CN111699532A - 利用数据流动性通过存货和内部流程跟踪器械而对在外科手术中使用的所有器械的综合成本的实时分析 - Google Patents
利用数据流动性通过存货和内部流程跟踪器械而对在外科手术中使用的所有器械的综合成本的实时分析 Download PDFInfo
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Abstract
本发明公开了用于跟踪外科手术成本的各种系统和方法。一种计算机系统诸如外科集线器被配置成能够可通信地耦接到多个外科装置。所述计算机系统能够被编程为经由从所述外科装置接收的围手术期数据来识别在外科手术期间正在利用的所述外科装置，然后计算与在所述外科手术中所使用的所述外科装置相关联的总成本。所述总成本能够包括以下各项的聚集：可重复使用的外科装置中的每个可重复使用的外科装置的维护成本和在所述外科手术期间所消耗的不可重复使用的外科装置的更换成本。
Description
相关申请的交叉引用
本专利申请要求2018年11月6日提交的标题为“REAL-TIME ANALYSIS OFCOMPREHENSIVE COST OF ALL INSTRUMENTATION USED IN SURGERY UTILIZING DATAFLUIDITY TO TRACK INSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES”的美国非临时专利申请序列号16/182,242的权益，该非临时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)款的规定要求2018年9月10日提交的标题为“SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDUREVARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMALSOLUTION”的美国临时专利申请号62/729,191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。
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“SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE”的美国临时专利申请号62/692,747、2018年6月30日提交的标题为SMART ENERGY ARCHITECTURE的美国临时专利申请号62/692,748和2018年6月30日提交的标题为“SMART ENERGY DEVICES”的美国临时专利申请号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4月19日提交的标题为“METHOD OF HUB COMMUNICATION”的美国临时专利申请号62/659,900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3月30日提交的标题为“CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS”的美国临时专利申请号62/650,898、2018年3月30日提交的标题为“SURGICAL SYSTEMS WITHOPTIMIZED SENSING 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“SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL 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“SURGICAL SMOKEEVACUATION 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3月8日提交的标题为“TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEMTHEREFOR”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“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。
本专利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“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“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，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)的外科手术室或手术房(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成员，以及该区域中的所有设备和固定装置。在执行外科手术中利用各种外科装置和系统。
发明内容
在一个一般方面，本公开涉及一种计算机系统，该计算机系统被配置成能够可通信地耦接到多个外科装置。该计算机系统包括处理器和耦接到该处理器的存储器。该存储器存储指令，这些指令在由处理器执行时使得计算机系统：至少部分地基于从多个外科装置中的一个或多个外科装置接收的围手术期数据来确定在外科手术期间利用多个外科装置中的哪些外科装置；确定在所述外科手术期间利用的所述多个外科装置中的每个外科装置是可重复使用的外科装置还是不可重复使用的外科装置；确定每个可重复使用的外科装置的维护成本；确定每个不可重复使用的外科装置的更换成本；以及根据每个可重复使用的外科装置的维护成本和每个不可重复使用的外科装置的更换成本来确定用于外科手术的多个外科装置的总成本。
在另一个一般方面，一种计算机系统，包括处理器和耦接到该处理器的存储器。该存储器存储指令，这些指令在由处理器执行时使得计算机系统：根据从一个或多个外科装置接收的围手术期数据来识别在外科手术期间利用的一个或多个外科装置；以及根据与一个或多个外科装置中的每个外科装置相关联的维护成本或更换成本来确定用于外科手术的一个或多个外科装置的总成本。
在又一个一般方面，一种用于确定外科手术的外科装置成本的由计算机实现的方法。该方法包括：由计算机系统至少部分地基于从多个外科装置中的一个或多个外科装置接收的围手术期数据来确定在外科手术期间利用多个外科装置中的哪些外科装置；由所述计算机系统确定在所述外科手术期间利用的所述多个外科装置中的每个外科装置是可重复使用的外科装置还是不可重复使用的外科装置；由所述计算机系统确定每个可重复使用的外科装置的维护成本；由所述计算机系统确定每个不可重复使用的外科装置的更换成本；以及由计算机系统根据每个可重复使用的外科装置的维护成本和每个不可重复使用的外科装置的更换成本来确定用于外科手术的多个外科装置的总成本。
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的各种方面(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由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部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独电力总线附接件，该横向模块化外壳被配置成能够接纳多个模块。
图7示出了根据本公开的至少一个方面的被配置成能够接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由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为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接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云计算系统的云部件。
图13为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为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轴。
图16为根据本公开的至少一个方面的示出了相关数据库之间的数据互操作性的数据库系统的示图。
图17为根据本公开的至少一个方面的示出了相关数据库之间的数据流动性的数据库系统的示图。
图18为根据本公开的至少一个方面的用于在数据库之间共享数据的过程的逻辑流程图。
图19为根据本公开的至少一个方面的其中在外科集线器、电子健康记录(EHR)和医院管理数据库之间共享特定数据的数据库系统的示图。
图20为根据本公开的至少一个方面的在EHR和医院管理数据库之间共享特定数据的数据库系统的示图。
图21为根据本公开的至少一个方面的示出了用于医疗设施数据库系统的安全和授权系统的示图。
图22为根据本公开的至少一个方面的可由外科集线器执行的成本分析算法的框图。
图23为根据本公开的至少一个方面的示出了用于通过医疗设施的外科装置的工作流程的框图。
图24为根据本公开的至少一个方面的用于计算与外科手术相关联的总成本的过程的逻辑流程图。
具体实施方式
本专利申请的申请人拥有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：
·标题为“SURGICAL NETWORK,INSTRUMENT,AND CLOUD RESPONSES BASED ONVALIDATION OF RECEIVED DATASET AND AUTHENTICATION OF ITS SOURCE ANDINTEGRITY”的美国专利申请号16/182,224；
·标题为“SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROMEXTERNAL DATA”的美国专利申请号16/182,230；
·标题为“MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ONMACHINE LEARNING”的美国专利申请号16/182,233；
·标题为“ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIEDCONTEXTUAL DATA IN ADDITION TO THE DATA”的美国专利申请号16/182,239；
·标题为“SURGICAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BASED ONSITUATIONAL AWARENESS”的美国专利申请号16/182,243；
