦被外科缝合器装置235传输，第四自描述数据分组4100就由外科集线器206接收。第四自描述数据分组4100通过对数据进行剥离和加时间戳4038来匿名化，如例如结合图23所讨论的。在肺切除外科手术完成之后，例如将如图34所示的那样评估第一缝合线4182a和第二缝合线4182b的密封完整性，并且评估结果将与和第四击发4172相关联的信息配对。
图34为根据本公开的一个方面的表征图33所示的装置002的第一击发4172的闭合力(FTC)对时间曲线4192和击发力(FTF)对时间曲线4194的图形图解4190。外科缝合器装置235被标识为002，其具有30mm钉仓S/N ESN736与PVS轴S/N M3615N(轴ID W30)。对于第一击发4172，外科缝合器装置235用于完成图33所示的肺切除外科手术。如图34所示，在匿名时间09:35:15，记录峰值击发力85N。外科缝合器装置235中的算法确定组织厚度为约1.1mm。如下文所述，表征标识为ID 002的外科装置235的第一击发4172的FTC对时间曲线4192和FTF对时间曲线4194将与肺切除外科手术的效果配对、被传输到外科集线器206、被匿名化并且存储在外科集线器206中或传输到云204以用于汇总、进一步处理、分析等。
图35为根据本公开的一个方面的示出了通过在外科缝合器击发后监测脉管的出血来评估缝合线密封完整性的缝合线可视化激光多普勒的图4200。上述激光多普勒技术在2017年12月28日提交的标题为“Advanced Imaging Acquisition Modulation”的美国临时专利申请序列号62/611,341以及标题为INTERACTIVE SURGICAL PLATFORM中有所描述，该专利申请据此全文以引用方式并入本文。激光多普勒提供图像4202，该图像适于检查沿着缝合线4180a、4180b、4182a的密封并且适于使任何缺陷密封的出血4206可视化。装置002的第一击发4172的激光多普勒检查显示在第一击发4172期间密封的支气管血管的第一部分4166a的第一缝合线4180a处的密封有缺陷。缝合线4180a密封以0.5cc的体积出血4206。在匿名时间09:55:15 4204记录图像4202，并且将其与图34所示的闭合力曲线4192和击发力曲线4194配对。数据对集按手术分组，并且本地存储在外科集线器206的存储装置248中和/或远程存储到云204的存储装置205以用于例如汇总、处理和分析。例如，云204的分析引擎将第一自描述分组4100中所包含的与第一击发4172相关联的信息相关联，并且指示在缝合线4166a处产生了缺陷密封。随时间推移，该信息可被汇总、分析并用于改善外科手术诸如例如肺肿瘤切除的效果。
图36示出了根据本公开的一个方面的按手术分组的两个配对数据集4210。上配对数据集4212按一个手术分组，并且下配对数据集4214按另一个手术分组。例如，上配对数据集4212按结合图33-图36所讨论的肺肿瘤切除手术来分组。因此，图36的描述的其余部分将参见图32-图35以及图1-图21所述的信息，以示出与包括外科集线器106、206的交互式外科系统100的环境的交互。下配对数据集4214按肝脏肿瘤切除外科手术来分组，在肝脏肿瘤切除外科手术中，外科医生治疗软组织。上配对数据集与失败的缝合线密封相关联，并且下配对数据集与成功的缝合线密封相关联。上配对数据集4212和下配对数据集4214由器械装置235采样，并且每个样本被形成为自描述数据分组4100，该自描述数据分组被传输到外科集线器206并且最终从外科集线器206传输到云204。样本可在分组之前本地存储在器械装置235中，或者可在飞行中传输。采样速率和传输速率由外科集线器206中的通信流量决定，并且可动态地调整以适应当前带宽限制。
上配对数据集4212包括在第一击发4172期间由器械/装置235记录的左数据集4216，该左数据集链接4224到在评估第一支气管血管4166a的缝合线密封4180a时记录的右数据集4218。左数据集4216指示具有1.1mm的厚度4238的“脉管”组织类型4236。左数据集4216中还包括在肺肿瘤切除外科手术的第一击发4172期间记录的对时间的闭合力曲线4192和击发力曲线4194(匿名实时)。左数据集4216示出在85Lbs.达到峰值并且在匿名实时4240t1a(09:35:15)记录的击发力。右数据集4218描绘缝合线可视化曲线4228，该缝合线可视化曲线描绘渗漏对时间。右数据集4218指示具有1.1mm的厚度4246的“脉管”组织类型4244经历了缝合线4180a密封失败4242。缝合线可视化曲线4228描绘缝合线4180a密封的渗漏体积(CC)对时间。缝合线可视化曲线4228示出达到0.5cc从而指示支气管血管4166a的失败缝合线4180a密封、在匿名时间4248(09:55:15)记录的渗漏体积。
下配对数据集4214包括在击发期间由器械/装置235记录的左数据集4220，该左数据集链接4226到在评估软组织的缝合线密封时记录的右数据集4222。左数据集4220指示具有2.1mm的厚度4238的“实质”组织类型4236。左数据集4220中还包括在肝脏肿瘤切除外科手术的第一击发期间记录的对时间的闭合力曲线4230和击发力曲线4232(匿名实时)。左数据集4220示出在100Lbs.达到峰值并且在匿名实时4240t1b(09:42:12)记录的击发力。右数据集4222描绘缝合线可视化曲线4228，该缝合线可视化曲线描绘渗漏对时间。右数据集4234指示具有2.2mm的厚度4246的“实质”组织类型4244经历了成功的缝合线密封。缝合线可视化曲线4234描绘缝合线密封的渗漏体积(CC)对时间。缝合线可视化曲线4234示出渗漏体积为0.0cc，从而指示软组织的成功缝合线密封、在匿名时间4248(10:02:12)记录的。
针对许多手术收集按手术分组的配对日期集4212、4214，并且记录包含在配对日期集4212、4214中的数据并将其匿名地存储在云204的存储装置205中以保护患者隐私，如结合图22-图29所示。在一个方面，配对日期集4212、4214数据以如结合图31和图32所述的自描述数据分组4100和结合图32-图36所述的外科手术示例的形式从器械/装置235或联接到外科集线器206的其它模块传输到外科集线器206和云204。在云204中对存储在云204的存储装置205中的配对日期集4212、4214的数据进行分析，以向器械/装置235或联接到外科集线器206的其它模块提供反馈，从而通知联接到机器人集线器222的外科机器人或外科医生由左数据集标识的条件最终导致成功或失败的密封。如结合图36所述，左上数据集4216导致密封失败，而左下数据集4220导致密封成功。这是有利的，因为按手术分组的配对数据集中所提供的信息可用于改善多种组织类型中的切除、横切和吻合的创建。该信息可用于避免可能导致密封失败的缺陷。
