CN111542282A - 具有用于控制端部执行器参数的预定义的可调节的控制算法的电动外科工具 - Google Patents

具有用于控制端部执行器参数的预定义的可调节的控制算法的电动外科工具 Download PDF

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CN111542282A
CN111542282A CN201880084679.3A CN201880084679A CN111542282A CN 111542282 A CN111542282 A CN 111542282A CN 201880084679 A CN201880084679 A CN 201880084679A CN 111542282 A CN111542282 A CN 111542282A
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surgical
end effector
hub
control
data
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F·E·谢尔顿四世
J·L·哈里斯
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Ethicon LLC
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Ethicon LLC
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Abstract

本发明公开了一种外科系统。所述外科系统包括：外科器械，所述外科器械包括端部执行器，其中所述端部执行器被配置成能够执行端部执行器功能；以及控制电路，所述控制电路被配置成能够控制所述端部执行器功能并随时间推移自动适应对所述端部执行器功能的控制，以及限制对所述端部执行器功能的控制的自动适应。

Description

具有用于控制端部执行器参数的预定义的可调节的控制算法 的电动外科工具
相关申请的交叉引用
本申请要求2018年11月6日提交的标题为具有用于控制端部执行器参数的预定义的可调节的控制算法的电动外科工具(POWERED SURGICAL TOOL WITH PREDEFINEDADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING END EFFECTOR PARAMETER)的美国非临时专利申请序列号16/182,249的权益，该申请的公开内容全文以引用方式并入本文。
本申请按照美国法典第35卷第119条(e)款的规定要求2018年9月10日提交的标题为具有用于控制至少一个端部执行器参数的预定义的可调节的控制算法的电动外科工具以及用于限制调节的装置(POWERED SURGICAL TOOL WITH A PREDEFINED ADJUSTABLECONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE END-EFFECTOR PARAMETER AND AMEANS FOR LIMITING THE ADJUSTMENT)的美国临时专利申请62/729,184的优先权，该专利申请的公开内容全文以引用方式并入本文。
本专利申请按照美国法典第35卷第119条(e)款的规定还要求2018年6月30日提交的标题为通过另一装置智能激活能量装置(SMART ACTIVATION OF AN ENERGY DEVICE BYANOTHER DEVICE)的美国临时专利申请62/692,747、2018年6月30日提交的标题为智能能量架构(SMART ENERGY ARCHITECTURE)的美国临时专利申请62/692,748和2018年6月30日提交的标题为智能能量装置(SMART ENERGY DEVICES)的美国临时专利申请62/692,768的优先权，这些临时专利申请中的每个的公开内容全文以引用方式并入本文。
本申请按照美国法典第35卷第119条(e)款的规定还要求2018年4月19日提交的标题为集线器通信方法(METHOD OF HUB COMMUNICATION)的美国临时专利申请62/659,900的优先权，该临时专利申请全文以引用方式并入本文。
本申请按照美国法典第35卷第119条(e)款的规定还要求2018年3月20日提交的标题为具有可分离阵列元件的电容耦合的返回路径垫(CAPACITIVE COUPLED RETURN PATHPAD WITH SEPARABLE ARRAY ELEMENTS)的美国临时专利申请62/650,898、2018年3月30日提交的标题为具有优化的感测能力的外科系统(SURGICAL SYSTEMS WITH OPTIMIZEDSENSING CAPABILITIES)的美国临时专利申请序列号62/650,887、2018年3月30日提交的标题为用于交互式外科平台的排烟模块(SMOKE EVACUATION MODULE FOR INTERACTIVESURGICAL PLATFORM)的美国临时专利申请序列号62/650,882和2018年3月30日提交的标题为外科排烟感测和控制(SURGICAL SMOKE EVACUATION SENSING AND CONTROLS)的美国临时专利申请序列号62/650,877的优先权，这些临时专利申请中的每个的公开内容全文以引用方式并入本文。
本申请按照美国法典第35卷第119条(e)款的规定还要求2018年3月8日提交的标题为超声装置中的温度控制以及用于此的控制系统(TEMPERATURE CONTROL INULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR)的美国临时专利申请序列号62/640,417和2018年3月8日提交的标题为估计超声端部执行器的状态以及用于此的控制系统(ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR)的美国临时专利申请序列号62/640,415的优先权，这些临时专利申请中的每个的公开内容全文以引用方式并入本文。
本申请按照美国法典第35卷第119条(e)款的规定还要求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、2017年12月28日提交的标题为基于云的医学分析(CLOUD-BASED MEDICALANALYTICS)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的优先权，这些临时专利申请中的每个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。
此外，在数字和信息时代，由于患者安全和对保持传统操作的普遍期望，医疗系统和设施通常较慢地实现利用较新和改善的技术的系统或手术。然而，通常情况下，医疗系统和设施可能因此缺乏与其他相邻或类似位置的设施的通信和知识共享。为了改善患者实践，期望找到更好地帮助将医疗系统和设施互连的方法。
附图说明
通过参考以下结合如下附图所作的说明可最好地理解本文所述各个方面(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手术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耦合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是根据本公开的至少一个方面的云计算系统的框图，该云计算系统包括耦合到外科集线器的多个智能外科器械，该外科集线器可连接到该云计算系统的云部件。
图13是根据本公开的至少一个方面的云计算系统的功能模块架构。
图14示出了根据本公开的至少一个方面的态势感知外科系统的图。
图15是根据本公开的至少一个方面的描绘外科集线器的态势感知的时间线。
图16是根据本公开的至少一个方面的用于控制各种装置参数的图形用户界面(GUI)的图。
图17是根据本公开的至少一个方面的用于控制外科装置的自适应参数的图形用户界面。
图18是根据本公开的至少一个方面的控制电路的流程图。
图19是描绘根据本公开的至少一个方面的外科系统的框图。
说明书
本专利申请的申请人拥有于2018年11月6日提交的以下美国专利申请，这些专利申请中的每个的公开内容全文以引用方式并入本文：
·美国专利申请16/182,224，标题为基于对所接收的数据集的验证及其来源和完整性验证的外科网络、器械和云响应(SURGICAL NETWORK,INSTRUMENT,AND CLOUDRESPONSES BASED ON VALIDATION OF RECEIVED DATASET AND AUTHENTICATION OF ITSSOURCE AND INTEGRITY)；
·美国专利申请16/182,230，其标题为用于呈现从外部数据解释的信息的外科系统(SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNALDATA)；
·美国专利申请16/182,233，其标题为基于机器学习的外科系统控制程序的改进(MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINELEARNING)；
·美国专利申请16/182,239，其标题为基于除数据之外的分层上下文数据的装置控制程序的调节(ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIEDCONTEXTUAL DATA IN ADDITION TO THE DATA)；
·美国专利申请16/182,243，其标题为基于态势感知的外科集线器和模块化装置响应调节(SURGICAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BASED ONSITUATIONAL AWARENESS)；
·美国专利申请16/182,248，其标题为外科器械对增长的严重性威胁的安全性响应的检测和递增(DETECTION AND ESCALATION OF SECURITY RESPONSES OF SURGICALINSTRUMENTS TO INCREASING SEVERITY THREATS)；
·美国专利申请16/182,251，其标题为交互式外科系统(INTERACTIVE SURGICALSYSTEM)；
·美国专利申请16/182,260，其标题为基于外科网络内的预定义参数的自动数据缩放、对齐和组织(AUTOMATED DATA SCALING,ALIGNMENT,AND ORGANIZING BASED ONPREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS)；
·美国专利申请16/182,267，其标题为利用单极返回电极感测病人的位置和接触以为外科网络提供态势感知(SENSING THE PATIENT POSITION AND CONTACT UTILIZINGTHE MONO-POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO ASURGICAL NETWORK)；
·美国专利申请16/182,246，其标题为基于空气传播的颗粒特性的调节(ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES)；
·美国专利申请16/182,256，其标题为基于态势感知的外科装置功能的调节(ADJUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ON SITUATIONAL AWARENESS)；
·美国专利申请16/182,242，其标题为利用数据流动性通过库存和内部流程跟踪手术器械的所有器械综合成本的实时分析(REAL-TIME ANALYSIS OF COMPREHENSIVE COSTOF ALL INSTRUMENTATION USED IN SURGERY UTILIZING DATA FLUIDITY TO TRACKINSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES)；
·美国专利申请16/182,255，其标题为根据基线对外科医生/工作人员绩效进行使用和技术分析，以优化当前和未来程序两者的装置利用率和性能(USAGE AND TECHNIQUEANALYSIS OF SURGEON/STAFF PERFORMANCE AGAINST A BASELINE TO OPTIMIZE DEVICEUTILIZATION AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES)；
·美国专利申请16/182,269，其标题为对腹部以外区域进行图像采集以改善对使用中的外科装置的放置和控制(IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMENTO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE)；
·美国专利申请16/182,278，其标题为外科网络使用数据上下文和接收系统/用户的要求来影响数据和元数据的包含或链接以建立连续性的数据通信(COMMUNICATION OFDATA WHERE A SURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTSOF A RECEIVING SYSTEM/USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA ANDMETADATA TO ESTABLISH CONTINUITY)；
·美国专利申请16/182,290，其标题为实时分析手术变量对最优解决方案针对基线突出显示差异的外科网络建议(SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIMEANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCESFROM THE OPTIMAL SOLUTION)；
·美国专利申请16/182,232，其标题为通过外科屏障控制外科系统(CONTROL OFA SURGICAL SYSTEM THROUGH A SURGICAL BARRIER)；
·美国专利申请16/182,227，其标题为基于系统或装置需求对通信、交互或处理的优先级的外科网络确定(SURGICAL NETWORK DETERMINATION OF PRIORITIZATION OFCOMMUNICATION,INTERACTION,OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS)；