·标题为“DETECTION AND ESCALATION OF SECURITY RESPONSES OF SURGICALINSTRUMENTS TO INCREASING SEVERITY THREATS”的美国专利申请号16/182,248；
·标题为“INTERACTIVE SURGICAL SYSTEM”的美国专利申请号16/182,251；
·标题为“AUTOMATED DATA SCALING,ALIGNMENT,AND ORGANIZING BASED ONPREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS”的美国专利申请号16/182,260；
·标题为“SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO-POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO A SURGICALNETWORK”的美国专利申请号16/182,267；
·标题为“POWERED SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CONTROLALGORITHM FOR CONTROLLING END EFFECTOR PARAMETER”的美国专利申请号16/182,249；
·标题为“ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES”的美国专利申请号16/182,246；
·标题为“ADJUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ONSITUATIONAL AWARENESS”的美国专利申请号16/182,256；
·标题为“USAGE AND TECHNIQUE ANALYSIS OF SURGEON/STAFF PERFORMANCEAGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTHCURRENT AND FUTURE PROCEDURES”的美国专利申请号16/182,255；
·标题为“IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IMPROVEPLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE”的美国专利申请号16/182,269；
·标题为“COMMUNICATION OF DATA WHERE A SURGICAL NETWORK IS USINGCONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVING SYSTEM/USER TO INFLUENCEINCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY”的美国专利申请号16/182,278；
·标题为“SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OFPROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THEOPTIMAL SOLUTION”的美国专利申请号16/182,290；
·标题为“CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER”的美国专利申请号16/182,232；
·标题为“SURGICAL NETWORK DETERMINATION OF PRIORITIZATION OFCOMMUNICATION,INTERACTION,OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS”的美国专利申请号16/182,227；
·标题为“WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICEWITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESSOF DEVICES”的美国专利申请号16/182,231；
·标题为“ADJUSTMENT OF STAPLE HEIGHT OF AT LEAST ONE ROW OF STAPLESBASED ON THE SENSED TISSUE THICKNESS OR FORCE IN CLOSING”的美国专利申请号16/182,229；
·标题为“STAPLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARYLOCKOUTS BASED ON SENSED PARAMETERS”的美国专利申请号16/182,234；
·标题为“POWERED STAPLING DEVICE CONFIGURED TO ADJUST FORCE,ADVANCEMENT SPEED,AND OVERALL STROKE OF CUTTING MEMBER BASED ON SENSEDPARAMETER OF FIRING OR CLAMPING”的美国专利申请号16/182,240；
·标题为“VARIATION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL INCOOPERATION WITH VARYING CLAMP ARM PRESSURE TO ACHIEVE PREDEFINED HEAT FLUXOR POWER APPLIED TO TISSUE”的美国专利申请号16/182,235；以及
·标题为“ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BYCLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSIONLOCATION”的美国专利申请号16/182,238。
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：
·标题为“A CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORKCONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSED SITUATION ORUSAGE”美国临时专利申请号62/729,183；
·标题为“AUTOMATED DATA SCALING,ALIGNMENT,AND ORGANIZING BASED ONPREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION”的美国临时专利申请号62/729,177；
·标题为“INDIRECT COMMAND AND CONTROL OF A FIRST OPERATING ROOMSYSTEM THROUGH THE USE OF A SECOND OPERATING ROOM SYSTEM WITHIN A STERILEFIELD WHERE THE SECOND OPERATING ROOM SYSTEM HAS PRIMARY AND SECONDARYOPERATING MODES”的美国临时专利申请号62/729,176；
·标题为“POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE,ADVANCEMENT SPEED,AND OVERALL STROKE OF CUTTING MEMBER OF THE DEVICE BASED ONSENSED PARAMETER OF FIRING OR CLAMPING”的美国临时专利申请号62/729,185；
·标题为“POWERED SURGICAL TOOL WITH A PREDEFINED ADJUSTABLE CONTROLALGORITHM FOR CONTROLLING AT LEAST ONE END EFFECTOR PARAMETER AND A MEANS FORLIMITING THE ADJUSTMENT”的美国临时专利申请号62/729,184；
·标题为“SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONOPOLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE HUB”的美国临时专利申请号62/729,182；
·标题为“SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OFPROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THEOPTIMAL SOLUTION”的美国临时专利申请号62/729,191；
·标题为“ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BYCLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSIONLOCATION”的美国临时专利申请号62/729,195；以及
·标题为“WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICEWITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESSOF DEVICES”的美国临时专利申请号62/729,186。
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：
·标题为“ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROLSYSTEM THEREFOR”的美国专利申请号16/115,214；
·标题为“TEMPERATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTROLSYSTEM THEREFOR”的美国专利申请号16/115,205；
·标题为“RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINEDELECTRICAL SIGNALS”的美国专利申请号16/115,233；