图37为右肺4156的图，并且图38为包括肺的气管4252和支气管4254、4256的支气管树4250的图。如图37所示，右肺4156由分成上叶4162、中叶4160和下叶4165的三个叶构成，这三个叶由倾斜裂隙4167和水平裂隙4160分开。由于心脏的位置，左肺仅由两个较小的叶构成。如图38所示，在每个肺内部，右支气管4254和左支气管4256分成称为支气管4258的许多较小气道，从而大大增加表面积。每个支气管4258终止于称为肺泡4260的空气囊，在其中进行与血流的气体交换。
图39为根据本公开的一个方面的描绘了用于存储按手术分组的配对匿名数据集的控制程序或逻辑配置的方法的逻辑流程图4300。参见图1-图39，在一个方面，本公开提供了一种被配置成能够与外科器械235通信的外科集线器206。外科集线器206包括处理器244和联接到处理器244的存储器249。存储器249存储能够由处理器244执行以进行以下操作的指令：从第一源接收4302第一数据集，第一数据集与外科手术相关联；从第二源接收4304第二数据集，第二数据集与外科手术的功效相关联；通过去除标识患者、手术或手术的预定时间的信息来将第一数据集和第二数据集匿名化4306；以及存储4308第一匿名化数据集和第二匿名化数据集以生成按手术分组的数据对。第一数据集在第一时间生成，第二数据集在第二时间生成，并且第二时间与第一时间是分开且不同的。
在另一方面，存储器249存储能够由处理器244执行以基于数据对重建一系列时序事件的指令。在另一方面，存储器249存储能够由处理器244执行以基于数据对重建一系列联接但不受约束的数据集的指令。在另一方面，存储器249存储能够由处理器244执行以进行以下操作的指令：对数据对进行加密，定义用于数据对的备份格式，以及将数据对镜像到云204的存储装置205。
传输到基于云的医疗分析的数据的确定
在一个方面，本公开提供了一种用于存储外科装置的参数和状态的通信集线器和存储装置，该外科装置具有确定何时、多久与基于云的分析系统进行共享、待与基于云的分析系统共享的数据的传输速率和类型的能力。本公开还提供了用于确定分析系统在何处传送用于集线器和外科装置的新操作参数的技术。
在外科集线器环境中，大量数据可相当快速地生成，并且可引起外科集线器网络中的存储和通信瓶颈。一种解决方案可包括本地确定何时将数据传输到基于云的医疗分析系统以及将何种数据传输到基于云的医疗分析系统，以用于外科集线器数据的进一步处理和操纵。可基于可用的本地数据存储容量来确定导出外科集线器数据的定时和速率。特定用户、患者或手术的用户定义的包括或不包括使得能够包括数据集以用于分析或自动删除。可基于所检测的外科集线器网络停工时间或可用容量来确定上传或传送到基于云的医疗分析系统的时间。
参见图1-图39，在一个方面，本公开提供了一种外科集线器206，该外科集线器包括存储装置248、联接到存储装置248的处理器244和联接到处理器244的存储器249。存储器249存储能够由处理器244执行以进行以下操作的指令：从外科器械235接收数据，基于存储装置248的可用存储容量来确定将数据传输到基于云的远程医疗分析网络204的速率，基于存储装置248的可用存储容量或所检测的外科集线器网络206的停工时间来确定将数据传输到基于云的远程医疗分析网络204的频率，以及基于包括或不包括与用户、患者或外科手术相关联的数据来确定将数据传输到基于云的远程医疗分析网络204的数据类型。
在另一方面，存储器249存储能够由处理器244执行以接收用于外科集线器206或外科器械235的新操作参数的指令。
在各个方面，本公开提供了一种用于确定如上所述的将数据传输到基于云的远程医疗分析网络的速率、频率和数据类型的控制电路。在各个方面，本公开提供了一种非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，这些计算机可读指令在被执行时致使机器确定传输到基于云的远程医疗分析网络的速率、频率和数据类型。
在一个方面，外科集线器206被配置成能够确定何种数据待传输到基于云的分析系统204。例如，包括本地处理能力的外科集线器206模块化装置235可确定传输到基于云的分析系统204的速率、频率和数据类型，以用于分析和处理。
在一个方面，外科集线器206包括用于存储装置235的参数和状态的模块化通信集线器203和存储装置248，该装置235具有确定何时和多久可与基于云的分析系统204共享数据、可与基于云的分析系统204共享的数据的传输速率和类型的能力。在另一方面，云分析系统204传送用于外科集线器206和联接到外科集线器206的外科装置235的新操作参数。基于云的分析系统204在2017年12月28日提交的并且标题为CLOUD-BASED MEDICALANALYTICS的共同拥有的美国临时专利申请序列号62/611,340中有所描述，该专利申请全文以引用方式并入本文。
在一个方面，联接到本地外科集线器206的装置235确定何时将数据传输到云分析系统204以及将何种数据传输到云分析系统204，以用于公司分析改进。在一个示例中，存储装置248中剩余的可用本地数据存储容量控制导出数据的定时和速率。又如，特定用户、患者或手术的用户定义的包括或不包括允许包括数据集以用于分析或自动删除。又如，所检测的网络停工时间或可用容量确定上传或传送的时间。
在另一方面，用于诊断故障模式的数据的传输由特定事件键控。例如，手术中的用户定义的装置、器械或工具故障发起关于该器械记录的数据的存档和传输，以用于故障模式分析。此外，当标识到故障事件时，将该事件周围的所有数据存档并打包以便送回以用于预测性信息(PI)分析。将作为PI故障的一部分的数据标记用于存储和维护，直到医院或基于云的分析系统释放对数据的保留为止。
器械的重大故障可发起数据的自动存档和提交以用于含义分析。在原始设备制造商(OEM)装置上检测到伪造部件或适配器发起对该部件的记载及对其使用结果和效果的记录。