·美国专利申请16/182,231，其标题为基于装置使用和态势感知的无菌外科场地中外科装置与另一装置的无线配对(WIRELESS PAIRING OF A SURGICAL DEVICE WITHANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE ANDSITUATIONAL AWARENESS OF DEVICES)；
·美国专利申请16/182,229，其标题为基于所感测的组织厚度或闭合中的力调整至少一排钉的钉高度(ADJUSTMENT OF STAPLE HEIGHT OF AT LEAST ONE ROW OF STAPLESBASED ON THE SENSED TISSUE THICKNESS OR FORCE IN CLOSING)；
·美国专利申请16/182,234，其标题为基于感测参数的强制和任意锁定装订装置(STAPLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ONSENSED PARAMETERS)；
·美国专利申请16/182,240，其标题为被配置成能够基于击发或夹持的感测参数来调节力、推进速度和切割构件的总体行程的电动缝合装置(POWERED STAPLING DEVICECONFIGURED TO ADJUST FORCE,ADVANCEMENT SPEED,AND OVERALL STROKE OF CUTTINGMEMBER BASED ON SENSED PARAMETER OF FIRING OR CLAMPING)；
·美国专利申请16/182,235，其标题为射频和超声功率电平的变型与变化的夹持臂压力协作以实现施加到组织的预定义热通量或功率(VARIATION OF RADIO FREQUENCYAND ULTRASONIC POWER LEVEL IN COOPERATION WITH VARYING CLAMP ARM PRESSURE TOACHIEVE PREDEFINED HEAT FLUX OR POWER APPLIED TO TISSUE)；以及
·美国专利申请16/182,238，其标题为改变夹持臂施加的压力以在切割前进位置提供阈值控制压力的超声能量装置(ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSUREAPPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUTPROGRESSION LOCATION)。
本专利申请的申请人拥有于2018年9月10日提交的以下美国专利申请，这些专利申请中的每个的公开内容全文以引用方式并入本文：
·美国临时专利申请62/729,183，其标题为基于感测情况或使用情况调节其功能的外科网络或外科网络连接装置的控件(A CONTROL FOR A SURGICAL NETWORK ORSURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSEDSITUATION OR USAGE)；
·美国临时专利申请62/729,177，其标题为传输前基于外科网络内的预定义参数的自动数据缩放、对齐和组织(AUTOMATED DATA SCALING,ALIGNMENT,AND ORGANIZINGBASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORETRANSMISSION)；
·美国临时专利申请62/729,176，其标题为通过在无菌区域内使用第二手术室系统对第一手术室系统进行间接指挥和控制，其中第二手术室系统具有主要和次要操作模式(INDIRECT COMMAND AND CONTROL OF A FIRST OPERATING ROOM SYSTEM THROUGH THEUSE OF A SECOND OPERATING ROOM SYSTEM WITHIN A STERILE FIELD WHERE THE SECONDOPERATING ROOM SYSTEM HAS PRIMARY AND SECONDARY OPERATING MODES)；
·美国临时专利申请62/729,185，其标题为能够基于击发或夹持的感测参数来调节装置的力、推进速度和切割构件的总体行程的电动缝合装置(POWERED STAPLING DEVICETHAT IS CAPABLE OF ADJUSTING FORCE,ADVANCEMENT SPEED,AND OVERALL STROKE OFCUTTING MEMBER OF THE DEVICE BASED ON SENSED PARAMETER OF FIRING ORCLAMPING)；
·美国临时专利申请62/729,184，其标题为具有用于控制至少一个端部执行器参数的预定义能够调节的控制算法的电动外科工具以及用于限制调节的装置(POWEREDSURGICAL TOOL WITH A PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLINGAT LEAST ONE END EFFECTOR PARAMETER AND A MEANS FOR LIMITING THE ADJUSTMENT)；
·美国临时专利申请62/729,182，其标题为利用单极返回垫电极感测病人的位置和接触以为集线器提供态势感知(SENSING THE PATIENT POSITION AND CONTACTUTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONALAWARENESS TO THE HUB)；
·美国临时专利申请62/729,191，其标题为实时分析手术变量对最优解决方案针对基线突出显示差异的外科网络建议(SURGICAL NETWORK RECOMMENDATIONS FROM REALTIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTINGDIFFERENCES FROM THE OPTIMAL SOLUTION)；
·美国临时申请62/729,195，其标题为改变夹持臂施加的压力以在切割前进位置提供阈值控制压力的超声能量装置(ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSUREAPPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUTPROGRESSION LOCATION)；以及
·美国临时专利申请62/729,186，其标题为基于装置使用和态势感知的无菌外科场地中外科装置与另一装置的无线配对(WIRELESS PAIRING OF A SURGICAL DEVICE WITHANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE ANDSITUATIONAL AWARENESS OF DEVICES)。
本专利申请的申请人拥有于2018年8月28日提交的以下美国专利申请，这些专利申请中的每个的公开内容全文以引用方式并入本文：
·美国专利申请16/115,214，其标题为超声端部执行器的估计状态及其控制系统(ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR)；
·美国专利申请16/115,205，其标题为超声端部执行器的温度控制及其控制系统(TEMPERATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR)；
·美国专利申请16/115,233，其标题为用于递送组合电信号的射频能量装置(RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS)；
·美国专利申请16/115,208，其标题为根据组织位置控制超声外科器械(CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION)；
·美国专利申请16/115,220，其标题为根据组织的存在控制超声外科器械的激活(CONTROLLING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THEPRESENCE OF TISSUE)；
·美国专利申请16/115,232，其标题为经由超声系统确定组织组成(DETERMININGTISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM)；
·美国专利申请16/115,239，其标题为根据频移确定超声机电系统的状态(DETERMINING THE STATE OF AN ULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TOFREQUENCY SHIFT)；
·美国专利申请16/115,247，其标题为确定超声端部执行器的状态(DETERMININGTHE STATE OF AN ULTRASONIC END EFFECTOR)；
·美国专利申请16/115,211，其标题为电外科系统的态势感知(SITUATIONALAWARENESS OF ELECTROSURGICAL SYSTEMS)；
·美国专利申请16/115,226，其标题为用于控制电子外科器械的不同机电系统的机构(MECHANISMS FOR CONTROLLING DIFFERENT ELECTROMECHANICAL SYSTEMS OF ANELECTROSURGICAL INSTRUMENT)；
·美国专利申请16/115,240，其标题为检测端部执行器浸入液体中(DETECTIONOF END EFFECTOR IMMERSION IN LIQUID)；
·美国专利申请16/115,249，其标题为由于无意的电容耦合引起的能量中断(INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING)；
·美国专利申请16/115,256，其标题为增加射频以生成无垫单极环路(INCREASING RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLAR LOOP)；
·美国专利申请16/115,223，其标题为基于能量模态自动调节压力的双极组合式装置(BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ONENERGY MODALITY)；以及
·美国专利申请16/115,238，其标题为能量装置的激活(ACTIVATION OF ENERGYDEVICES)。
本专利申请的申请人拥有于2018年8月23日提交的以下美国专利申请，这些专利申请中的每个的公开内容全文以引用方式并入本文：
·美国临时专利申请62/721,995，其标题为根据组织位置控制超声外科器械(CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION)；
·美国临时专利申请62/721,998，其标题为电外科系统的态势感知(SITUATIONALAWARENESS OF ELECTROSURGICAL SYSTEMS)；
·美国临时专利申请62/721,999，其标题为由于不当的电容耦合引起的能量中断(INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING)；
·美国临时专利申请62/721,994，其标题为基于能量模态自动调节压力的双极组合式装置(BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASEDON ENERGY MODALITY)；以及
·美国临时专利申请62/721,996，其标题为用于递送组合电信号的射频能量装置(RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS)。
本专利申请的申请人拥有于2018年6月30日提交的以下美国专利申请，这些专利申请中的每个的公开内容全文以引用方式并入本文：
·美国临时专利申请62/692,747，其标题为通过另一装置智能激活能量装置(SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE)；
·美国临时专利申请62/692,748，其标题为智能能量架构(SMART ENERGYARCHITECTURE)；以及
·美国临时专利申请62/692,768，其标题为智能能量装置(SMART ENERGYDEVICES)。
本专利申请的申请人拥有于2018年6月29日提交的以下美国专利申请，这些专利申请中的每个的公开内容全文以引用方式并入本文：
·美国专利申请序列号16/024,090，其标题为具有可分离阵列元件的电容耦合的返回路径垫(CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS)；
·美国专利申请序列号16/024,057，其标题为根据感测的闭合参数控制外科器械(CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS)；
·美国专利申请序列号16/024,067，其标题为用于基于围手术期间的信息调节端部执行器参数的系统(SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ONPERIOPERATIVE INFORMATION)；
·美国专利申请序列号16/024,075，其标题为用于智能供电的外科缝合的安全系统(SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING)；
·美国专利申请序列号16/024,083，其标题为用于智能供电的外科缝合的安全系统(SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING)；
·美国专利申请序列号16/024,094，其标题为用于检测端部执行器组织分布不规则的外科系统(SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTIONIRREGULARITIES)；
·美国专利申请序列号16/024,138，其标题为用于检测外科端部执行器与癌组织的接近度的系统(SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TOCANCEROUS TISSUE)；
·美国专利申请序列号16/024,150，其标题为外科器械料筒传感器组件(SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES)；