·标题为“CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TOTISSUE LOCATION”的美国专利申请号16/115,208；
·标题为“CONTROLLING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENTACCORDING TO THE PRESENCE OF TISSUE”的美国专利申请号16/115,220；
·标题为“DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM”的美国专利申请号16/115,232；
·标题为“DETERMINING THE STATE OF AN ULTRASONIC ELECTROMECHANICALSYSTEM ACCORDING TO FREQUENCY SHIFT”的美国专利申请号16/115,239；
·标题为“DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR”的美国专利申请号16/115,247；
·标题为“SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS”的美国专利申请号16/115,211；
·标题为“MECHANISMS FOR CONTROLLING DIFFERENT ELECTROMECHANICALSYSTEMS OF AN ELECTROSURGICAL INSTRUMENT”的美国专利申请号16/115,226；
·标题为“DETECTION OF END EFFECTOR IMMERSION IN LIQUID”的美国专利申请号16/115,240；
·标题为“INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVECOUPLING”的美国专利申请号16/115,249；
·标题为“INCREASING RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLARLOOP”的美国专利申请号16/115,256；
·标题为“BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTSPRESSURE BASED ON ENERGY MODALITY”的美国专利申请号16/115,223；以及
·标题为“ACTIVATION OF ENERGY DEVICES”的美国专利申请号16/115,238。
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：
·标题为“CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TOTISSUE LOCATION”的美国临时专利申请号62/721,995；
·标题为“SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS”的美国临时专利申请号62/721,998；
·标题为“INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVECOUPLING”的美国临时专利申请号62/721,999；
·标题为“BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTSPRESSURE BASED ON ENERGY MODALITY”的美国临时专利申请号62/721,994；以及
·标题为“RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINEDELECTRICAL SIGNALS”的美国临时专利申请号62/721,996。
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：
·标题为“SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE”的美国临时专利申请号62/692,747；
·标题为“SMART ENERGY ARCHITECTURE”的美国临时专利申请号62/692,748；以及
·标题为“SMART ENERGY DEVICES”的美国临时专利申请号62/692,768。
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：
·标题为“CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAYELEMENTS”的美国专利申请序列号16/024,090；
·标题为“CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSEDCLOSURE PARAMETERS”的美国专利申请序列号16/024,057；
·标题为“SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ONPERIOPERATIVE INFORMATION”的美国专利申请序列号16/024,067；
·标题为“SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING”的美国专利申请序列号16/024,075；
·标题为“SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING”的美国专利申请序列号16/024,083；
·标题为“SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUEDISTRIBUTION IRREGULARITIES”的美国专利申请序列号16/024,094；
·标题为“SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TOCANCEROUS TISSUE”的美国专利申请序列号16/024,138；
·标题为“SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES”的美国专利申请序列号16/024,150；
·标题为“VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY”的美国专利申请序列号16/024,160；
·标题为“SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE”的美国专利申请序列号16/024,124；
·标题为“SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT”的美国专利申请序列号16/024,132；
·标题为“SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY”的美国专利申请序列号16/024,141；
·标题为“SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSIONCAPABILITIES”的美国专利申请序列号16/024,162；·标题为“SURGICAL EVACUATIONSENSING AND MOTOR CONTROL”的美国专利申请序列号16/024,066；
·标题为“SURGICAL EVACUATION SENSOR ARRANGEMENTS”的美国专利申请序列号16/024,096；
·标题为“SURGICAL EVACUATION FLOW PATHS”的美国专利申请序列号16/024,116；
·标题为“SURGICAL EVACUATION SENSING AND GENERATOR CONTROL”的美国专利申请序列号16/024,149；
·标题为“SURGICAL EVACUATION SENSING AND DISPLAY”的美国专利申请序列号16/024,180；
·标题为“COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUBOR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM”的美国专利申请序列号16/024,245；
·标题为“SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROLCIRCUIT FOR INTERACTIVE SURGICAL PLATFORM”的美国专利申请序列号16/024,258；
·标题为“SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FORCOMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE”的美国专利申请序列号16/024,265；以及
·标题为“DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS”的美国专利申请序列号16/024,273。
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：
·标题为“A Method of using reinforced flex circuits with multiplesensors with electrosurgical devices”的美国临时专利申请序列号62/691,228；
·标题为“controlling a surgical instrument according to sensedclosure parameters”的美国临时专利申请序列号62/691,227；
·标题为“SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE”的美国临时专利申请序列号62/691,230；
·标题为“SURGICAL EVACUATION SENSING AND MOTOR CONTROL”的美国临时专利申请序列号62/691,219；
·标题为“COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUBOR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/691,257；
·标题为“SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FORCOMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE”的美国临时专利申请序列号62/691,262；以及