图40为根据本公开的一个方面的描绘了用于确定传输到基于云的远程分析网络的速率、频率和数据类型的控制程序或逻辑配置的方法的逻辑流程图4320。参见图1-图40，在一个方面，本公开提供了一种外科集线器206，该外科集线器包括存储装置248、联接到存储装置248的处理器244和联接到处理器244的存储器249。存储器249存储能够由处理器244执行以进行以下操作的指令：从外科器械235接收4322数据，基于存储装置248的可用存储容量来确定4324将数据传输到基于云的远程医疗分析网络204的速率。任选地，存储器249存储能够由处理器244执行以进行以下操作的指令：基于存储装置248的可用存储容量来确定4326将数据传输到基于云的远程医疗分析网络204的频率。任选地，存储器249存储能够由处理器244执行以进行以下操作的指令：检测外科集线器网络停工时间，以及基于所检测的外科集线器网络206停工时间来确定4326将数据传输到基于云的远程医疗分析网络204的频率。任选地，存储器249存储能够由处理器244执行以进行以下操作的指令：基于包括或不包括与用户、患者或外科手术相关联的数据来确定4328将数据传输到基于云的远程医疗分析网络204的数据类型。
在另一方面，存储器249存储能够由处理器244执行以接收用于外科集线器206或外科器械235的新操作参数的指令。
态势感知是外科系统根据从数据库和/或器械接收的数据确定或推断与外科手术相关的信息的一些方面的能力。该信息可包括正在进行的手术的类型、正被操作的组织的类型或作为手术对象的体腔。利用与外科手术相关的上下文信息，外科系统可例如改善其控制连接到外科系统的模块化装置(例如，机器人臂和/或机器人外科工具)的方式，并且在外科手术的过程期间向外科医生提供背景化的信息或建议。
现在参见图41，其示出了描绘集线器诸如例如外科集线器106或206的态势感知的时间线5200。时间线5200是说明性的外科手术以及外科集线器106、206可以从外科手术中每个步骤从数据源接收的数据导出的背景信息。时间线5200描绘了护士、外科医生和其它医疗人员在肺段切除手术期间将采取的典型步骤，从建立手术室开始到将患者转移到术后恢复室为止。
态势感知外科集线器106、206在整个外科手术过程中从数据源接收数据，包括每次医疗人员利用与外科集线器106、206配对的模块化装置时生成的数据。外科集线器106、206可从配对的模块化装置和其它数据源接收该数据，并且在接收新数据时不断导出关于正在进行的手术的推断(即，背景信息)，诸如在任何给定时间执行手术的哪个步骤。外科集线器106、206的态势感知系统能够例如记录与用于生成报告的手术相关的数据，验证医务人员正在采取的步骤，提供可能与特定手术步骤相关的数据或提示(例如，经由显示屏)，基于背景调节模块化装置(例如，激活监测器，调节医学成像装置的视场(FOV)，或者改变超声外科器械或RF电外科器械的能量水平)，以及采取上述任何其它此类动作。
作为该示例性手术中的第一步5202，医院工作人员从医院的EMR数据库中检索患者的EMR。基于EMR中的选择的患者数据，外科集线器106、206确定待执行的手术是胸腔手术。
第二步5204，工作人员扫描用于手术的进入的医疗用品。外科集线器106、206与在各种类型的手术中使用的用品列表交叉引用扫描的用品，并确认供应的混合物对应于胸腔手术。另外，外科集线器106、206还能够确定手术不是楔形手术(因为进入的用品缺乏胸腔楔形手术所需的某些用品，或者在其它方面不对应于胸腔楔形手术)。
第三步5206，医疗人员经由可通信地连接到外科毂集线器106、206的扫描器来扫描患者带。然后，外科集线器106、206可基于所扫描的数据来确认患者的身份。
第四步5208，医务工作人员打开辅助设备。所利用的辅助设备可根据外科手术的类型和外科医生待使用的技术而变化，但在此示例性情况下，它们包括排烟器、吹入器和医学成像装置。当激活时，作为其初始化过程的一部分，作为模块化装置的辅助设备可以自动与位于模块化装置特定附近的外科集线器106、206配对。然后，外科集线器106、206可通过检测在该术前阶段或初始化阶段期间与其配对的模块化装置的类型来导出关于外科手术的背景信息。在该具体示例中，外科集线器106、206确定外科手术是基于配对模块化装置的该特定组合的VATS手术。基于来自患者的EMR的数据的组合，手术中使用的医疗用品的列表以及连接到集线器的模块化装置的类型，外科集线器106、206通常可推断外科小组将执行的具体手术。一旦外科集线器106、206知道正在执行什么具体手术，外科集线器106、206便可从存储器或云中检索该手术的步骤，然后交叉参照其随后从所连接的数据源(例如，模块化装置和患者监测装置)接收的数据，以推断外科团队正在执行的外科手术的什么步骤。
第五步5210，工作人员成员将EKG电极和其它患者监测装置附接到患者。EKG电极和其它患者监测装置能够与外科集线器106、206配对。当外科集线器106、206开始从患者监测装置接收数据时，外科集线器106、206因此确认患者在手术室中。
第六步5212，医疗人员诱导患者麻醉。外科集线器106、206可基于来自模块化装置和/或患者监测装置的数据(包括例如EKG数据、血压数据、呼吸机数据、或它们的组合)推断患者处于麻醉下。在第六步5212完成时，肺分段切除手术的术前部分完成，并且手术部分开始。
第七步5214，折叠正在操作的患者肺部(同时通气切换到对侧肺)。例如，外科集线器106、206可从呼吸机数据推断出患者的肺已经塌缩。外科集线器106、206可推断手术的手术部分已开始，因为其可将患者的肺部塌缩的检测与手术的预期步骤(可先前访问或检索)进行比较，从而确定使肺塌缩是该特定手术中的手术步骤。
第八步5216，插入医学成像装置(例如，内窥镜)，并启动来自医学成像装置的视频。外科集线器106、206通过其与医学成像装置的连接来接收医学成像装置数据(即，视频或图像数据)。在接收到医学成像装置数据之后，外科集线器106、206可确定外科手术的腹腔镜式部分已开始。另外，外科集线器106、206可确定正在执行的特定手术是分段切除术，而不是叶切除术(注意，楔形手术已经基于外科集线器106、206基于在手术的第二步5204处接收到的数据而排除)。来自医学成像装置124(图2)的数据可用于以多种不同的方式确定与正在执行的手术类型相关的背景信息，包括通过确定医学成像装置相对于患者解剖结构的可视化取向的角度，监测所利用的医学成像装置的数量(即，被激活并与外科集线器106、206配对)，以及监测所利用的可视化装置的类型。例如，一种用于执行VATS肺叶切除术的技术将摄像机放置在隔膜上方的患者胸腔的下前拐角中，而一种用于执行VATS分段切除术的技术将摄像机相对于分段裂缝放置在前肋间位置。例如，使用模式识别或机器学习技术，可对态势感知系统进行训练，以根据患者解剖结构的可视化识别医学成像装置的定位。作为另一个示例，一种用于执行VATS肺叶切除术的技术利用单个医学成像装置，而用于执行VATS分段切除术的另一种技术利用多个摄像机。作为另一示例，一种用于执行VATS分段切除术的技术利用红外光源(其可作为可视化系统的一部分可通信地联接到外科集线器)以可视化不用于VATS肺部切除术中的分段裂隙。通过从医学成像装置跟踪这些数据中的任何或所有，外科集线器106、206因此可确定正在进行的外科手术的具体类型和/或用于特定类型的外科手术的技术。