·美国专利申请序列号16/024,160，其标题为可变输出料筒传感器组件(VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY)；
·美国专利申请序列号16/024,124，其标题为具有柔性电极的外科器械(SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE)；
·美国专利申请序列号16/024,132，其标题为具有柔性电路的外科器械(SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT)；
·美国专利申请序列号16/024,141，其标题为具有组织标记组件的外科器械(SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY)；
·美国专利申请序列号16/024,162，其标题为具有优先数据传输能力的外科系统(SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES)；
·美国专利申请序列号16/024,066，其标题为外科排抽感测和马达控制(SURGICAL EVACUATION SENSING AND MOTOR CONTROL)；
·美国专利申请序列号16/024,096，其标题为外科排抽传感器布置方式(SURGICAL EVACUATION SENSOR ARRANGEMENTS)；
·美国专利申请序列号16/024,116，其标题为外科排抽流动路径(SURGICALEVACUATION FLOW PATHS)；
·美国专利申请序列号16/024,149，其标题为外科排抽感测和发生器控制(SURGICAL EVACUATION SENSING AND GENERATOR CONTROL)；
·美国专利申请序列号16/024,180，其标题为外科排抽感测和显示(SURGICALEVACUATION SENSING AND DISPLAY)；
·美国专利申请序列号16/024,245，其标题为将排烟系统参数传递至用于交互式外科平台的排烟模块中的集线器或云(COMMUNICATION OF SMOKE EVACUATION SYSTEMPARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVESURGICAL PLATFORM)；
·美国专利申请序列号16/024,258，其标题为包括用于交互式外科平台的包括分段控制电路的排烟系统(SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROLCIRCUIT FOR INTERACTIVE SURGICAL PLATFORM)；
·美国专利申请序列号16/024,265，其标题为具有用于过滤器和排烟装置之间的通信的通信电路的外科排抽系统(SURGICAL EVACUATION SYSTEM WITH A COMMUNICATIONCIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE)；以及
·美国专利申请序列号16/024,273，其标题为双串联大型液滴过滤器和小型液滴过滤器(DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS)。
本专利申请的申请人拥有于2018年6月28日提交的以下美国临时专利申请，这些专利申请中的每个的公开内容全文以引用方式并入本文：
·美国临时专利申请序列号62/691,228，其标题为在电外科装置中使用多传感器增强型柔性电路的方法(A Method of using reinforced flex circuits with multiplesensors with electrosurgical devices)；
·美国临时专利申请序列号62/691,227，其标题为根据感测的闭合参数控制外科器械(controlling a surgical instrument according to sensed closureparameters)；
·美国临时专利申请序列号62/691,230，其标题为具有柔性电极的外科器械(SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE)；
·美国临时专利申请序列号62/691,219，其标题为外科排抽感测和马达控制(SURGICAL EVACUATION SENSING AND MOTOR CONTROL)；
·美国临时专利申请序列号62/691,257，其标题为将排烟系统参数传递至用于交互式外科平台的排烟模块中的集线器或云(COMMUNICATION OF SMOKE EVACUATION SYSTEMPARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVESURGICAL PLATFORM)；
·美国临时专利申请序列号62/691,262，其标题为“SURGICAL EVACUATIONSYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND ASMOKE EVACUATION DEVICE”；以及
·美国临时专利申请序列号62/691,251，其标题为双串联大型液滴过滤器和小型液滴过滤器(DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS)。
本专利申请的申请人拥有于2018年4月19日提交的以下美国临时专利申请，其公开内容全文以引用方式并入本文：
·美国临时专利申请序列号62/659,900，其标题为集线器通信方法(METHOD OFHUB COMMUNICATION)。
本专利申请的申请人拥有于2018年3月30日提交的以下美国临时专利申请，这些临时专利申请中的每个的公开内容以引用方式全文并入本文：
·2018年3月30日提交的美国临时专利申请62/650,898，其标题为具有可分离阵列元件的电容耦合的返回路径垫(CAPACITIVE COUPLED RETURN PATH PAD WITHSEPARABLE ARRAY ELEMENTS)；
·美国临时专利申请序列号62/650,887，其标题为具有优化感测能力的外科系统(SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES)；
·美国专利申请序列号62/650,882，其标题为用于交互式外科平台的排烟模块(SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM)；以及
·美国专利申请序列号62/650,877，其标题为外科排烟感测和控制(SURGICALSMOKE EVACUATION SENSING AND CONTROLS)。
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，这些专利申请中的每个的公开内容全文以引用方式并入本文：
·美国专利申请序列号15/940,641，其标题为具有加密通信能力的交互式外科系统(INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES)；
·美国专利申请序列号15/940,648，其标题为具有状况处理装置和数据能力的交互式外科系统(INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICESAND DATA CAPABILITIES)；
·美国专利申请序列号15/940,656，其标题为手术室装置控制和通信的外科集线器协调(SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATINGROOM DEVICES)；
·美国专利申请序列号15/940,666，其标题为手术室中的外科集线器的空间感知(SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS)；
·美国专利申请序列号15/940,670，其标题为通过智能外科集线器从次级源导出的数据的协作利用(COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARYSOURCES BY INTELLIGENT SURGICAL HUBS)；
·美国专利申请序列号15/940,677，其标题为外科集线器控制布置方式(SURGICAL HUB CONTROL ARRANGEMENTS)；
·美国专利申请序列号15/940,632，其标题为数据询问患者记录并创建匿名记录的数据剥离方法(DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD)；
·美国专利申请序列号15/940,640，其标题为用于存储待与基于云的分析系统共享的外科装置的参数和状况的通信集线器和存储装置(COMMUNICATION HUB AND STORAGEDEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHAREDWITH CLOUD BASED ANALYTICS SYSTEMS)；
·美国专利申请序列号15/940,645，其标题为在发行器械处生成的自述数据包(SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT)；
·美国专利申请序列号15/940,649，其标题为用于将装置测量参数与结果互连的数据配对(DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH ANOUTCOME)；
·美国专利申请序列号15/940,654，其标题为外科集线器态势感知(SURGICALHUB SITUATIONAL AWARENESS)；
·美国专利申请序列号15/940,663，其标题为外科系统分布式处理(SURGICALSYSTEM DISTRIBUTED PROCESSING)；
·美国专利申请序列号15/940,668，其标题为外科集线器数据的聚集和报告(AGGREGATION AND REPORTING OF SURGICAL HUB DATA)；
·美国专利申请序列号15/940,671，其标题为用于确定手术室中的装置的外科集线器空间感知(SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATINGTHEATER)；
·美国专利申请序列号15/940,686，其标题为显示将钉仓与先前线性钉线对准(DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE)；
·美国专利申请序列号15/940,700，其标题为无菌场交互式控制显示(STERILEFIELD INTERACTIVE CONTROL DISPLAYS)；
·美国专利申请序列号15/940,629，其标题为计算机实现的交互式外科系统(COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS)；
·美国专利申请序列号15/940,704，其标题为使用激光和红绿蓝显色来确定背散射光的特性(USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT)；
·美国专利申请序列号15/940,722，其标题为“CHARACTERIZATION OF TISSUEIRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY”；
·美国专利申请序列号15/940,742，其标题为双CMOS阵列成像(DUAL CMOS ARRAYIMAGING)。
·美国专利申请序列号15/940,636，其标题为针对外科装置的自适应控制程序更新(ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES)；
·美国专利申请序列号15/940,653，其标题为针对外科集线器的自适应控制程序更新(ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS)；
·美国专利申请序列号15/940,660，其标题为用于定制和向用户推荐的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONSTO A USER)；
·美国专利申请序列号15/940,679，其标题为用于将本地使用趋势与较大数据集的资源采集行为链接的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FORLINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OFLARGER DATA SET)；
·美国专利申请序列号15/940,694，其标题为用于将器械功能分段个性化的医疗设施的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITYSEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION)；
·美国专利申请序列号15/940,634，其标题为用于安全和认证趋势和反应性测量的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY ANDAUTHENTICATION TRENDS AND REACTIVE MEASURES)；
·美国专利申请序列号15/940,706，其标题为“DATA HANDLING ANDPRIORITIZATION IN A CLOUD ANALYTICS NETWORK”；
·美国专利申请序列号15/940,675，其标题为用于耦合的外科装置的云接口(CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES)；
·美国专利申请序列号15/940,627，其标题为用于机器人辅助外科平台的驱动布置方式(DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；
·美国专利申请序列号15/940,637，其标题为用于机器人辅助外科平台的通信布置方式(COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；
·美国专利申请序列号15/940,642，其标题为用于机器人辅助外科平台的控制(CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；
·美国专利申请序列号15/940,676，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)；