·标题为“DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS”的美国临时专利申请序列号62/691,251。
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，这些临时专利申请的公开内容全文以引用方式并入本文：
·标题为“METHOD OF HUB COMMUNICATION”的美国临时专利申请序列号62/659,900。
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全文以引用方式并入本文：
·2018年3月30日提交的标题为“CAPACITIVE COUPLED RETURN PATH PAD WITHSEPARABLE ARRAY ELEMENTS”的美国临时专利申请号62/650,898；
·标题为“SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES”的美国临时专利申请序列号62/650,887；
·标题为“SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM”的美国专利申请序列号62/650,882；以及
·标题为“SURGICAL SMOKE EVACUATION SENSING AND CONTROLS”的美国专利申请序列号62/650,877。
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：
·标题为“INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES”的美国专利申请序列号15/940,641；
·标题为“INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OFDEVICES AND DATA CAPABILITIES”的美国专利申请序列号15/940,648；
·标题为“SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OFOPERATING ROOM DEVICES”的美国专利申请序列号15/940,656；
·标题为“SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS”的美国专利申请序列号15/940,666；
·标题为“COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARYSOURCES BY INTELLIGENT SURGICAL HUBS”的美国专利申请序列号15/940,670；
·标题为“SURGICAL HUB CONTROL ARRANGEMENTS”的美国专利申请序列号15/940,677；
·标题为“DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD”的美国专利申请序列号15/940,632；
·标题为“COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERSAND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICSSYSTEMS”的美国专利申请序列号15/940,640；
·标题为“SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUINGINSTRUMENT”的美国专利申请序列号15/940,645；
·标题为“DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETERWITH AN OUTCOME”的美国专利申请序列号15/940,649；
·标题为“SURGICAL HUB SITUATIONAL AWARENESS”的美国专利申请序列号15/940,654；
·标题为“SURGICAL SYSTEM DISTRIBUTED PROCESSING”的美国专利申请序列号15/940,663；
·标题为“AGGREGATION AND REPORTING OF SURGICAL HUB DATA”的美国专利申请序列号15/940,668；
·标题为“SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER”的美国专利申请序列号15/940,671；
·标题为“DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEARSTAPLE LINE”的美国专利申请序列号15/940,686；·标题为“STERILE FIELD INTERACTIVECONTROL DISPLAYS”的美国专利申请序列号15/940,700；
·标题为“COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”的美国专利申请序列号15/940,629；
·标题为“USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TODETERMINE PROPERTIES OF BACK SCATTERED LIGHT”的美国专利申请序列号15/940,704；
·标题为“CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OFMONO-CHROMATIC LIGHT REFRACTIVITY”的美国专利申请序列号15/940,722；
·标题为“DUAL CMOS ARRAY IMAGING”的美国专利申请序列号15/940,742；
·标题为“ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES”的美国专利申请序列号15/940,636；
·标题为“ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS”的美国专利申请序列号15/940,653；
·标题为“CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER”的美国专利申请序列号15/940,660；
·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15/940,679；
·标题为“CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTEDINDIVIDUALIZATION OF INSTRUMENT FUNCTION”的美国专利申请序列号15/940,694；
·标题为“CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY ANDAUTHENTICATION TRENDS AND REACTIVE MEASURES”的美国专利申请序列号15/940,634；
·标题为“DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICSNETWORK”的美国专利申请序列号15/940,706；
·标题为“CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES”的美国专利申请序列号15/940,675；
·标题为“DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,627；
·标题为“COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国专利申请序列号15/940,637；
·标题为“CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,642；
·标题为“AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国专利申请序列号15/940,676；
·标题为“CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,680；
·标题为“COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国专利申请序列号15/940,683；
·标题为“DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,690；以及
·标题为“SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,711。
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全文以引用方式并入本文：
·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 TODETERMINE PROPERTIES 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 ANDAUTHENTICATION TRENDS 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 ANALYTICSNETWORK”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；
·标题为“AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国临时专利申请序列号62/649,307；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全文以引用方式并入本文：
·标题为“TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEMTHEREFOR”的美国临时专利申请序列号62/640,417；以及
·标题为“ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROLSYSTEM THEREFOR”的美国临时专利申请序列号62/640,415。
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全文以引用方式并入本文：
·标题为“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341；
·标题为“CLOUD-BASED MEDICAL ANALYTICS”的美国临时专利申请序列号62/611,340；以及