第九步5218，外科团队开始手术的解剖步骤。外科集线器106、206可推断外科医生正在解剖以调动患者的肺，因为其从RF发生器或超声发生器接收指示正在击发能量器械的数据。外科集线器106、206可将所接收的数据与外科手术的检索步骤交叉，以确定在过程中的该点处(即，在先前讨论的手术步骤完成之后)击发的能量器械对应于解剖步骤。在某些情况下，能量器械可为安装到机器人外科系统的机械臂的能量工具。
第十步5220，外科团队继续进行手术的结扎步骤。外科集线器106、206可推断外科医生正在结扎动脉和静脉，因为其从外科缝合和切割器械接收指示器械正在被击发的数据。与先前步骤相似，外科集线器106、206可通过将来自外科缝合和切割器械的数据的接收与该过程中的检索步骤进行交叉引用来推导该推论。在某些情况下，外科器械可以是安装到机器人外科系统的机器人臂的外科工具。
第十一步5222，执行手术的分段切除术部分。外科集线器106、206可推断外科医生正在基于来自外科缝合和切割器械的数据(包括来自其仓的数据)横切软组织。仓数据可对应于例如由器械击发的钉的大小或类型。由于不同类型的钉用于不同类型的组织，因此仓数据可指示正被缝合和/或横切的组织的类型。在这种情况下，被击发的钉的类型用于软组织(或其它类似的组织类型)，这允许外科集线器106、206推断手术的分段切除术部分正在进行。
第十二步5224中，执行节点解剖步骤。外科集线器106、206可基于从发生器接收的指示正在击发RF或超声器械的数据来推断外科团队正在解剖节点并且执行泄漏测试。对于该特定手术，在横切软组织后使用的RF或超声器械对应于节点解剖步骤，该步骤允许外科集线器106、206进行此类推论。应当指出的是，外科医生根据手术中的具体步骤定期在外科缝合/切割器械和外科能量(即，RF或超声)器械之间来回切换，因为不同器械更好地适于特定任务。因此，其中使用缝合/切割器械和外科能量器械的特定序列可指示外科医生正在执行的手术的步骤。此外，在某些情况下，机器人工具可用于外科手术中的一个或多个步骤，和/或手持式外科器械可用于外科手术中的一个或多个步骤。(一个或多个)外科医生可例如在机器人工具与手持式外科器械之间交替和/或可同时使用装置。在第十二步5224完成时，切口被闭合并且手术的术后部分开始。
第十三步5226，逆转患者的麻醉。例如，外科集线器106、206可基于例如呼吸机数据(即，患者的呼吸率开始增加)推断出患者正在从麻醉中醒来。
最后，第十四步5228是医疗人员从患者移除各种患者监测装置。因此，当集线器从患者监测装置丢失EKG、BP和其它数据时，外科集线器106、206可推断患者正在被转移到恢复室。如从该示例性手术的描述可以看出，外科集线器106、206可根据从可通信地联接到外科集线器106、206的各种数据源接收的数据来确定或推断给定外科手术的每个步骤何时发生。
态势感知进一步描述于2017年12月28日提交的标题为INTERACTIVE SURGICALPLATFORM的美国临时专利申请序列号62/611,341中，该专利申请全文以引用方式并入本文。在某些情况下，机器人外科系统(包括本文所公开的各种机器人外科系统)的操作可由集线器106、206基于其态势感知和/或来自其器件的反馈和/或基于来自云102的信息来控制。
在一个方面，本公开提供了一种外科集线器，包括：处理器；以及联接到该处理器的存储器，该存储器存储能够由该处理器执行以进行以下操作的指令：询问外科器械，其中该外科器械是患者数据的第一源；从该外科器械检索第一数据集，其中该第一数据集与患者和外科手术相关联；询问医学成像装置，其中该医学成像装置是患者数据的第二源；从该医学成像装置检索第二数据集，其中该第二数据集与该患者和该外科手术的效果相关联；通过密钥将该第一数据集和该第二数据集相关联；以及将相关联的第一数据集和第二数据集传输到该外科集线器外部的远程网络。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以进行以下操作的指令：使用密钥来检索第一数据集；通过去除第一数据集与患者的关联来对该第一数据集匿名化；使用密钥来检索第二数据集；通过去除第二数据集与患者的关联来对第二数据集匿名化；对匿名化的第一数据集和第二数据集进行配对；以及基于匿名化的配对第一数据集和第二数据集来确定按该外科手术分组的外科手术的成功率。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以进行以下操作的指令：检索匿名化的第一数据集；检索匿名化的第二数据集；以及使用密钥重新整合匿名化的第一数据集和第二数据集。本公开还提供了一种外科集线器，其中第一数据集和第二数据集定义相应的第一数据分组和第二数据分组中的第一数据有效载荷和第二数据有效载荷。本公开还提供了一种用于执行上述功能中的任一者的控制电路和/或非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，这些计算机可读指令在被执行时致使机器执行上述功能中的任一者。
在另一方面，本公开提供了一种外科集线器，包括：处理器；以及联接到处理器的存储器，该存储器存储能够由该处理器执行以进行以下操作的指令：从第一源接收第一数据分组，该第一数据分组包括第一前导码、第一数据有效载荷，第一数据有效载荷的源和第一加密证书，其中第一前导码定义第一数据有效载荷，并且第一加密证书验证第一数据分组的真实性；从第二源接收第二数据分组，该第二数据分组包括第二前导码、第二数据有效载荷、第二数据有效载荷的源和第二加密证书，其中第二前导码定义第二数据有效载荷，并且第二加密证书验证第二数据分组的真实性；将第一数据分组和第二数据分组相关联；以及生成包括第一数据有效载荷和第二数据有效载荷的第三数据分组。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以进行以下操作的指令：确定数据有效载荷来自新的源；验证该数据有效载荷的新的源；以及改变在外科集线器处进行的数据收集过程以从该新的源接收后续数据分组。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以基于密钥来将第一数据分组和第二数据分组相关联的指令。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以对该第三数据分组的数据有效载荷匿名化的指令。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以进行以下操作的指令：接收匿名化的第三数据分组，以及使用该密钥将匿名化的第三数据分组重新整合到第一数据分组和第二数据分组中。本公开还提供了一种用于执行上述功能中的任一者的控制电路和/或非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，这些计算机可读指令在被执行时致使机器执行上述功能中的任一者。