·美国专利申请序列号15/940,680，其标题为用于机器人辅助外科平台的控制器(CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；
·美国专利申请序列号15/940,683，其标题为用于机器人辅助外科平台的协作外科动作(COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；
·美国专利申请序列号15/940,690，其标题为“DISPLAY ARRANGEMENTS FORROBOT-ASSISTED SURGICAL PLATFORMS”；以及
·美国专利申请序列号15/940,711，其标题为用于机器人辅助外科平台的感测布置方式(SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)。
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，这些临时专利申请中的每个的公开内容以引用方式全文并入本文：
·美国临时专利申请序列号62/649,302，其标题为具有加密通信能力的交互式外科系统(INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES)；
·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；
·美国专利申请序列号62/649,310，其标题为计算机实现的交互式外科系统(COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS)；
·美国临时专利申请序列号62/649,291，其标题为使用激光和红绿蓝显色来确定背散射光的特性(USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT)；
·美国专利申请序列号62/649,296，其标题为针对外科装置的自适应控制程序更新(ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES)；
·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；
·美国临时专利申请序列号62/649,315，其标题为云分析网络中的数据处理和优先级(DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK)；
·标题为CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES的美国临时专利申请序列号62/649,313；
·美国专利申请序列号62/649,320，其标题为用于机器人辅助外科平台的驱动布置方式(DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；
·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
·美国临时专利申请序列号62/649,323，其标题为用于机器人辅助外科平台的感测布置方式(SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)。
本专利申请的申请人拥有于2018年3月8日提交的以下美国临时专利申请，这些临时专利申请中的每个的公开内容以引用方式全文并入本文：
·美国临时专利申请序列号62/640,417，其标题为超声装置中的温度控制以及为此的控制系统(TEMPERATURE CONTROL INULTRASONIC DEVICE AND CONTROL SYSTEMTHEREFOR)；以及
·美国临时专利申请序列号62/640,415，其标题为估计超声端部执行器的状态以及为此的控制系统(ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROLSYSTEM THEREFOR)。
本专利申请的申请人拥有于2017年12月28日提交的以下美国临时专利申请，这些临时专利申请中的每个的公开内容以引用方式全文并入本文：
·美国临时专利申请序列号62/611,341，其标题为交互式外科平台(INTERACTIVESURGICAL PLATFORM)；
·美国临时专利申请序列号62/611,340，其标题为基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS)；以及
·美国专利申请序列号62/611,339，其标题为机器人辅助的外科平台(ROBOTASSISTED SURGICAL PLATFORM)。
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，或与其他方面、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他方面、方面和/或示例的表达中的任何一个或多个组合。
外科集线器
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，可包括耦合到存储装置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2描绘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耦合的外科工具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。
其他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。
在各个方面，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，其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可使成像系统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，其可通过集线器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，协调信息流进一步描述于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中，该专利申请的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(INTERACTIVESURGICAL 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，该专利的公开内容全文以引用方式并入本文。
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(其可包括单极发生器142、双极发生器144和/或超声发生器143)、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、抽吸/冲洗模块128和/或手术室标测模块133。
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为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可滑动地移动成与该功率和数据触点电接合，并且其中第一能量发生器模块可滑动地移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于第二功率和数据触点的电接触。
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示出了外科集线器壳体136和能够滑动地接纳在外科集线器壳体136的对接底座151中的组合发生器模块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。耦合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耦合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耦合到发生器模块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，该侧支架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的对应托架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。在其他方面，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耦合到另一个抽屉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耦合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，可包括耦合到存储装置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还可耦合到本地计算机系统210以提供本地计算机处理和数据操纵。外科数据网络201可被配置成能够无源的、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可耦合到模块化通信集线器203。网络集线器207和/或网络交换机209可耦合到网络路由器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也可耦合到网络交换机209。网络交换机209可耦合到网络集线器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，诸如耦合到内窥镜的成像模块138、耦合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的其他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。耦合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、存储器和应用程序)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他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耦合到网络路由器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接收的数据包发射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。
在其他示例中，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)。在其他方面，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和以上的任何其他无线和有线协议。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，其被放大并发射至网络路由器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他计算机化装置。如图10中所示，模块化控制塔236包括耦合到计算机系统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耦合到与内窥镜239耦合的成像模块238、与能量装置241耦合的发生器模块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、任选地耦合到显示器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耦合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耦合到模块化控制塔236，如本文所述。模块化控制塔236可耦合到集线器显示器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/或其他可视化系统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示出了包括耦合到模块化控制塔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发射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发射激光脉冲、接收从手术室的围墙弹回的激光脉冲，以及将发射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经由系统总线耦合到通信模块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)或任何其他外围总线。
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的单循环闪存或其他非易失性存储器(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Stellaris
Figure BDA0002558706680000341
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他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。
用户通过耦合到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。这些和其他输入装置经由(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他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，其他装置或装置诸如(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、对等装置或其他公共网络节点等，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)。
在各个方面，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9-10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至少一个方面的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(TexasInstruments)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并且耦合到暂停/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328耦合到命令解码器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可使用提供通信和电力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电缆将USB网络集线器300、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。