·标题为“ROBOT ASSISTED SURGICAL PLATFORM”的美国专利申请序列号62/611,339。
在详细说明外科装置和发生器的各种方面之前，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。
外科集线器
参见图1，由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并且/或者与集线器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118观察外科部位时，患者侧推车120可通过患者体内的微创切口来操纵至少一个可移除地耦接的外科工具117。外科部位的图像可通过医疗成像装置124获得，该医疗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“ROBOT ASSISTEDSURGICAL PLATFORM”的美国临时专利申请序列号62/611,339中有所描述，该临时专利申请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“CLOUD-BASED MEDICAL ANALYTICS”的美国临时专利申请序列号62/611,340中，该临时专利申请的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接装置(CCD)传感器和互补金属氧化物半导体(CMOS)传感器。
成像装置124的光学部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被构造用于微创手术中。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。多光谱图像是捕集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集的附加信息。多光谱成像的使用在2017年12月28日提交的标题为“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341的标题“Advanced Imaging Acquisition Module”下更详细地描述，该临时专利申请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灭菌。在“外科室”(即，手术室或治疗室)中所需的严格的卫生和灭菌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及其附接件和部件。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成员，以及该区域中的所有设备和固定装置。
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，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的各种部件在2017年12月28日提交的标题为“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341的标题“Advanced Imaging Acquisition Module”下有所描述，该临时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可使得可视化系统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被进一步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者查看。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被进一步配置成能够协调流向外科器械112的显示器的信息流。例如，协调信息流在2017年12月28日提交的标题为“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341中进一步有所描述，该专利申请的公开内容全文以引用方式并入本文。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的示例性外科器械在2017年12月28日提交的标题为“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341中在标头“外科器械硬件”下有所描述，该临时专利申请的公开内容例如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/或手术室映射模块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，这减小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部件、双极RF能量发生器部件和单极RF能量发生器部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可滑动地移动成与功率和数据触点电接合，并且其中第二能量发生器可滑动地移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。耦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耦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使得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耦接到另一个抽屉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独功率总线附接件，该横向模块化外壳160被配置成能够接纳外科集线器206的多个模块。横向模块化外壳160被配置成能够横向接纳和互连模块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接纳外科集线器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接纳在主模块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。在另一个方面，相机模块包括CMOS传感器。在另一个方面，相机模块被构造用于扫描波束成像。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更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更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接纳相机模块，该相机模块可被构造用于与第一通道按扣配合接合。第二通道被配置成能够可滑动地接纳光源模块，该光源模块可被构造用于与第二通道按扣配合接合。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按扣配合接合。
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“COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR”美国专利号7,995,045中，该专利全文以引用方式并入本文。此外，2011年7月19日公布的标题为“SBI MOTION ARTIFACTREMOVAL APPARATUS AND METHOD”的美国专利号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，该专利全文以引用方式并入本文。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“CONTROLLABLE MAGNETIC SOURCE TO FIXTUREINTRACORPOREAL APPARATUS”的美国专利申请公布号2011/0306840和2014年8月28日公布的标题为“SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE”的美国专利申请公布号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，可包括耦接到存储装置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还可耦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可被构造为无源的、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构造网络集线器207或网络交换机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机。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可耦接到网络路由器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也可耦接到网络交换机209。网络交换机209可耦接到网络集线器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接纳多个装置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，诸如耦接到内窥镜的成像模块138、耦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。耦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集的图像)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状况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至网络集线器的构造。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、构造和维护，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示出了由计算机实现的交互式外科系统200。由计算机实现的交互式外科系统200在许多方面类似于由计算机实现的交互式外科系统100。