在另一方面，本公开提供了一种被配置成能够与外科器械通信的外科集线器，该外科集线器包括：处理器；以及联接到该处理器的存储器，该存储器存储能够由处理器执行以进行以下操作的指令：接收与外科手术相关联的第一数据集，其中该第一数据集在第一时间生成；接收与外科手术的功效相关联的第二数据集，其中该第二数据集在第二时间生成，其中该第二时间与该第一时间是分开且不同的；通过去除标识患者、手术或手术的预定时间的信息来对第一数据集和第二数据集匿名化；以及存储第一匿名化数据集和第二匿名化数据集以生成按手术分组的数据对。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以基于该数据对重建一系列时序事件的指令。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以基于该数据对重建一系列联接但不受约束的数据集的指令。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以进行以下操作的指令：对数据对进行加密；定义用于数据对的备份格式；以及将数据对镜像到云存储装置。本公开还提供了一种用于执行上述功能中的任一者的控制电路和/或非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，这些计算机可读指令在被执行时致使机器执行上述功能中的任一者。
在另一方面，本公开提供了一种外科集线器，包括：存储装置；联接到所述存储装置的处理器；以及联接到处理器的存储器，该存储器存储能够由处理器执行以进行以下操作的指令：从外科器械接收数据；基于该存储装置的可用存储容量来确定将该数据传输到基于云的远程医疗分析网络的速率；基于该存储装置的该可用存储容量或所检测的外科集线器网络停工时间来确定将该数据传输到该基于云的远程医疗分析网络的频率；以及基于包括或不包括与用户、患者或外科手术相关联的数据来确定将该数据传输到基于云的远程医疗分析网络的数据类型。本公开还提供了一种外科集线器，其中存储器存储能够由处理器执行以接收用于外科集线器或外科器械的新操作参数的指令。本公开还提供了一种用于执行上述功能中的任一者的控制电路和/或非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，这些计算机可读指令在被执行时致使机器执行上述功能中的任一者。
在另一方面，本公开提供了一种外科集线器，包括：控件，该控件被配置成能够：从外科器械接收数据；基于该存储装置的可用存储容量来确定将该数据传输到基于云的远程医疗分析网络的速率；基于该存储装置的该可用存储容量或所检测的外科集线器网络停工时间来确定将该数据传输到该基于云的远程医疗分析网络的频率；以及基于包括或不包括与用户、患者或外科手术相关联的数据来确定将该数据传输到基于云的远程医疗分析网络的数据类型。
本文所述主题的各个方面在以下编号的实施例中加以阐述。
实施例1：一种外科集线器，包括：存储装置；联接到所述存储装置的处理器；以及联接到所述处理器的存储器，所述存储器存储能够由所述处理器执行以进行以下操作的指令：从联接到所述外科集线器的外科器械接收数据；以及基于所述存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到基于云的远程医疗分析网络的速率。
实施例2：根据实施例1所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：基于所述存储装置的所述可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
实施例3：根据实施例1-2中任一项所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：检测外科集线器网络停工时间；以及基于所检测的外科集线器网络停工时间来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
实施例4：根据实施例1-3中任一项所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：基于包括或不包括与用户、患者或外科手术相关联的数据来确定从所述外科集线器传输到所述基于云的远程医疗分析网络的数据类型。
实施例5：根据实施例1-4中任一项所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：确定何时将数据从所述外科集线器传输到所述基于云的远程医疗分析网络。
实施例6：根据实施例1-5中任一项所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：从所述基于云的远程医疗分析网络接收用于所述外科集线器的新操作参数。
实施例7：根据实施例1-6中任一项所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：从所述基于云的远程医疗分析网络接收用于所述外科器械的新操作参数。
实施例8：一种从外科集线器将数据传输到基于云的远程医疗分析网络的方法，所述外科集线器包括存储装置、联接到所述存储装置的处理器、以及联接到所述处理器的存储器，所述存储器存储能够由所述处理器执行的指令，所述方法包括：由处理器从联接到所述外科集线器的外科器械接收数据；以及由所述处理器基于联接到所述外科集线器的存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的速率。
实施例9：根据实施例8所述的方法，所述方法包括由所述处理器基于所述存储装置的所述可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
实施例10：根据实施例8-9中任一项所述的方法，所述方法包括由所述处理器检测外科集线器网络停工时间；以及由所述处理器基于所检测的外科集线器网络停工时间来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