关于外科集线器和/或外科集线器网络的结构和功能的附加细节可见于2018年4月19日提交的标题为集线器通信方法(METHOD OF HUB COMMUNICATION)的美国临时专利申请62/659,900，该专利申请全文以引用方式并入本文。
云系统硬件和功能模块
图12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。在一个方面，计算机实现的交互式外科系统被配置成能够监测和分析与各种外科系统的操作相关的数据，这些外科系统包括外科集线器、外科器械、机器人装置以及手术室或医疗设施。计算机实现的交互式外科系统包括基于云的分析系统。虽然基于云的分析系统被描述为外科系统，但不一定如此限制，并且其通常可以是基于云的医疗系统。如图12所示，基于云的分析系统包括多个外科器械7012(可与器械112相同或类似)、多个外科集线器7006(可与集线器106相同或类似)，以及外科数据网络7001(可与网络201相同或类似)，以将外科集线器7006耦合到云7004(可与云204相同或类似)。多个外科集线器7006中的每个外科集线器通信地耦合到一个或多个外科器械7012。集线器7006还经由网络7001通信地耦合到计算机实现的交互式外科系统的云7004。云7004是用于存储、操纵和传送基于各种外科系统的操作生成的数据的远程集中式硬件和软件源。如图12所示，经由网络7001实现对云7004的访问，该网络可以是互联网或一些其他合适的计算机网络。耦合到云7004的外科集线器7006可被认为是云计算系统(即，基于云的分析系统)的客户端侧。外科器械7012与外科集线器7006配对，以用于控制和实施如本文所述的各种外科手术或手术。
此外，外科器械7012可包括收发器，以用于将数据传输到这些收发器对应的外科集线器7006(其还可包括收发器)和从这些收发器对应的外科集线器7006传输数据。外科器械7012和对应的集线器7006的组合可指示用于提供医疗操作的特定位置，诸如医疗设施(例如，医院)中的手术室。例如，外科集线器7006的存储器可存储位置数据。如图12所示，云7004包括中央服务器7013(其可与图1中的远程服务器113和/或图9中的远程服务器213相同或类似)、集线器应用服务器7002、数据分析模块7034和输入/输出(“I/O”)接口7007。云7004的中央服务器7013共同管理云计算系统，该云计算系统包括监测客户端外科集线器7006的请求并管理云7004的处理容量以用于执行请求。中央服务器7013中的每个中央服务器包括耦合到合适的存储器装置7010的一个或多个处理器7008，该存储器装置可包括易失性存储器诸如随机存取存储器(RAM)和非易失性存储器诸如磁存储装置。存储器装置7010可包括机器可执行指令，这些机器可执行指令在被执行时使得处理器7008执行数据分析模块7034以用于下文所述的基于云的数据分析、操作、推荐和其他操作。此外，处理器7008可独立地或结合由集线器7006独立地执行的集线器应用程序来执行数据分析模块7034。中央服务器7013还包括可驻留在存储器2210中的聚集医疗数据数据库2212。
基于经由网络7001与各种外科集线器7006的连接，云7004可聚集来自由各种外科器械7012及其对应集线器7006生成的特定数据的数据。此类聚集数据可存储在云7004的聚集医疗数据库7011内。具体地讲，云7004可有利地对聚集数据执行数据分析和操作，以产生见解和/或执行单个集线器7006自身无法实现的功能。为此，如图12所示，云7004和外科集线器7006通信地耦合以传输和接收信息。I/O接口7007经由网络7001连接到多个外科集线器7006。这样，I/O接口7007可被配置成能够在外科集线器7006和聚集医疗数据数据库7011之间传输信息。因此，I/O接口7007可促进基于云的分析系统的读/写操作。可响应于来自集线器7006的请求来执行此类读/写操作。这些请求可通过集线器应用程序传输到集线器7006。I/O接口7007可包括一个或多个高速数据端口，这些一个或多个高速数据端口可包括通用串行总线(USB)端口、IEEE 1394端口，以及用于将云7004连接到集线器7006的Wi-Fi和蓝牙I/O接口。云7004的集线器应用服务器7002被配置成能够托管由外科集线器7006执行的软件应用(例如，集线器应用)并向其提供共享的能力。例如，集线器应用服务器7002可以管理集线器应用程序通过集线器7006提出的请求、控制对聚集医疗数据数据库7011的访问，以及执行负载平衡。参考图13详细地描述了数据分析模块7034。
本公开中描述的特定云计算系统配置被具体设计成解决在使用医疗装置(诸如外科器械7012、112)执行的医疗手术和手术的背景下产生的各种问题。具体地讲，外科器械7012可为数字外科装置，该数字外科装置被配置为与云7004进行交互以用于实施改善外科操作的性能的技术。各种外科器械7012和/或外科集线器7006可包括触摸控制的用户界面，使得临床医生可控制外科器械7012和云7004之间的交互的各方面。也可使用用于控制的其他合适的用户界面，诸如听觉控制的用户界面。
图13为根据本公开的至少一个方面的示出计算机实现的交互式外科系统的功能架构的框图。基于云的分析系统包括多个数据分析模块7034，这些数据分析模块可由云7004的处理器7008执行，以用于为医疗领域中具体产生的问题提供数据分析解决方案。如图13所示，基于云的数据分析模块7034的功能可经由由集线器应用服务器7002托管的集线器应用程序7014来辅助，这些集线器应用服务器可在外科集线器7006上访问。云处理器7008和集线器应用程序7014可以结合操作，以执行数据分析模块7034。应用程序接口(API)7016限定对应于集线器应用程序7014的一组协议和例程。另外，API7016管理向聚集医疗数据数据库7011中存储和检索数据或从该聚集医疗数据数据库中存储和检索数据以用于应用程序7014的操作。高速缓存7018也存储数据(例如，暂时地)并且耦合到API 7016以更有效地检索由应用程序7014使用的数据。图13中的数据分析模块7034包括资源优化模块7020、数据收集和聚集模块7022、认证和安全模块7024、控制程序更新模块7026、患者结果分析模块7028、推荐模块7030以及数据分类和优先化模块7032。根据一些方面，云7004还可以实现其他合适的数据分析模块。在一个方面，数据分析模块用于基于分析趋势、结果和其他数据的特定推荐。
例如，数据收集和聚集模块7022可用于生成自描述数据(例如，元数据)，包括显著特征或配置(例如，趋势)的识别、冗余数据集的管理以及数据在配对数据集中的存储，这些配对数据集可通过外科手术分组，但不一定锁定到实际外科手术日期和外科医生。具体地讲，由外科器械7012的操作生成的配对数据集可包括应用二进制分类，例如，出血或非出血事件。更一般地，二进制分类可表征为期望的事件(例如，成功的外科手术)或不期望的事件(例如，误击发或误用的外科器械7012)。聚集自描述数据可对应于从外科集线器7006的各种组或子组接收的单个数据。因此，数据收集和聚集模块7022可基于从外科集线器7006接收的原始数据来生成聚集元数据或其他组织数据。为此，处理器7008可以可操作地耦合到集线器应用程序7014和聚集医疗数据数据库7011，以用于执行数据分析模块7034。数据收集和聚集模块7022可以将聚集组织数据存储到聚集医疗数据数据库2212中。
资源优化模块7020可以分析该聚集数据以确定用于特定或一组医疗设施的资源的最佳使用。例如，资源优化模块7020可基于此类器械7012的对应预测需求来确定一组医疗设施的外科缝合器械7012的最佳顺序点。资源优化模块7020还可评估各种医疗设施的资源使用或其他操作配置，以确定是否可改善资源使用。类似地，推荐模块7030可以分析来自数据收集和聚集模块7022的聚集组织数据以提供推荐。例如，推荐模块7030可基于例如高于预期的错误率向医疗设施(例如，医疗服务提供方，诸如医院)推荐应将特定外科器械7012升级至改进版本。另外，推荐模块7030和/或资源优化模块7020可推荐更好的供应链参数，诸如产品重新排序点，并且提供不同外科器械7012的建议、其使用或手术步骤以改善外科结果。医疗设施可经由对应的外科集线器7006接收此类推荐。还可提供关于各种外科器械7012的参数或配置的更具体的推荐。集线器7006和/或外科器械7012还可各自具有显示由云7004提供的数据或推荐的显示屏。
患者结果分析模块7028可分析与外科器械7012的当前使用的操作参数相关联的外科结果。患者结果分析模块7028还可以分析和评估其他潜在操作参数。就这一点而言，推荐模块7030可以基于产生更好的外科结果(诸如更好的密封或更少的出血)来推荐使用这些其他潜在操作参数。例如，推荐模块7030可向外科集线器7006传输关于何时针对对应的缝合外科器械7012使用特定仓的推荐。因此，基于云的分析系统在控制公共变量时可被配置为分析大量原始数据的集合并提供对多个医疗设施的集中式推荐(有利地基于聚集数据来确定)。例如，基于云的分析系统可基于医疗实践的类型、患者的类型、患者的数量、医疗提供方之间的地理类似性、医疗提供方/设施使用类似类型的器械等来分析、评估和/或聚集数据，使得任何单个医疗设施都不能独立地分析。
控制程序更新模块7026可被配置为在对应的控制程序被更新时执行各种外科器械7012推荐。例如，患者结果分析模块7028可以识别将特定控制参数与成功(或不成功)结果相关联的相关性。当更新的控制程序经由控制程序更新模块7026传输到外科器械7012时，可解决此类相关性。经由对应的集线器7006传输的对器械7012的更新可结合由云7004的数据收集和聚集模块7022采集和分析的聚集性能数据。另外，患者结果分析模块7028和推荐模块7030可基于聚集性能数据来识别使用器械7012的改善的方法。
基于云的分析系统可包括由云7004实现的安全特征。这些安全特征可由认证和安全模块7024管理。每个外科集线器7006可具有相关联的唯一凭证，诸如用户名、密码和其他合适的安全凭证。这些凭证可存储在存储器7010中并且与允许的云访问级别相关联。例如，基于提供准确的凭证，外科集线器7006可被授予访问权限以在预先确定的程度上与云通信(例如，可仅参与传输或接收某些限定类型的信息)。为此，云7004的聚集医疗数据数据库7011可以包括用于验证所提供的凭证的准确性的认证凭证的数据库。不同的凭证可与对与云7004进行交互的不同权限级别相关联，诸如用于接收由云7004生成的数据分析的预先确定的访问级别。
此外，出于安全目的，云可以维护集线器7006、器械7012和可包括禁止装置的“黑名单”的其他装置的数据库。具体地讲，可禁止黑名单上列出的外科集线器7006与云进行交互，同时黑名单上列出的外科器械7012可不具有对于对应的集线器7006的功能访问权限并且/或者可在与其对应的集线器7006配对时被阻止完全起作用。附加地或另选地，云7004可基于不相容性或其他指定标准来标记器械7012。这样，可以识别和解决伪造的医疗装置以及在整个基于云的分析系统中对此类装置的不当重复使用。
外科器械7012可使用无线收发器来传输无线信号，这些无线信号可表示例如用于访问对应集线器7006和云7004的认证凭证。有线收发器也可用于发射信号。此类认证凭证可存储在外科器械7012的相应存储装置中。认证和安全模块7024可确定认证凭证是准确的还是伪造的。认证和安全模块7024还可动态地生成用于增强的安全性的认证凭证。凭证也可被加密，诸如通过使用基于哈希函数的加密。在传输适当认证时，外科器械7012可将信号传输到对应的集线器7006并且最终传输到云7004以指示器械7012准备好获取和传输医疗数据。作为响应，云7004可以转变成能够接收医疗数据以存储到聚集医疗数据数据库7011中的状态。该数据传输准备就绪可例如由器械7012上的光指示器指示。云7004还可将信号传输到外科器械7012以用于更新其相关联的控制程序。云7004可传输涉及特定类别的外科器械7012(例如，电外科器械)的信号，使得控制程序的软件更新仅传输到适当的外科器械7012。此外，云7004可用于实现系统范围内的解决方案，以基于选择性数据传输和认证凭证来解决本地或全局问题。例如，如果一组外科器械7012被识别为具有共同的制造缺陷，则云7004可改变对应于该组的认证凭证以实施该组的可操作闭锁件。
基于云的分析系统可允许监测多个医疗设施(例如，医院之类的医疗设施)以确定改进的实践并相应地推荐改变(例如，经由推荐模块2030)。因此，云7004的处理器7008可分析与单个医疗设施相关联的数据以识别该设施并且将该数据与和组中的其他医疗设施相关联的其他数据聚集。例如，可以基于类似的操作实践或地理位置来限定组。这样，云7004可提供医疗设施组范围的分析和推荐。基于云的分析系统还可用于增强的态势感知。例如，处理器7008可对推荐对特定设施的成本和有效性的影响进行预测建模(相对于总体操作和/或各种医疗手术)。还可将与该特定设施相关联的成本和有效性与其他设施或任何其他类似设施的对应本地区域进行比较。
数据分类和优先化模块7032可以基于关键性(例如，与数据相关联的医疗事件的严重性、出乎意料、怀疑)对数据进行优先化和分类。这种分类和优先化可以与上述其他数据分析模块7034的功能结合使用，以改善本文所述的基于云的分析和操作。例如，数据分类和优先化模块7032可为由数据收集和聚集模块7022以及患者结果分析模块7028执行的数据分析分配优先级。不同的优先级可导致来自云7004的特定响应(对应于紧急性级别)，诸如加速响应递增、特殊处理、从聚集医疗数据数据库7011排除或其他合适的响应。此外，如果需要，云7004可通过集线器应用服务器传输对来自对应外科器械7012的附加数据的请求(例如，推送消息)。推送消息可导致在对应的集线器7006上显示的用于请求支持或附加数据的通知。在云检测到显著的不规则性或异常值并且云不能确定不规则性的原因的情况下，可能需要该推送消息。中央服务器7013可被编程为在某些重要情况下触发该推送消息，例如，诸如当数据被确定为不同于超过预先确定的阈值的预期值时或当其表现出安全性已被包括时。
关于云分析系统的附加细节可见于2018年4月19日提交的标题为集线器通信方法(METHOD OF HUB COMMUNICATION)的美国临时专利申请62/659,900，该专利申请全文以引用方式并入本文。
态势感知