例如，由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，由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包括耦接到计算机系统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耦接到耦接到内窥镜239的成像模块238、耦接到能量装置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、任选地耦接到显示器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耦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耦接到模块化控制塔236，如本文所述。模块化控制塔236可耦接到集线器显示器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示出了包括耦接到模块化控制塔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可以分层构造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“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341中的标题“Surgical Hub Spatial Awareness Within an Operating Room”下所述，该临时专利申请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。
处理器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、用于改善高于40MHz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。安全控制器可被构造成能够专门用于IEC 61508和ISO26262安全关键应用等等，以提供高级集成安全特征部，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，本文所述的各种部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9-10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328耦接到命令解码器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可将构造在多达六个逻辑层(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。功率构造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其它细节可见于2018年4月19日提交的标题为“METHOD OF HUB COMMUNICATION”的美国临时专利申请号62/659,900中，该专利申请以引用的方式全文并入本文。
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由计算机实现的交互式外科系统的框图。在一个方面，由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，该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。由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，并且通常可以是基于云的医疗系统。如图12中所示，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耦接到云7004(可与云204相同或类似)。多个外科集线器7006中的每一个通信地耦接到一个或多个外科器械7012。集线器7006还经由网络7001通信地耦接到由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中所示，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它合适的计算机网络。耦接到云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，以用于控制和实现如本文所述的各种外科手术或操作。
此外，外科器械7012可包括收发器，以用于向其对应的外科集线器7006(该外科集线器也可包括收发器)传输数据和从该外科集线器传输数据。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中所示，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共同掌管云计算系统，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中的每一个包括耦接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，该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、建议和其它操作。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中的聚集医疗数据的数据库2212。
基于经由网络7001到各种外科集线器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/或执行单独集线器7006自身无法实现的功能。为此，如图12中所示，云7004和外科集线器7006通信地耦接以传输和接收信息。I/O接口7007经由网络7001连接到多个外科集线器7006。以这种方式，I/O接口7007可被配置成能够在外科集线器7006和聚集医疗数据的数据库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，该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执行的软件应用程序(例如，集线器应用程序)并向其提供共享能力。例如，集线器应用服务器7002可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的数据库7011的访问以及执行负载平衡。参考图13更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)执行的医疗操作和手术的情境中产生的各种问题。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成能够与云7004进行交互以用于实现改善外科操作的执行的技术。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之间的交互方面。也可使用用于控制的其它合适的用户界面，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了由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，该多个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特别产生的问题提供数据分析解决方案。如图13中所示，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，该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定义对应于集线器应用程序7014的一组协议和例程。另外，API 7016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还存储数据(例如，暂时地)并且耦接到API 7016以用于更有效地检索应用程序7014所使用的数据。图13中的数据分析模块7034包括资源优化模块7020、数据收集和汇总模块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、建议模块7030以及数据分类和优先化模块7032。根据一些方面，云7004还可以实现其它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、结果和其它数据的特定建议。
例如，数据收集和汇总模块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的操作生成的对数据集可包括应用二元分类，例如，出血或非出血事件。更一般地，二元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)。聚集的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独数据。因此，数据收集和汇总模块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它组织数据。为此，处理器7008可以可操作地耦接到集线器应用程序7014和聚集医疗数据的数据库7011以用于执行数据分析模块7034。数据收集和汇总模块7022可以将聚集组织数据存储到聚集医疗数据的数据库2212中。
资源优化模块7020可被配置成能够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优使用。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外科缝合器械7012对于一组医疗设施的最优顺序点。资源优化模块7020还可评估各种医疗设施的资源使用或其它操作配置以确定是否可改善资源使用。类似地，建议模块7030可被配置成能够分析来自数据收集和汇总模块7022的聚集组织数据以提供建议。例如，建议模块7030可基于例如高于预期错误率向医疗设施(例如，医疗服务提供商，诸如医院)建议应将特定外科器械7012升级至改善的版本。另外，建议模块7030和/或资源优化模块7020可建议更好的供应链参数，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接收此类建议。还可提供关于各种外科器械7012的参数或配置的更具体的建议。集线器7006和/或外科器械7012还可各自具有显示由云7004提供的数据或建议的显示屏。