实施例11：根据实施例8-10中任一项所述的方法，所述方法包括由所述处理器基于包括或不包括与用户、患者或外科手术相关联的数据来确定从所述外科集线器传输到所述基于云的远程医疗分析网络的数据类型。
实施例12：根据实施例8-11中任一项所述的方法，所述方法包括由所述处理器确定何时将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络。
实施例13：根据实施例8-12中任一项所述的方法，所述方法包括由所述处理器从所述基于云的远程医疗分析网络接收用于所述外科集线器的新操作参数。
实施例14：根据实施例8-13中任一项所述的方法，所述方法包括由所述处理器从所述基于云的远程医疗分析网络接收用于所述外科器械的新操作参数。
实施例15：一种非暂态计算机可读介质，所述非暂态计算机可读介质存储计算机可读指令，所述计算机可读指令在被执行时致使机器：从联接到所述外科集线器的外科器械接收数据；以及基于所述存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到基于云的远程医疗分析网络的速率。
实施例16：根据实施例15所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：基于所述存储装置的所述可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
实施例17：根据实施例15-16中任一项所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：检测外科集线器网络停工时间；以及基于所检测的外科集线器网络停工时间来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
实施例18：根据实施例15-17中任一项所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：基于包括或不包括与用户、患者或外科手术相关联的数据来确定从所述外科集线器传输到所述基于云的远程医疗分析网络的数据类型。
实施例19：根据实施例15-18中任一项所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：确定何时将数据从所述外科集线器传输到所述基于云的远程医疗分析网络。
实施例20：根据实施例15-19中任一项所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：从所述基于云的远程医疗分析网络接收用于所述外科集线器的新操作参数。
实施例21：根据实施例15-20中任一项所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：从所述基于云的远程医疗分析网络接收用于所述外科器械的新操作参数。
尽管已举例说明和描述了多个形式，但是申请人的意图并非将所附权利要求的范围约束或限制在此类细节中。在不脱离本公开的范围的情况下，可实现对这些形式的许多修改、变化、改变、替换、组合和等同物，并且本领域技术人员将想到这些形式的许多修改、变化、改变、替换、组合和等同物。此外，另选地，可将与所描述的形式相关联的每个元件的结构描述为用于提供由所述元件执行的功能的器件。另外，在公开了用于某些部件的材料的情况下，也可使用其他材料。因此，应当理解，上述具体实施方式和所附权利要求旨在涵盖属于本发明所公开的形式范围内的所有此类修改形式、组合和变型形式。所附权利要求旨在涵盖所有此类修改、变化、改变、替换、修改和等同物。
上述具体实施方式已通过使用框图、流程图和/或示例阐述了装置和/或方法的各种形式。只要此类框图、流程图和/或示例包含一个或多个功能和/或操作，本领域的技术人员就要将其理解为此类框图、流程图和/或示例中的每个功能和/或操作都可以单独和/或共同地通过多种硬件、软件、固件或实际上它们的任何组合来实施。本领域的技术人员将会认识到，本文公开的形式中的一些方面可作为在一台或多台计算机上运行的一个或多个计算机程序(如，作为在一个或多个计算机系统上运行的一个或多个程序)，作为在一个或多个处理器上运行的一个或多个程序(如，作为在一个或多个微处理器上运行的一个或多个程序)，作为固件，或作为实际上它们的任何组合全部或部分地在集成电路中等效地实现，并且根据本发明，设计电子电路和/或编写软件和/或硬件的代码将在本领域技术人员的技术范围内。另外，本领域的技术人员将会认识到，本文所述主题的机制能够作为多种形式的一个或多个程序产品进行分布，并且本文所述主题的示例性形式适用，而不管用于实际进行分布的信号承载介质的具体类型是什么。
用于编程逻辑以执行各种所公开的方面的指令可存储在系统内的存储器内，诸如动态随机存取存储器(DRAM)、高速缓存、闪存存储器或其它存储器。此外，指令可经由网络或通过其它计算机可读介质来分发。因此，机器可读介质可包括用于存储或传输以机器(例如，计算机)读形式的信息的机构，但不限于软盘、光学盘、光盘、只读存储器(CD-ROM)、磁光盘、只读存储器(ROM)、随机存取存储器(RAM)、可擦除可编程只读存储器(EPROM)、电可擦除可编程只读存储器(EEPROM)、磁卡或光卡、闪存存储器、或经由电信号、光学信号、声学信号或其它形式的传播信号(例如，载波、红外信号、数字信号等)在因特网上传输信息时使用的有形的、机器可读存储装置。因此，非暂态计算机可读介质包括适于以机器(例如，计算机)可读的形式存储或传输电子指令或信息的任何类型的有形机器可读介质。
如本文任一方面所用，术语“控制电路”可指例如硬连线电路系统、可编程电路系统(例如，计算机处理器，该计算机处理器包括一个或多个单独指令处理内核、处理单元，处理器、微控制器、微控制器单元、控制器、数字信号处理器(DSP)、可编程逻辑装置(PLD)、可编程逻辑阵列(PLA)、场可编程门阵列(FPGA))、状态机电路系统、存储由可编程电路系统执行的指令的固件、以及它们的任何组合。控制电路可以集体地或单独地实现为形成更大系统的一部分的电路系统，例如集成电路(IC)、专用集成电路(ASIC)、片上系统(SoC)、台式计算机、膝上型计算机、平板计算机、服务器、智能电话等。因此，如本文所用，“控制电路”包括但不限于具有至少一个离散电路的电子电路、具有至少一个集成电路的电子电路、具有至少一个专用集成电路的电子电路、形成由计算机程序配置的通用计算装置的电子电路(如，至少部分地实施本文所述的方法和/或装置的由计算机程序配置的通用计算机，或至少部分地实施本文所述的方法和/或装置的由计算机程序配置的微处理器)、形成存储器装置(如，形成随机存取存储器)的电子电路，和/或形成通信装置(如，调节解调器、通信开关或光电设备)的电子电路。本领域的技术人员将会认识到，可以模拟或数字方式或它们的一些组合实施本文所述的主题。