尽管包括响应于感测数据的控制算法的“智能”装置可以是对在不考虑感测数据的情况下操作的“哑巴”装置的改进，但当孤立地考虑时，即在没有正在被执行的外科手术的类型或正在手术的组织的类型的背景下，一些感测数据可能是不完整的或不确定的。在不知道手术背景(例如，知道正在手术的组织的类型或正在被执行的手术的类型)的情况下，控制算法可能在给定的特定无背景感测数据的情况下错误地或次优地控制模块化装置。例如，用于响应于特定的感测参数来控制外科器械的控制算法的最佳方式可根据正在手术的特定组织类型而变化。这是由于以下事实：不同的组织类型具有不同的特性(例如，抗撕裂性)，并且因此不同地响应于由外科器械采取的动作。因此，可能期望外科器械即使在感测到针对特定参数的相同测量时也采取不同的动作。作为一个特定示例，响应于器械感测到用于闭合其端部执行器的意外高的力来控制外科缝合和切割器械的最佳方式将根据组织类型是易于撕裂还是抗撕裂而变化。对于易于撕裂的组织(诸如肺部组织)，器械的控制算法将响应于用于闭合的意外高的力而最佳地使马达速度逐渐下降，从而避免撕裂组织。对于抗撕裂的组织(诸如胃组织)，器械的控制算法将响应于用于闭合的意外高的力而最佳地使马达速度逐渐上升，从而确保端部执行器被适当地夹持在组织上。在不知道是肺部组织还是胃组织已被夹持的情况下，控制算法可做出次优决定。
一种解决方案利用包括系统的外科集线器，该系统被配置成能够基于从各种数据源接收到的数据来导出关于正在被执行的外科手术的信息，然后相应地控制配对的模块化装置。换句话讲，外科集线器被配置成能够从所接收的数据推断关于外科手术的信息，然后基于所推断的外科手术的背景来控制与外科集线器配对的模块化装置。图14示出了根据本公开的至少一个方面的态势感知外科系统5100的图。在一些范例中，数据源5126包括例如模块化装置5102(其可包括被配置成能够检测与患者和/或模块化装置本身相关联的参数的传感器)、数据库5122(例如，包含患者记录的EMR数据库)和患者监测装置5124(例如，血压(BP)监测器和心电图(EKG)监测器)。
外科集线器5104(其可在许多方面与集线器106类似)可被配置成能够例如基于所接收的数据的特定组合或从数据源5126接收数据的特定顺序从数据导出与外科手术有关的背景信息。从所接收的数据推断的背景信息可包括例如正在被执行的外科手术的类型、外科医生正在执行的外科手术的特定步骤、正在手术的组织的类型或为手术的对象的体腔。外科集线器5104的一些方面从所接收的数据导出或推断与外科手术有关的信息的这种能力可被称为“态势感知”。在一个范例中，外科集线器5104可并入态势感知系统，该态势感知系统是与外科集线器5104相关联的从所接收的数据导出与外科手术有关的背景信息的硬件和/或程序设计。
外科集线器5104的态势感知系统可被配置成能够以多种不同的方式从接收自数据源5126的数据导出背景信息。在一个范例中，态势感知系统包括已经在训练数据上进行训练以将各种输入(例如，来自数据库5122、患者监测装置5124和/或模块化装置5102的数据)与关于外科手术的对应背景信息相关联的模式识别系统或机器学习系统(例如，人工神经网络)。换句话讲，机器学习系统可被训练成从所提供的输入准确地导出关于外科手术的背景信息。在另一范例中，态势感知系统可包括查找表，该查找表存储与对应于背景信息的一个或多个输入(或输入范围)相关联的关于外科手术的预先表征的背景信息。响应于利用一个或多个输入的查询，查找表可返回态势感知系统用于控制模块化装置5102的对应背景信息。在一个范例中，由外科集线器5104的态势感知系统接收的背景信息与用于一个或多个模块化装置5102的特定控制调节或一组控制调节相关联。在另一范例中，态势感知系统包括当提供背景信息作为输入时生成或检索用于一个或多个模块化装置5102的一个或多个控制调节的另外的机器学习系统、查找表或其他此类系统。
结合有态势感知系统的外科集线器5104为外科系统5100提供了许多益处。一个益处包括改进对感测和收集到的数据的解释，这将继而改进外科手术过程期间的处理精度和/或数据的使用。回到先前的示例，态势感知外科集线器5104可确定正在手术的组织的类型；因此，当检测到用于闭合外科器械的端部执行器的意外高的力时，态势感知外科集线器5104可正确地使用于组织类型的外科器械的马达速度逐渐上升或逐渐下降。
作为另一个示例，正在手术的组织的类型可影响针对特定组织间隙测量对外科缝合和切割器械的压缩率和负荷阈值进行的调节。态势感知外科集线器5104可推断正在被执行的外科手术是胸腔手术还是腹部手术，从而允许外科集线器5104确定被外科缝合和切割器械的端部执行器夹持的组织是肺部组织(对于胸腔手术)还是胃组织(对于腹部手术)。然后，外科集线器5104可针对组织的类型适当地调节外科缝合和切割器械的压缩率和负荷阈值。
作为又一个示例，在吹入手术期间被操作的体腔的类型可影响排烟器的功能。态势感知外科集线器5104可确定外科部位是否处于压力下(通过确定外科手术正在利用吹入)并确定手术类型。由于一种手术类型通常在特定的体腔内执行，外科集线器5104然后可针对在其中进行操作的体腔适当地控制排烟器的马达速率。因此，态势感知外科集线器5104可提供对于胸腔和腹部手术两者一致的烟排出量。
作为又一个示例，正在被执行的手术的类型可影响超声外科器械或射频(RF)电外科器械操作的最佳能量水平。例如，关节镜手术需要更高的能量水平，因为超声外科器械或RF电外科器械的端部执行器浸没在流体中。态势感知外科集线器5104可确定外科手术是否是关节镜手术。然后，外科集线器5104可调节发生器的RF功率水平或超声振幅(即“能量水平”)以补偿流体填充的环境。相关地，正在手术的组织的类型可影响超声外科器械或RF电外科器械操作的最佳能量水平。态势感知外科集线器5104可确定正在被执行的外科手术的类型，然后根据该外科手术的预期组织概况分别定制超声外科器械或RF电外科器械的能量水平。此外，态势感知外科集线器5104可被配置成能够在整个外科手术过程中而不是仅在逐个手术的基础上调节超声外科器械或RF电外科器械的能量水平。态势感知外科集线器5104可确定正在被执行或随后将要被执行的外科手术的步骤，然后更新用于发生器和/或超声外科器械或RF电外科器械的控制算法，以根据该外科手术步骤将能量水平设定在适合于预期组织类型的值。
作为又一示例，可从附加数据源5126提取数据，以改进外科集线器5104从一个数据源5126提取的结论。态势感知外科集线器5104可用已从其他数据源5126构建的关于外科手术的背景信息来扩充其从模块化装置5102接收的数据。例如，态势感知外科集线器5104可被配置成能够根据从医学成像装置接收到的视频或图像数据来确定止血是否已经发生(即，在外科部位的出血是否已经停止)。然而，在一些情况下，视频或图像数据可能是不确定的。因此，在一个范例中，外科集线器5104还可被配置成能够将生理测量值(例如，由可通信地连接至外科集线器5104的BP监测器感测的血压)与止血的视觉或图像数据(例如，来自可通信地耦合到外科集线器5104的医学成像装置124(图2))进行比较，以确定缝合线或组织焊缝的完整性。换句话讲，外科集线器5104的态势感知系统可考虑生理测量数据以在分析可视化数据时提供附加的背景。当可视化数据本身可能是不确定的或不完整的时，附加背景可以是有用的。
另一益处包括根据正在被执行的外科手术的特定步骤主动且自动地控制配对的模块化装置5102，以减少在外科手术过程期间医疗人员需要与外科系统5100交互或控制外科系统的次数。例如，如果态势感知外科集线器5104确定手术的后续步骤需要使用RF电外科器械，则其可主动地激活与该器械连接的发生器。主动地激活能量源允许器械在手术的先前步骤一完成就准备好使用。
作为另一个示例，态势感知外科集线器5104可根据在外科部位处外科医生预期需要查看的(一个或多个)特征来确定外科手术的当前步骤或后续步骤是否需要在显示器上的不同视图或放大程度。然后，外科集线器5104可相应地主动改变所显示的视图(例如，由用于可视化系统108的医学成像装置提供)，使得在整个外科手术中自动调节显示器。
作为又一个示例，态势感知外科集线器5104可确定外科手术的哪个步骤正在被执行或随后将要执行以及针对外科手术的该步骤是否需要特定数据或数据之间的比较。外科集线器5104可被配置成能够基于正在被执行的外科手术的步骤自动地调用数据屏幕，而无需等待外科医生请求该特定信息。
另一益处包括在外科手术的设置期间或在外科手术的过程期间检查错误。例如，态势感知外科集线器5104可确定手术室是否被正确地或最佳地设置以用于待执行的外科手术。外科集线器5104可被配置成能够确定正在被执行的外科手术的类型，(例如，从存储器中)检索对应的清单、产品位置或设置需求，然后将当前手术室布局与外科集线器5104确定的用于该正在被执行的外科手术类型的标准布局进行比较。在一个范例中，外科集线器5104可被配置成能够将用于手术的物品列表(例如，由合适的扫描仪5132进行扫描)和/或与外科集线器5104配对的装置列表与用于给定外科手术的物品和/或装置的推荐或预期清单进行比较。外科集线器5104可被配置成能够如果列表之间存在任何不连续性，则提供指示特定模块化装置5102、患者监测装置5124和/或其他外科物品缺失的警示。在一个范例中，外科集线器5104可被配置成能够例如经由接近传感器来确定模块化装置5102和患者监测装置5124的相对距离或位置。外科集线器5104可将装置的相对位置与用于特定外科手术的推荐或预期布局进行比较。外科集线器5104可被配置成能够如果在布局之间存在任何不连续性，则提供指示用于该外科手术的当前布局偏离推荐布局的警示。
作为另一个示例，态势感知外科集线器5104可确定外科医生(或其他医疗人员)在外科手术过程期间是否正在出错或以其他方式偏离预期的动作过程。例如，外科集线器5104可被配置成能够确定正在被执行的外科手术的类型，(例如，从存储器中)检索对应的步骤列表或设备使用的顺序，然后将在外科手术过程期间正在被执行的步骤或正在被使用的设备与外科集线器5104确定的针对该正在被执行的外科手术类型的预期步骤或设备进行比较。在一个范例中，外科集线器5104可被配置成能够提供指示在外科手术中的特定步骤处正在执行意外动作或正在使用意外装置的警示。
总体而言，用于外科集线器5104的态势感知系统通过针对每种外科手术的特定背景调节外科器械(和其他模块化装置5102)(诸如针对不同的组织类型进行调节)并在外科手术期间验证动作来改善外科手术结果。态势感知系统还根据手术的特定背景通过自动建议下一步骤、提供数据以及调节显示器和手术室中的其他模块化装置5102来提高外科医生执行外科手术的效率。
现在参见图15，其描绘时间线5200，该时间线描绘集线器(例如，外科集线器106或206(图1至图11))的态势感知。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、外科医生和其他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他数据源接收该数据，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他此类动作。
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，或者在其他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电极和其他患者监测装置附接到患者。EKG电极和其他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耦合到外科集线器)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(或其他类似的组织类型)，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和其他数据时，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可根据从可通信地耦合到外科集线器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。
态势感知在2018年4月19日提交的美国临时专利申请序列号62/659,900(标题为集线器通信的方法(METHOD OF HUB COMMUNICATION)，其以引用方式全文并入本文)中进一步描述。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/或来自其部件的反馈和/或基于来自云104的信息来控制。
对功能参数的本地自主调节
限制对电动外科器械的自适应程序调节
在各个方面，可调节的自主控制程序可包含对外科器械算法的限制。在一个方面，具有用于控制端部执行器208109的至少一个参数的预定义的可调节的控制算法的电动外科器械208100(图19)还可包括用于将对该控制算法的调节限于一个或多个预定义的可调节性窗口的装置。
在一个方面，可调节的控制算法控制端部执行器208109的至少一个功能。在一个方面，可调节性取决于至少一个感测参数。在一个方面，感测参数包括外科医生、设施、区域或广大用户先前使用外科器械208100的历史数据集。在一个方面，对调节的限制由外科器械208100和/或外科集线器(例如，102、202)进行预定义。在一个方面，该限制为总体最大阈值。在一个方面，该限制为每次使用调节。在一个方面，该限制基于特定用户在特定设施或特定区域中的使用。
在一个方面，控制程序可限制控制程序学习调节。例如，在合格的聚集中，事件或行为可能必须通过检查以确定其是否将被允许影响例如特定外科器械208100或一类外科器械208100的长期行为。由外科器械208100或外科集线器(例如，102、202)执行的控制程序可排除对控制程序的行为具有最小影响的个性化故障或一次性故障(例如，由于不可重复误差而损坏或错误插入的仓)。换句话讲，与个性化故障相关联的数据可以传输或可以不传输到外科集线器(例如，102、202)和/或主数据库取决于个性化故障的性质。然而，即使是传输，个体化故障也可从用于影响外科器械208100的长期行为的聚集数据库中排除，作为防止或检测外科器械208100的未来缺陷的手段。
作为合格的聚集的另一个示例，行为的权重效应可用于影响调节的量(例如，导致患者损伤的“0级”缺陷作为单个事件可对装置性能具有比微小变化的数量更大的影响(例如，10倍))。
在一个方面，控制程序可跨一系列参数限制控制程序学习调节。例如，学习调节可限于给定时间间隔(例如，一周、一个月或另一间隔±10％)内的控制算法的最大调节。这将防止新用户、手术室工作人员或其他人员的轮换带来不同的行为而极大地改变所有其他用户的器械行为(尤其是在例如其他一些用户正在休假，不在周末工作或在一段时间内没有主动使用器械的情况下)。
又如，可对给定用户应用对性能行为的最大和最小总限制。对于给定BIOS或控制程序版本，这可具有寿命累积效应或最大调节。例如，每当更新控制程序时，调节可被传输或其可被“重置”为标称目标值，并且系统将必须重新学习调节。这将允许系统受益于改善的控制程序，而无需在程序以不同方式操作的情况下重新学习相同的调节。又如，如果需要，用户能够暂时使用其他用户的设置，但不能更改那些设置。
在一个方面，控制程序可以设置每台手术使用的控制程序调节次数的上限或最大值。这将最小化从一次使用到下一次使用的行为上的巨大变化。此外，这也可以根据每个用户的每次使用情况加以考虑，因此对于不同的用户具有不同的行为，并最小化了从一个用户到下一个用户的装置性能调节。