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它潜在操作参数。就这一点而言，建议模块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)来建议使用这些其它潜在操作参数。例如，建议模块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使用特定仓的建议。因此，基于云的分析系统在控制公共变量时可被配置成能够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建议(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、医疗提供商之间的地理类似性、哪些医疗提供商/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单独都不能独立地分析。
控制程序更新模块7026可被配置成能够在对应的控制程序被更新时执行各种外科器械7012建议。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)结果链接的相关性。当更新的控制程序经由控制程序更新模块7026传输至外科器械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的数据收集和汇总模块7022收集和分析的聚集性能数据。另外，患者结果分析模块7028和建议模块7030可基于聚集性能数据来识别使用器械7012的改善方法。
基于云的分析系统可包括由云7004实现的安全特征。这些安全特征可由授权和安全模块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、密码和其它合适的安全凭证。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定程度上与云通信(例如，可仅参与传输或接收某些限定类型的信息)。为此，云7004的聚集医疗数据的数据库7011可包括用于验证所提供的凭证的准确性的授权凭证的数据库。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”的其它装置的数据库。具体地讲，可不允许黑名单上列出的外科集线器7006与云进行交互，而黑名单上列出的外科器械7012不可具有对对应的集线器7006的功能访问和/或可在与其对应的集线器7006配对时被阻止完全起作用。除此之外或作为另外一种选择，云7004可基于不相容性或其它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，该无线信号可表示例如用于访问对应集线器7006和云7004的授权凭证。有线收发器也可用于传输信号。此类授权凭证可存储在外科器械7012的相应存储器装置中。授权和安全模块7024可确定授权凭证是准确的还是伪造的。授权和安全模块7024还可动态地生成用于增强的安全的授权凭证。凭证也可被加密，诸如通过使用基于散列的加密。在传输适当授权时，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可转变成能够用于接收医疗数据以存储到聚集医疗数据的数据库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授权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授权凭证以实现该组的操作闭锁。
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)以确定改善的实践并相应地建议改变(例如，经由建议模块2030)。因此，云7004的处理器7008可分析与单独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它医疗设施相关联的其它数据聚集。例如，可以基于类似的操作实践或地理位置来定义组。这样，云7004可提供医疗设施组范围内的分析和建议。基于云的分析系统也可用于增强态势感知。例如，处理器7008可对建议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它设施或任何其它可比较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。这种排序和优先化可以与上述其它数据分析模块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可为由数据收集和汇总模块7022以及患者结果分析模块7028执行的数据分析分配优先级。不同的优先级别可引起来自云7004的特定响应(对应于紧急性级别)，诸如加速响应的递增、特殊处理、聚集医疗数据的数据库7011的排除或其它合适的响应。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)。推送消息可引起在对应的集线器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性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可被编程为在某些显著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定阈值的预期值时或当其表现出安全已被包括时。
关于云分析系统的其它细节可见于2018年4月19日提交的标题为“METHOD OF HUBCOMMUNICATION”的美国临时专利申请号62/659,900中，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(其可在许多方面类似于集线器106)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来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。在另一个范例中，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。在另一个范例中，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、查找表或其它此类系统。
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载阈值进行的调节。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载阈值。
作为又一个示例，在吹入规程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。
作为又一个示例，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可用已从其它数据源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，来自可通信地耦接到外科集线器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。
另一个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/或装置的建议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/或其它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建议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建议布局的警示。
作为另一个示例，态势感知外科集线器5104可确定外科医生(或其它医疗人员)在外科手术过程期间是否正在出错或以其它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利用意外装置的警示。
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(和其它模块化装置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它模块化装置5102来提高外科医生执行外科手术的效率。
现在参见图15，其示出了描绘集线器诸如外科集线器106或206(图1至图11)的态势感知的时间轴5200。时间轴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。时间轴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可以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论(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过程相关的数据，验证医务人员正在采取的步骤，提供可能与特定过程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利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。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第一手术步骤。
第八步5216，插入医疗成像装置(例如，内窥镜)，并启动来自医疗成像装置的视频。外科集线器106、206通过其与医疗成像装置的连接来接收医疗成像装置数据(即，视频或图像数据)。在接收到医疗成像装置数据之后，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)。来自医疗成像装置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，包括通过确定医疗成像装置相对于患者解剖结构的可视化取向的角度，监测利用的医疗成像装置的数量(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相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相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疗成像装置的定位。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疗成像装置，而用于执行VATS分段切除术的另一种技术利用多个相机。作为另一个示例，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。通过从医疗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器人臂的能量工具。