如本文的任何方面所用，术语“逻辑”可指被配置成能够执行前述操作中的任一者的应用程序、软件、固件和/或电路系统。软件可体现为记录在非暂态计算机可读存储介质上的软件包、代码、指令、指令集和/或数据。固件可以体现为在存储器装置中硬编码(例如，非易失性)的代码、指令或指令集和/或数据。
如本文任一方面所用，术语“器件”、“系统”、“模块”等可指计算机相关实体、硬件、硬件和软件的组合、软件或执行中的软件。
如本文任一方面中所用，“算法”是指导致所需结果的有条理的步骤序列，其中“步骤”是指物理量和/或逻辑状态的操纵，物理量和/或逻辑状态可以(但不一定)采用能被存储、转移、组合、比较和以其它方式操纵的电或磁信号的形式。常用于指这些信号，如位、值、元素、符号、字符、术语、数字等。这些和类似的术语可与适当的物理量相关联并且仅仅是应用于这些量和/或状态的方便的标签。
网络可包括分组交换网络。通信装置可能够使用所选择的分组交换网络通信协议来彼此通信。一个示例性通信协议可包括可允许使用传输控制协议/因特网协议(TCP/IP)进行通信的以太网通信协议。以太网协议可符合或兼容电气和电子工程师学会(IEEE)于2008年12月发布的名为“IEEE 802.3标准”的以太网标准和/或本标准的更高版本。另选地或附加地，通信装置能够使用X.25通信协议彼此通信。X.25通信协议可符合或符合国际电信联盟电信标准化部门(ITU-T)颁布的标准。另选地或附加地，通信装置能够使用帧中继通信协议彼此通信。帧中继通信协议可符合或符合国际电话和电话协商委员会(CCITT)和/或美国国家标准学会(ANSI)发布的标准。另选地或附加地，收发器能够使用异步传输模式(ATM)通信协议彼此通信。ATM通信协议可符合或兼容ATM论坛于2001年8月发布的名为“ATM-MPLS网络互通2.0”的ATM标准和/或该标准的更高版本。当然，本文同样设想了不同的和/或之后开发的连接取向的网络通信协议。
除非上述公开中另外明确指明，否则可以理解的是，在上述公开中，使用术语如“处理”、“估算”、“计算”、“确定”、“显示”的讨论是指计算机系统或类似的电子计算装置的动作和进程，其操纵表示为计算机系统的寄存器和存储器内的物理(电子)量的数据并将其转换成相似地表示为计算机系统存储器或寄存器或其他此类信息存储、传输或显示装置内的物理量的其他数据。
一个或多个部件在本文中可被称为“被配置成”、“可被配置成”、“可操作/可操作地”、“适于/可适于”、“能够”、“可适形/适形于”等。本领域的技术人员将会认识到，除非上下文另有所指，否则“被配置为”通常可涵盖活动状态的部件和/或未活动状态的部件和/或待机状态的部件。
术语“近侧”和“远侧”在本文中是相对于操纵外科器械的柄部部分的临床医生来使用的。术语“近侧”是指最靠近临床医生的部分，术语“远侧”是指远离临床医生定位的部分。还应当理解，为简洁和清楚起见，本文可结合附图使用诸如“竖直”、“水平”、“上”和“下”等空间术语。然而，外科器械在许多方向和位置中使用，并且这些术语并非限制性的和/或绝对的。
本领域的技术人员将认识到，一般而言，本文、以及特别是所附权利要求(例如，所附权利要求的正文)中所使用的术语通常旨在为“开放”术语(例如，术语“包括”应解释为“包括但不限于”，术语“具有”应解释为“至少具有”，术语“包含”应解释为“包含但不限于”等)。本领域的技术人员还应当理解，如果所引入权利要求叙述的具体数目为预期的，则这样的意图将在权利要求中明确叙述，并且在不存在这样的叙述的情况下，不存在这样的意图。例如，为有助于理解，下述所附权利要求可含有对介绍性短语“至少一个”和“一个或多个”的使用以引入权利要求。然而，对此类短语的使用不应视为暗示通过不定冠词“一个”或“一种”引入权利要求表述将含有此类引入权利要求表述的任何特定权利要求限制在含有仅一个这样的表述的权利要求中，甚至当同一权利要求包括介绍性短语“一个或多个”或“至少一个”和诸如“一个”或“一种”(例如，“一个”和/或“一种”通常应解释为意指“至少一个”或“一个或多个”)的不定冠词时；这也适用于对用于引入权利要求表述的定冠词的使用。
另外，即使明确叙述引入权利要求叙述的特定数目，本领域的技术人员应当认识到，此种叙述通常应解释为意指至少所叙述的数目(例如，在没有其它修饰语的情况下，对“两个叙述”的裸叙述通常意指至少两个叙述、或两个或更多个叙述)。此外，在其中使用类似于“A、B和C中的至少一者等”的惯例的那些情况下，一般而言，这种结构意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B和C中的至少一者的系统”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。在其中使用类似于“A、B或C中的至少一者等”的惯例的那些情况下，一般而言，这种结构意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B或C中的至少一者的系统”应当包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。本领域的技术人员还应当理解，通常，除非上下文另有指示，否则无论在具体实施方式、权利要求或附图中呈现两个或更多个替代术语的转折性词语和/或短语应理解为涵盖包括所述术语中的一者、所述术语中的任一个或这两个术语的可能性。例如，短语“A或B”通常将被理解为包括“A”或“B”或“A和B”的可能性。
对于所附的权利要求，本领域的技术人员将会理解，其中表述的操作通常可以任何顺序进行。另外，尽管以(一个或多个)序列出了多个操作流程图，但应当理解，可以不同于所示顺序的其它顺序进行所述多个操作，或者可以同时进行所述多个操作。除非上下文另有规定，否则此类替代排序的示例可包括重叠、交错、中断、重新排序、增量、预备、补充、同时、反向，或其他改变的排序。此外，除非上下文另有规定，否则像“响应于”、“相关”这样的术语或其它过去式的形容词通常不旨在排除此类变体。
值得一提的是，任何对“一个方面”、“一方面”、“一范例”、“一个范例”的提及均意指结合所述方面所述的具体特征、结构或特性包括在至少一个方面中。因此，在整个说明书的不同位置出现的短语“在一个方面”、“在一方面”、“在一范例”、“在一个范例”不一定都指同一方面。此外，具体特征、结构或特性可在一个或多个方面中以任何合适的方式组合。