在一个方面，控制程序可被编程为实施预定义可调节性包络。在该方面，可实施自适应算法和技术以本地调节(即，调节给定外科集线器(例如，102、202)的控制程序或例如单个设施的外科集线器的本地网络的控制程序)总体控制方案。调节方法可通过机器学习(例如，作为神经网络)来实施，以用于更新/控制附接装置的算法。
在至少一种情况下，公开了一种用于控制各种装置参数诸如上述那些参数的GUI。GUI可显示在例如被控制的装置和/或装置所连接的外科集线器(例如，102、202)上。GUI允许用户根据装置类型(例如，缝合器、能量装置、窥视镜等)根据动作类型(例如，缝合器的夹持、击发或关节运动设置)为特定外科医生选择设置(例如，“Dr.Smith”或“Dr.Jones”)。随着用户对装置的使用经验的增加，可学习到装置的不同设置。
在一个方面，控制程序可提供覆写能力，以允许用户将装置默认为标称值或制造商的装置性能建议值。例如，可存在对装置的当前学习参数的指示，并且允许用户确定他们是否想要利用该定制性能。又如，用户可以选择对经调节的参数的覆写。这可发生在使用装置之前、开始时或手术期间，或甚至在致动期间。又如，控制程序可允许用户将装置重置为未调节状态，或者甚至由于将来测量的性能而禁用参数随时间推移而被调节的能力。
在一个方面，装置可识别用户使用或行为并确定性能参数调节以改善该行为的结果。然后它可在稍后的使用中检测到相同的行为或使用，但由于它是不同的用户，所以限制调节的应用，或者要求该用户在使用改进之前确认其使用。例如，如果检测到比所指示的更厚的组织以及其偏斜到砧座的组织阻挡件端部的组织的不均匀分布，则控制程序可通过在行程开始时减慢击发I型横梁推进并且增加所显示的稳定等待周期来针对这些变量进行调节。因此，如果在稍后的时间检测到钳口的相同不规则组织填充，但是器械显示用户与第一用户不同，则该器械可询问用户是否想要使用新的性能程序或标准程序，而不仅仅是像该第一用户在后续手术中使用该装置那样自动调节参数。
在至少一个实施方案中，外科器械系统包括例如外科端部执行器(诸如外科端部执行器208109)或外科器械(诸如本文所公开的那些(例如，208100))，该外科器械被配置成能够将至少一种端部执行器功能递送至患者和控制电路(诸如控制电路208103)，该控制电路被配置成能够操作外科端部执行器和/或外科端部执行器208109的功能。端部执行器208109的功能可由例如外科机器人和/或通过手持式器械柄部来致动。手持式器械柄部可由临床医生手动操作。例如，附接到外科机器人的端部执行器可由操作该外科机器人的临床医生手动操作和/或由该外科机器人的控制电路自动操作。端部执行器的功能可包括例如击发钉，其可包括切割组织和/或部署外科缝合端部执行器中的钉。另一个端部执行器功能可包括用外科缝合端部执行器来夹持组织。端部执行器功能的又一个示例可包括用外科能量装置使组织通电。应当理解，任何合适的端部执行器功能均可与本文所述的外科系统一起使用。
此类外科系统的控制电路可包括自适应控制程序，该自适应控制程序被配置成能够控制端部执行器功能并随时间推移而自适应，从而更好地适应端部执行器功能和/或外科器械系统的后续使用。此类自适应控制程序可利用各种类型的信息来自动调节和/或适应端部执行器功能的控制程序。例如，自适应控制程序可直接基于包括在端部执行器(诸如端部执行器208109)自身内、在患者体内和/或在外科套件内感测的参数的输入。自适应控制程序还可基于例如来自外科集线器(例如，102、202)的输入。机器学习可用于分析输入并对自适应控制程序进行调节，以尝试为每个后续使用提供端部执行器功能的更好的最终结果。
在至少一种情况下，控制程序的自适应性基于端部执行器(诸如端部执行器208109)内的本地感测参数。例如，外科缝合端部执行器中由组织和/或系统的其他方面施加到组织切割刀或击发构件208111上的负载可在端部执行器208109内测量。关于组织切割刀上的负载的信息可被馈送到控制电路208103，使得控制电路208103可自动调节该组织切割刀的控制程序。例如，如果在击发序列期间监测负载并且该负载变得越来越高，则自适应控制程序可预测出下一击发序列将包括类似的负载分布曲线，并且在至少一种情况下，自适应控制程序可自动减慢用于该下一击发序列的组织切割刀的击发速度，以防止组织切割刀被卡住。
在至少一种情况下，控制程序的自适应性基于在一段时间内收集到的信息。除上述之外，控制程序的自适应性可基于随时间推移收集到的特定信息。例如，自适应性可仅基于在特定外科医生使用装置时收集到的数据。在至少一种情况下，自适应性可仅基于在特定患者上使用期间、在特定手术室中使用期间、在国家的特定地区中使用期间和/或在特定类型的手术上使用期间收集到的数据。任何合适的数据分组可用于控制程序自适应性。在至少一种情况下，协作使用多个数据分组，并且控制程序的自适应性基于该多个数据分组。
在利用自适应控制程序的系统中，限制控制程序自身的自适应性可能是有利的。例如基于本地感测参数和/或基于来自外科医生的直接输入(例如，基于控制程序的自适应性)自动设置限制可防止对控制程序的不期望的自适应调节。除上述之外，对自适应控制程序施加的此类限制和/或限制，无论是自动施加还是手动施加，均可为控制电路的机器学习方面提供更多信息，以在后续使用中更好地操作端部执行器功能。例如，此类限制可由自适应限制程序来实施。
再次参见上文所述的组织切割刀示例，临床医生可意识到自适应控制程序将减慢组织切割刀的击发速度以用于后续击发序列；然而，在这种情况下，临床医生可能不希望用于下一击发序列的组织切割刀的击发速度减慢。临床医生可能想要对控制端部执行器(诸如端部执行器208109)的击发功能的自适应控制程序自动设置限制。在至少一种情况下，临床医生可能想要手动对控制击发功能的控制程序的自适应性进行限制。在所讨论的示例中，临床医生可能想要定义自适应控制程序被允许自动减慢的最慢的可能击发速度值。在这种情况下，在此类限制和/或限制被设置在适当位置之后，可不允许自适应控制程序将组织切割刀的击发速度调节到将降至低于限定的可能的最斜率击发速度的速度。限制和/或限制可在手术期间、手术之前和/或手术之后设置。在至少一种情况下，可通过显示器或听觉警示使临床医生实时知道控制程序的自适应性，从而允许该临床医生对控制程序的自适应性进行实时调节。
在至少一种情况下，由控制程序进行的自适应调节可对其设置边界。例如，控制电路(诸如控制电路208103)可分析端部执行器功能的行为，以确定该行为是否将影响控制程序的自适应性，从而影响端部执行器(诸如端部执行器208109)的长期行为。在这种情况下，可排除端部执行器208109的一次无意和/或可预防的故障，使得一次故障不被考虑到端部执行器208109的控制程序的自适应性中。例如，如果钉仓被不正确地装载到外科缝合端部执行器中并且尝试击发，则由于不正确地装载的钉仓而感测的这种不规则负载可被视为异常值并且不被考虑到端部执行器的控制程序的自适应性中。在至少一种情况下，此类误击发仍可纳入到控制程序的自适应性，但不具有与类似于误击发端部执行器所具有的类似负载水平的组织堵塞事件相同的权重。换句话讲，可能期望不完全忽略不正确地装载的仓误击发事件，而是以比仓被正确装载的情况下的组织堵塞事件更不具攻击性的方式将其应用于控制程序的自适应性。总而言之，异常值事件或行为可从使用的聚集数据库中排除，使得该异常值事件不会影响自适应控制程序的长期行为。
在至少一种情况下，当确定此类事件将对控制程序的自适应性产生的影响量时，某些事件(诸如上文所述的不正确地装载的仓误击发事件)可被赋予不同的权重值。例如，与在正确装配的仓击发之后产生的完整组织堵塞事件相比，由于不正确地装载的钉仓引起的误击发可被赋予显著较小的权重，从而对控制程序的自适应性提供显著较小的影响。在这种情况下，组织类型可能导致了完全组织堵塞事件，这可能更希望在临床医生和端部执行器再次遇到该类型组织时影响控制程序的自适应性。同时，临床医生可能不想基于不正确地装载的仓的用户错误和/或器械的误用来调节自适应控制程序自身。
在正常操作期间并且假设不误用端部执行器(诸如端部执行器208109)，对患者造成伤害和/或损伤的事件可被赋予高得多的权重，并且因此对控制程序的自适应性的影响要大于对患者造成很少甚至没有伤害和/或伤害的事件。
在至少一种情况下，对自适应控制程序的界定可跨一系列参数发生。例如，控制电路(诸如控制电路208103)例如可在特定时间段内仅允许对控制程序进行一定百分比的调节。例如，用于外科缝合端部执行器(诸如端部执行器208109)的自适应击发控制程序可被限制为在一周的时间内将控制程序的击发速度调节为击发速度的±10％。可以任何合适的时间间隔采用任何合适的百分比限制。此类布置可在特定时间段期间消除剧烈的自适应性。例如，端部执行器可能经历磨合期并且在其使用寿命开始期间具有一些异常序列。因此，在这种情况下，可能期望限制控制程序在其磨合期内对该端部执行器的自适应性。另一个优点可包括消除具有不同操作行为的跨多个用户的剧烈自适应性。
在至少一种情况下，最大和最小程序限制可特定于给定用户。在这种情况下，用户能够针对寿命累积效应来设置这些限制。在至少一种情况下，用户能够选择特定于另一用户的最大和最小程序限制。在至少一种情况下，在用户正在使用特定于另一用户的限制的情况下，该用户可能无法调节特定于该另一用户的限制，也不能通过自适应控制程序来调节那些限制，因为特定于这些限制的用户没有使用那些限制。
在至少一种情况下，自适应控制程序的限制可被传输到数据库和/或集线器(例如，102、202)中，并且该控制程序将被重置为标称目标值。在这种情况下，可能需要重新学习并且/或者重新调节限制。在另一种情况下，可为外科医生提供将限制重置为标称值或在最后一次使用结束时外科医生停止的情况下设置控制程序的选项。这将允许系统受益于改善的控制程序，并且在程序操作不同的情况下也许不需要相同的调节。
在至少一种情况下，对自适应控制程序设置的限制可基于每次使用。在至少一种情况下，可以将控制程序的自适应性与单个程序和/或控制程序所控制的特定端部执行器的使用寿命隔离开。
在至少一种情况下，自适应控制程序可限于预定义可调节性包络。一般来讲，可使用自适应算法和/或技术来本地调节自适应控制程序和/或外科器械系统的总体控制方案。对控制程序的调节还可基于神经网络，包括来自外科集线器(例如，102、202)的输入和在对控制程序进行调节时可能需要输入到神经网络中的任何其他信息。
图18描绘了控制电路(诸如本文所述的那些)的逻辑208060。逻辑208060包括控制208061端部执行器的参数、调节208063对参数的控制并且限制208065对参数的控制的调节。例如，控制208061端部执行器的参数可包括运行用于操作与组织切割刀操作地耦合的马达的控制程序。控制程序能够使马达朝远侧推进刀、朝近侧回缩刀并且/或者暂停对刀的致动。组织切割刀的速度和加速度也可通过控制程序来改变。调节208063对参数的控制可包括自动和/或手动修改和/或适应控制程序或对参数的控制208061，以在使用期间和/或针对每个后续使用表现更好。这被称为自适应控制程序，该自适应控制程序能够使用机器学习，例如使得正被控制的参数更好地操作。限制208065对参数的控制的调节可包括手动设置调节窗口或自适应控制程序被允许在其内自身变化的值的范围。例如，可以手动和/或自动地限定击发速度范围，以约束自适应控制程序保持在所设置的击发速度范围内。
例如，图16描绘了显示一系列菜单的GUI，这些菜单包括能够选择的选项以帮助临床医生操作特定外科器械，诸如器械208100。在例示的示例中，第一系列显示器208010描绘了多个可选择的菜单选项，其中在这种情况下选择特定外科医生、选择特定器械并且选择特定功能。在这种情况下，可选择特定外科医生使得控制电路(诸如控制电路208103)可加载特定设置(诸如针对该特定外科医生学习到的自适应限制)。可选择特定器械(诸如器械208100)，以便允许控制电路加载特定控制程序来操作该器械。这可包括对应于特定器械和特定外科医生的特定自适应限制程序。控制电路可以考虑所有选择的选项，以便加载用于操作所需装置的正确的控制程序和/或设置。在例示的示例中，已经为Dr.Jones选择了缝合器2的击发功能。这些选项可由控制电路自动感测到，并且在至少一种情况下不被选择。例如，该信息可能已经由例如外科集线器(例如，102、202)递送至对应于特定手术的包装件中的控制电路。在另一种情况下，外科医生可佩戴控制电路的部件可感测的识别芯片，例如，外科机器人诸如器械附接到的外科机器人110能够自动识别附接到机器人110的操作臂的器械，并且/或者特定器械的击发设置可由机器人基于例如外科医生在外科机器人控制界面上的间接输入来识别。
仍然参见图16，描绘了两个显示器208020，该两个显示器在至少一种情况下示出Dr.Jones对于缝合器2的击发功能的能够选择的选项。例如，如在这些显示器208020中可见，击发时间和夹持力被显示并且可与器械(诸如器械208100)的总击发速度相关。在这种情况下，Dr.Jones可能经验有限。基于存储的关于Dr.Jones的信息，控制电路(诸如控制电路208103)可得知此类经验。在这种情况下，击发速度的允许值的范围，无论它们是能够选择的学习到的限制和/或能够选择的直接函数参数，都可以大于经验丰富的外科医生允许的允许值的范围。例如，示出了显示器208030，其中向Dr.Smith(比Dr.Smith经验更丰富的外科医生)提供更严格的默认设置。这可由于外科医生对特定器械(诸如器械208100)进行的重复次数而发生。在至少一种情况下，可向具有较少经验的外科医生提供指示特定器械的较安全操作的允许值范围，而向具有较多经验的外科医生提供指示特定器械的危险操作的更多的允许值范围。
用户能够定制的性能以及程序行为
在各个方面，智能外科装置(例如，缝合装置)的控制程序行为能够通过用户交互进行定制，以便定制该装置的性能。
在一个方面，例如，外科装置(诸如器械208100)可经由具有能够调节的算法的用户能够调节的控件来控制。在至少一种情况下，公开了一种用于控制外科装置的自适应参数的GUI。缝合器使用自适应击发速度算法，该自适应击发速度算法基于由组织提供的对击发的阻力来调节击发速度。算法中的变量包括最小/最大速度、在该范围内的速度间隔的数量以及当力参数超过安全阈值时暂停击发的持续时间。这些变量是可缩放的或能够由用户(诸如经由GUI)来改变。这些输入通知系统用于缝合器的后续击发响应的阈值。
在一个方面，本地器械控件可允许用户调节其功能。控制器可具有例如能够按比例缩放的灵敏度以将致动控制器链接到电动致动运动。在一个方面，本地器械控件可由用户从一个功能重新分类到另一功能(即，控件可从第一或默认功能映射到第二功能)。
在一个方面，可利用受过训练的学习(例如，机器学习)来帮助用户定制装置(例如，外科器械，诸如器械208100或集线器(例如，102、202))的性能。例如，用户可输入他们对装置在其最近使用中提供的输出的个人意见。然后，装置可使用该附加信息来更好地调节该装置的受控功能的性能。此外，用户然后能够就装置的第二次使用与装置的第一次使用的相对性能输入意见。这种受过训练的行为将允许装置不仅可以个别地调谐其行为，而且可以调谐期望的结果。例如，实践中技术人员中的一名技术人员能够就装置的性能/功能输入他们的意见以调谐性能/功能，然后允许装置向该装置的所有其他用户呈现这种改善的输出行为。