本说明书提及和/或在任何申请数据表中列出的任何专利申请，专利，非专利公布或其它公开材料均以引用方式并入本文，只要所并入的材料在此不一致。因此，并且在必要的程度下，本文明确列出的公开内容代替以引用方式并入本文的任何冲突材料。据称以引用方式并入本文但与本文列出的现有定义、陈述或其他公开材料相冲突的任何材料或其部分，将仅在所并入的材料与现有的公开材料之间不产生冲突的程度下并入。
概括地说，已经描述了由采用本文所述的概念产生的许多有益效果。为了举例说明和描述的目的，已经提供了一个或多个形式的上述具体实施方式。这些具体实施方式并非意图为详尽的或限定到本发明所公开的精确形式。可以按照上述教导内容对本发明进行修改或变型。选择和描述的一个或多个形式是为了说明原理和实际应用，从而使本领域的普通技术人员能够利用适用于预期的特定用途的所述多个形式和多种修改形式。与此一同提交的权利要求书旨在限定完整范围。
Claims (21)
1.一种外科集线器，包括：
存储装置；
处理器，所述处理器联接到所述存储装置；以及
存储器，所述存储器联接到所述处理器，所述存储器存储能够由所述处理器执行以进行以下操作的指令：
从联接到所述外科集线器的外科器械接收数据；以及
基于所述存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到基于云的远程医疗分析网络的速率。
2.根据权利要求1所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：基于所述存储装置的所述可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
3.根据权利要求1所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：
检测外科集线器网络停工时间；以及
基于所检测的外科集线器网络停工时间来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
4.根据权利要求1所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：基于包括或不包括与用户、患者或外科手术相关联的数据来确定从所述外科集线器传输到所述基于云的远程医疗分析网络的数据类型。
5.根据权利要求1所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：确定何时将数据从所述外科集线器传输到所述基于云的远程医疗分析网络。
6.根据权利要求1所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：从所述基于云的远程医疗分析网络接收用于所述外科集线器的新操作参数。
7.根据权利要求1所述的外科集线器，其中，所述存储器存储能够由所述处理器执行以进行以下操作的指令：从所述基于云的远程医疗分析网络接收用于所述外科器械的新操作参数。
8.一种将数据从外科集线器传输到基于云的远程医疗分析网络的方法，所述外科集线器包括存储装置、联接到所述存储装置的处理器、以及联接到所述处理器的存储器，所述存储器存储能够由所述处理器执行的指令，所述方法包括：
由处理器从联接到所述外科集线器的外科器械接收数据；以及
由所述处理器基于联接到所述外科集线器的存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的速率。
9.根据权利要求8所述的方法，所述方法包括由所述处理器基于所述存储装置的所述可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
10.根据权利要求8所述的方法，所述方法包括：
由所述处理器检测外科集线器网络停工时间；以及
由所述处理器基于所检测的外科集线器网络停工时间来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
11.根据权利要求8所述的方法，所述方法包括由所述处理器基于包括或不包括与用户、患者或外科手术相关联的数据来确定从所述外科集线器传输到所述基于云的远程医疗分析网络的数据类型。
12.根据权利要求8所述的方法，所述方法包括由所述处理器确定何时将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络。
13.根据权利要求8所述的方法，所述方法包括由所述处理器从所述基于云的远程医疗分析网络接收用于所述外科集线器的新操作参数。
14.根据权利要求1所述的方法，所述方法包括由所述处理器从所述基于云的远程医疗分析网络接收用于所述外科器械的新操作参数。
15.一种非暂态计算机可读介质，所述非暂态计算机可读介质存储计算机可读指令，所述计算机可读指令在被执行时致使机器：
从联接到所述外科集线器的外科器械接收数据；以及
基于所述存储装置的可用存储容量来确定将所述数据从所述外科集线器传输到基于云的远程医疗分析网络的速率。
16.根据权利要求15所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：基于所述存储装置的所述可用存储容量来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
17.根据权利要求15所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：
检测外科集线器网络停工时间；以及
基于所检测的外科集线器网络停工时间来确定将所述数据从所述外科集线器传输到所述基于云的远程医疗分析网络的频率。
18.根据权利要求15所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：基于包括或不包括与用户、患者或外科手术相关联的数据来确定从所述外科集线器传输到所述基于云的远程医疗分析网络的数据类型。
19.根据权利要求15所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：确定何时将数据从所述外科集线器传输到所述基于云的远程医疗分析网络。
20.根据权利要求15所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：从所述基于云的远程医疗分析网络接收用于所述外科集线器的新操作参数。
21.根据权利要求15所述的非暂态计算机可读介质，存储计算机可读指令，所述计算机可读指令在被执行时致使机器：从所述基于云的远程医疗分析网络接收用于所述外科器械的新操作参数。
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