在至少一种情况下，可提供控制界面(诸如图形用户界面或任何合适的控制界面)以允许临床医生选择他们是想要覆盖学习还是将限制设置为标称值。换句话讲，在使用端部执行器(例如端部执行器208111)之前，可能会提示用户并询问他们是否希望重置自适应控制程序。此类重置可将装置设置为制造商建议的默认状态。在至少一种情况下，向用户示出自适应控制程序的当前状态以及其学习的或设置的限制。用户然后能够选择他们是否想要利用此种定制性能。在至少一种情况下，可向用户示出自适应控制程序的当前状态的简要历史记录。例如，可以向下一用户显示哪些外科医生已使用并促成了自适应控制程序及其限制和/或在数据聚集期间涉及哪些手术室工作人员以达到自适应控制程序的当前状态，以允许该下一用户决定自适应控制程序是否处于在其手术中使用的理想状态。可在使用端部执行器208111之前、之后和/或期间选择此类覆写。更具体地讲，可在端部执行器功能自身的致动期间选择此类覆写。在这种情况下，外科医生可基于端部执行器的实时事件和/或行为对关于击发期间的自适应控制程序的状态具有第二想法，并且希望覆写自适应控制程序和/或设置在该自适应控制程序上的限制。
在至少一种情况下，可为用户提供完全禁用在自适应控制程序上设置限制的能力。除此之外，例如，可以向用户提供完全禁用自适应控制程序的自适应性的能力，使得可以在机器学习不会影响驱动和/或控制端部执行器功能的方式的意义上完全手动操作端部执行器的功能。
在至少一种情况下，控制电路(诸如控制电路208103)可被配置成能够基于用户使用端部执行器的行为来识别端部执行器(诸如端部执行器208111)的用户。在这种情况下，自适应控制程序可如上所述进行自适应，并且可如上所述在自适应控制程序上学习和/或设置限制。如果控制电路确定不同用户正在使用端部执行器208111，则可使新用户知道设置在当前端部执行器上的适当位置的自适应控制程序，并且可询问新用户是否想要继续进行当前自适应控制程序。在至少一种情况下，如果控制电路确定不同的用户正在使用端部执行器，则自适应控制程序可以排除在新用户下使用端部执行器的情况，以免影响自适应控制程序和/或端部执行器的自适应控制程序的限制。
现在将描述受益于用户检测的示例。例如，可检测到比预期更厚的组织以及组织偏斜到砧座的组织阻挡件端部的组织的不均匀分布。这可通过在击发行程开始时减慢击发构件的击发速度并增加稳定等待周期来调节。等待组织在钳口内调节和扁平化可有助于推进击发构件穿过较厚的组织。如果发生类似事件，但控制电路检测到另一用户正在使用同一器械(例如，器械208100)，例如，在相同情况下，控制电路可能询问用户是想要使用改善的性能程序还是具有其学习和/或设置限制的自适应控制程序，或者询问用户是否想要使用标准自适应控制程序，而不仅仅是自动调节参数(就像第一用户在后续手术中使用该装置那样)。这可在不同用户在执行类似手术时具有不同偏好的情况下提供优势。
在至少一种情况下，用户能够限定和/或选择自适应控制程序能够在其中适应的值的范围和/或窗口。参见图17，示出了其中向用户提供了调谐允许的调节的选项的显示器，使得端部执行器(诸如端部执行器208111)的自适应控制程序(例如，它们即将使用或正在使用)允许在端部执行器的使用期间进行调谐。在例示的示例中，缝合器使用自适应击发速度算法或程序，该自适应击发速度算法或程序基于由组织提供的击发构件所经受的阻力来调节击发速度。图17所示的GUI和对应的控制电路(诸如控制电路208103)例如允许与其一起使用的端部执行器的性能的定制性。可对算法中的各种变量设置限制。此类变量包括最小和最大速度调节、范围内的速度间隔的数量以及力参数超过安全阈值时暂停击发的持续时间。这些变量能够缩放并且/或者能够被用户改变，使得用户可以手动地限定窗口，利用该窗口允许自适应击发速度算法或控制程序在其中进行调节。在至少一种情况下，这些输入通知系统用于后续击发响应的阈值。在例示的示例中，显示器208040和208050描绘了用于调节自适应击发速度程序的击发速度范围以在内进行操作的第一滑块、用于调节用户想要自适应击发速度暂停的暂停持续时间的第二滑块以及能够选择的数量的速度选项，其中用户可限定在设置范围内期望的速度间隔的量。在每个显示器208040和208050上选择不同的设置。
在至少一种情况下，例如，用户能够输入他们对装置输出的意见，从而输入自适应控制程序的性能及其学习的限制。此类调查可在整个手术完成之后和/或在装置使用一周之后进行。在另一种情况下，此类调查可在装置的寿命使用之后进行，使得机器学习可在下一装置的控制程序中使用该调查的数据以更好地调节控制功能的性能。例如，此类意见可对应于装置从一次使用到下一次使用和/或从一次手术到下一次手术的性能。这种受过训练的行为将允许装置不仅可以个别地调谐其行为而且可以调谐期望的结果。这可以由实践中的技术人员中的一名技术人员来完成，然后允许装置将这种改善的输出和行为呈现给该装置的所有其他用户。
图19示出了包括用户界面208101和控制电路208103的外科器械208100，该控制电路被配置成能够从用户界面208101接收输入。外科器械208100还包括马达驱动器208105、被配置成能够由马达驱动器208105驱动并由控制电路208103控制的马达208107，以及包括被配置成能够由马达208107驱动的击发构件208111的端部执行器208109。在至少一种情况下，外科器械208100的各种部件可代替基于能量的外科器械，诸如超声外科器械。本文所述的控制电路(诸如控制电路208103)被配置成能够控制由任何合适的装置供电的任何合适的端部执行器功能或参数。在至少一种情况下，用户界面208101包括基于计算机的输入而不是基于人的输入。例如，此类基于计算机的输入可源自例如外科集线器(例如，102、202)。外科器械208100可与本文所述的任何系统、装置和/或控制电路一起使用。本文所述的各种系统、装置和/或控制电路可用于治疗外科患者。在所示的示例中，外科缝合器可利用击发构件诸如击发构件208111来切割患者的组织和/或在外科手术期间驱动钉穿过组织以紧固组织。在这种情况下，提供能够提供击发构件的改善的操作的控制电路可能是有利的。本文的任何控制电路可提供此类优点。在至少一种情况下，击发构件208111包括例如在马达208107和钉之间延伸的击发组件，该击发组件被配置成能够由滑动件射出。在至少一种情况下，击发构件208111包括例如在马达208107和钉之间延伸的击发组件的一个或多个部件，该一个或多个部件被配置成能够由滑动件射出。
实施例
本文所述主题的各个方面在以下编号的实施例中陈述：
实施例1-一种外科系统，包括：外科器械，所述外科器械包括端部执行器，其中所述端部执行器被配置成能够执行端部执行器功能；以及控制电路，所述控制电路被配置成能够控制所述端部执行器功能并随时间推移自动适应对所述端部执行器功能的控制，以及限制对所述端部执行器功能的控制的自动适应。
实施例2-根据实施例1所述的外科系统，其中，所述控制电路被进一步配置成能够使用机器学习来自动适应对所述端部执行器功能的控制。
实施例3-根据实施例1或2所述的外科系统，其中，所述自动适应取决于所述外科器械中的感测参数。
实施例4-根据实施例3所述的外科系统，其中，所述感测参数包括来自先前使用所述外科器械的先前感测的参数的集合。
实施例5-根据实施例4所述的外科系统，其中，所述先前感测的参数的集合包括在由特定用户使用所述外科器械期间感测的参数。
实施例6-根据实施例4或5所述的外科系统，其中，所述先前感测的参数的集合包括在所述外科器械在特定位置的使用期间感测的参数。
实施例7-根据实施例1、2、3、4、5或6所述的外科系统，其中，所述控制电路被进一步配置成能够将对所述端部执行器功能的控制的自动适应限于特定调节范围。
实施例8-根据实施例7所述的外科系统，其中，所述特定调节范围是预定义的。
实施例9-根据实施例7或8所述的外科系统，其中，所述特定调节范围能够手动调节。
实施例10-根据实施例7、8或9所述的外科系统，其中，由所述控制电路基于机器学习自动调节所述特定调节范围。
实施例11-根据实施例1、2、3、4、5、6、7、8、9或10所述的外科系统，其中，所述控制电路被进一步配置成能够将对所述端部执行器功能的控制的自动适应限于最大阈值调节。
实施例12-根据实施例1、2、3、4、5、6、7、8、9、10或11所述的外科系统，其中，限制对所述端部执行器功能的控制的自动适应是基于每次使用的。
实施例13-根据实施例1、2、3、4、5、6、7、8、9、10、11或12所述的外科系统，其中，限制对所述端部执行器功能的控制的自动适应是基于特定用户的。
实施例14-根据实施例1、2、3、4、5、6、7、8、9、10、11、12或13所述的外科系统，其中，限制对所述端部执行器功能的控制的自动适应是基于所述外科器械的特定位置的。
实施例15-一种外科系统，包括：外科器械，所述外科器械包括端部执行器；以及控制电路，所述控制电路被配置成能够控制所述端部执行器的参数、自动调节对所述参数的控制，以及将对所述参数的控制的自动调节限于可调节性窗口。
实施例16-根据实施例15所述的外科系统，其中，所述控制电路被配置成能够使用机器学习自动调节对所述参数的控制。
实施例17-根据实施例15或16所述的外科系统，其中，所述可调节性窗口能够由临床医生手动选择。
实施例18-根据实施例15、16或17所述的外科系统，其中，基于机器学习自动选择所述可调节性窗口。
实施例19-一种外科系统，包括：外科器械，所述外科器械包括端部执行器；以及控制电路，所述控制电路被配置成能够接收关于感测参数的信息、控制端部执行器功能、基于所述感测参数随时间推移适应对所述端部执行器功能的控制，以及限制对所述端部执行器功能的控制的适应。
实施例20-根据实施例19所述的外科系统，其中，限制对所述端部执行器功能的控制的适应包括将对所述端部执行器功能的控制的适应限于适应性范围。
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、闪存存储器或其他存储器。此外，指令可经由网络或通过其他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发射以机器(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、声学信号或其他形式的传播信号(例如，载波、红外信号、数字信号等)在因特网上发射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)可读的形式存储或发射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)或场可编程门阵列(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、比较和以其他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，通信装置可以能够使用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“被配置为”、“可被配置为”、“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，在没有其他修饰语的情况下，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他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”这样的术语或其他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，非专利公布或其他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 (20)

1.一种外科系统，包括：
外科器械，所述外科器械包括端部执行器，其中所述端部执行器被配置成能够执行端部执行器功能；和
控制电路，所述控制电路被配置成能够：
控制所述端部执行器功能并随时间推移自动适应对所述端部执行器功能的控制；以及
限制对所述端部执行器功能的控制的自动适应。
2.根据权利要求1所述的外科系统，其中，所述控制电路被进一步配置成能够使用机器学习来自动适应对所述端部执行器功能的控制。
3.根据权利要求1所述的外科系统，其中，所述自动适应取决于所述外科器械中的感测参数。
4.根据权利要求3所述的外科系统，其中，所述感测参数包括来自先前使用所述外科器械的先前感测的参数的集合。
5.根据权利要求4所述的外科系统，其中，所述先前感测的参数的集合包括在由特定用户使用所述外科器械期间感测的参数。
6.根据权利要求4所述的外科系统，其中，所述先前感测的参数的集合包括在所述外科器械在特定位置的使用期间感测的参数。
7.根据权利要求1所述的外科系统，其中，所述控制电路被进一步配置成能够将对所述端部执行器功能的控制的自动适应限于特定调节范围。
8.根据权利要求7所述的外科系统，其中，所述特定调节范围是预定义的。
9.根据权利要求7所述的外科系统，其中，所述特定调节范围能够手动调节。
10.根据权利要求7所述的外科系统，其中，由所述控制电路基于机器学习自动调节所述特定调节范围。
11.根据权利要求1所述的外科系统，其中，所述控制电路被进一步配置成能够将对所述端部执行器功能的控制的自动适应限于最大阈值调节。
12.根据权利要求1所述的外科系统，其中，限制对所述端部执行器功能的控制的自动适应是基于每次使用的。
13.根据权利要求1所述的外科系统，其中，限制对所述端部执行器功能的控制的自动适应是基于特定用户的。
14.根据权利要求1所述的外科系统，其中，限制对所述端部执行器功能的控制的自动适应是基于所述外科器械的特定位置的。
15.一种外科系统，包括：
外科器械，所述外科器械包括端部执行器；和
控制电路，所述控制电路被配置成能够：
控制所述端部执行器的参数；
自动调节对所述参数的控制；以及
将对所述参数的控制的自动调节限于可调节性窗口。
16.根据权利要求15所述的外科系统，其中，所述控制电路被配置成能够使用机器学习自动调节对所述参数的控制。
17.根据权利要求15所述的外科系统，其中，所述可调节性窗口能够由临床医生手动选择。
18.根据权利要求15所述的外科系统，其中，基于机器学习自动选择所述可调节性窗口。
19.一种外科系统，包括：
外科器械，所述外科器械包括端部执行器；和
控制电路，所述控制电路被配置成能够：
接收关于感测参数的信息；
控制端部执行器功能；
基于所述感测参数随时间推移适应对所述端部执行器功能的控制；以及
限制对所述端部执行器功能的控制的适应。
20.根据权利要求19所述的外科系统，其中，限制对所述端部执行器功能的控制的适应包括将对所述端部执行器功能的控制的适应限于适应性范围。
CN201880084679.3A 2017-12-28 2018-11-14 具有用于控制端部执行器参数的预定义的可调节的控制算法的电动外科工具 Pending CN111542282A (zh)

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