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，在横切软组织后利用的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，并且/或者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，反向麻醉患者。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可根据从可通信地耦接到外科集线器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2018年4月19日提交的标题为“METHOD OF HUBCOMMUNICATION”的美国临时专利申请序列号62/659,900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(包括例如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。
结构化数据共享
在本文已描述了多种计算机系统，包括外科集线器106、206(图1至图11)和外科集线器106、206可通信地连接到其上的各种计算系统，包括云计算系统104、204、7004(图1、图9和图12至图13)。在其它实施方式中，外科集线器106、206可以可通信地彼此连接或连接到医疗设施内或与医疗设施相关联的各种数据库以形成本地计算机系统网络。在这些各种方面的每个方面，外科集线器106、206、数据库和其它计算机系统生成并且利用与患者、外科手术、外科工作人员等有关的大量数据。因此，外科集线器106、206和其它计算机系统以有效且结构化的方式彼此共享数据可能是有益的。因此，本文所述的计算机系统可被配置成能够聚集和共享在手术室(OR)内以及在整个医疗设施内所收集的数据，以便执行对手术室手术和效率、患者结果、外科工作人员绩效等的分析。总而言之，本文所述的系统和技术可用于遍及设施的数据收集和解释。
可利用多种范式或技术来在相关或连接的数据库之间有效地共享数据，诸如实现关系数据库模型或利用一致的数据格式，使得数据可跨网络中的不同的计算机系统迁移。本文所述的两个通用的结构化数据共享范式被称为“数据互操作性”和“数据流动性”。这些数据共享范式可被表征为由计算机网络内的每个计算机系统执行的规则集，该规则集定义了由计算机网络内的计算机系统以及在这些计算机系统之间如何以及以哪些方式共享数据。该规则集可体现为存储在计算机系统的存储器(例如，图10中所示的外科集线器206的存储器249)中的计算机可执行指令集，该计算机可执行指令集在由处理器(例如，处理器244)执行时，使得计算机系统执行所描述的用于与其它连接的计算机系统共享数据的步骤。此外，本文所述的所有数据库可存储在计算机系统的存储器(例如，存储器249)中，该计算机系统诸如是外科集线器106、206或数据库服务器。当在本文规定数据库彼此传达或共享数据时，这是指存储数据库的计算机系统正在如所描述的那样创建、更新、检索和/或管理数据库内的数据。此外，可通过由计算机系统执行的数据库管理系统来管理对数据库的访问和控制，该数据库管理系统可包括存储在计算机系统的存储器(例如，存储器249)中的计算机可执行指令，这些计算机可执行指令允许用户与各种数据库交互以及允许由各种数据库以及在它们之间传达数据。
数据互操作性被定义为计算机或数据库系统通过使数据库根据预定义规则将特定数据自动传输到接收方数据库来协同工作的能力。对于由计算机系统或在计算机系统处生成的每种类型的数据，数据互操作性范式的规则描述了计算机应将每种类型的数据传输到哪个(些)接收方数据库以及在某些情况下将传输到每个特定接收方数据库的每种数据的数据格式。在一些方面，数据互操作性可被表征为计算机系统之间的单向数据通信。此外，在一些方面，通过单向通信信道传输数据的计算机系统可能缺乏从接收计算机系统接收回相同类型数据的能力。这些方面可以是有益的，以便例如具有一个数据库驱动器或控制存储在或呈现在另一个数据库中的数据。
为了例示这些概念，图16为根据本公开的至少一个方面的示出了相关数据库之间的数据互操作性的数据库系统212000的示图。在所描绘的方面，数据库系统212000包括可通信地连接到第二数据库212004的第一数据库212002。在一个方面，第一数据库212002可被编程为以单独或主要单向的方式将数据传输到第二数据库212004。换句话讲，将数据更新或新数据流从第一数据库212002传输到第二数据库212004，反之亦然。在一些方面，可将存储在第一数据库212002中的所有数据限制为数据库212002、212004之间的单向数据流。在其它方面，可将存储在第一数据库212002中的数据的特定类型或子集限制为数据库212002、212004之间的单向数据流。
例如，第一数据库212002可包括EHR数据库，并且第二数据库212004可包括药房数据库。在该实施方式中，数据互操作性规则集可规定，当在EHR数据库中更新患者的EHR以指示已向患者开出新的药物时，可将相关处方数据作为新处方请求自动传输到药房数据库以供药房部门进行处理。因此，第一数据库212002可被编程为将表示处方请求的数据传输212006到第二数据库212004。处方请求中的数据可包括例如药物交互作用数据和来自相关联的患者EHR的当前药物列表。此外，数据互操作性规则集可规定，当响应于所接收的处方请求准备处方时，可将账单更新自动传输到EHR数据库。因此，第二数据库212004可被编程为响应于处方请求或在履行处方请求时将表示账单更新的数据传输212008到第一数据库212002。这些类型的数据中的每一者的传输可相对于相应的数据库212002、212004是单向的。
作为另一个示例，第一数据库212002可包括手术室调度数据库，并且第二数据库212004可包括医疗用品数据库。在该实施方式中，数据互操作性规则集可规定，当调度新手术或将新手术输入到手术室调度数据库中时，可将已调度手术的相关数据自动传输到医疗用品数据库，以指示医疗用品部门应准备哪些用品以及应在什么时间和日期进行准备。因此，当调度新手术时，手术室调度数据库可将表示该手术的数据自动传输212006到医疗用品数据库。因此，得以访问医疗用品数据库的员工可自动接收更新，使得他们可在调度时间准备已调度手术所需的产品和器械。
作为又一个示例，第一数据库212002可包括实验室数据库，并且第二数据库212004可包括EHR数据库。在该实施方案中，数据互操作性规则集可规定，当患者的实验室结果被上载到实验室数据库时，可将实验室结果数据自动传输到EHR数据库以与患者的EHR相关联。因此，实验室数据库可在完成测试后用表示测试结果和实验室结果的数据自动填充EHR数据库。因此，得以访问患者EHR的医师和任何其它个体都可立即访问任何命令的测试和实验室的结果，而无需采取任何进一步的措施。
作为又一个示例，第一数据库212002可包括处方输入数据库或EHR数据库，并且第二数据库212004可包括药物分配数据库或药房数据库。在该实施方案中，数据互操作性规则集可规定，当为患者输入新处方时，可将相关处方数据作为新处方请求自动传输到药房数据库以供药房部门进行处理。因此，药物分配数据库可在执业医生输入处方时自动接收处方，使得可根据需要准备好处方。
作为又一个示例，第一数据库212002可包括病理数据库，并且第二数据库212004可包括手术室数据库(例如，存储在外科集线器106、206中)。在该实施方式中，数据互操作性规则集可规定，当接收到患者的新病理结果时，可将相关病理数据自动传输到手术室数据库以供外科工作人员进行检查。因此，可将存储在病理数据库中的数据(包括更新或结果)通过对手术室数据库的更新自动传输212006到手术室。可在病理数据库和手术室数据库之间实时地(诸如在外科手术的过程期间)传输212006数据，以通知该手术的后续步骤。作为具体例示，在用于除去患者肺部的小肿瘤的楔形切除手术期间，外科工作人员将切除的标本发送给病理部门，以在患者仍处于手术室中时检查是否存在恶性肿瘤。如果病理部门确认存在恶性肿瘤，则外科工作人员通常会选择在取出楔形的肺叶上完成肺叶切除手术。因此，如上所述，通过利用病理数据库和外科集线器之间的数据互操作性范式，可使得在经由外科集线器的外科手术的过程期间从其它部门向外科工作人员提供通知的过程自动化。
数据流动性被定义为数据根据预定义规则从一个数据库流到另一个数据库的能力，这些预定义规则针对存储在数据库中的数据集描述了数据库之间的双向关系。在一些方面，数据流动性范式可定义数据是否被传输到特定接收方数据库和/或数据是否被链接到特定接收方数据库。例如，可利用关系数据库技术(即，数据库之间定义的关系)与其它数据库自动共享数据或将数据转移到其它数据库。在一个方面，数据库可执行规则集，该规则集定义哪些类型的数据将被自动传输到哪个特定接收方数据库。此外，在一个方面，数据库可执行规则集，该规则集根据与数据相关联的外科背景数据(元数据)来定义数据的格式或数据被传输到的数据库。该规则集可体现为存储在计算机系统的存储器(例如，图10中所示的外科集线器206的存储器249)中的计算机可执行指令集，该计算机可执行指令集在由处理器(例如，处理器244)执行时，使得计算机系统执行所描述的用于与其它连接的计算机系统共享数据的步骤。
例如，外科集线器可利用态势感知(上文在标头“态势感知(SITUATIONALAWARENESS)”下进行描述)以基于从外科器械、患者监测器以及其它外科装置或数据库所接收的围手术期数据来确定外科背景(例如，外科手术类型或正在执行的外科手术步骤)，然后将外科背景与正在生成的数据相关联(例如，将外科背景存储为所生成数据的元数据)。所确定的外科背景可能会影响哪个(些)特定数据库接收特定数据、多少数据被传输到接收方数据库、数据被传输的数据格式等。因此，计算机系统(例如，外科集线器)然后可根据所确定的外科背景将所收集的数据(具有或不具有其相关联的外科元数据)传输到特定的接收方数据库或特定的数据格式。在各种方面，外科背景可能会影响所传输的数据周围的比特大小、数量、分辨率和/或时间范围(例如，以特定采样率捕获的数据的样本数量)。因此，数据流动性范式允许相关数据库根据每个接收方数据库的需要来共享与每个数据库有关的数据。换句话讲，根据数据流动性范式共享数据的计算机系统可预测由计算机系统所接收的数据的潜在使用和需要，然后相应地将数据自动路由到接收方数据库或计算机系统。此外，外科背景可规定计算机系统传输数据的格式、计算机系统所传输的数据的广度等。
为了例示这些概念，图17为根据本公开的至少一个方面的示出了相关数据库之间的数据流动性的数据库系统的示图。在所描绘的方面，数据库系统212020包括各自可通信地连接在一起的第一数据库212022、第二数据库212024和第三数据库212026。在一个方面，数据库212022、212024、212026中的每一者被编程为以双向方式传达数据。换句话讲，当数据库212022、212024、212026中的一者中的特定数据集被更新并且更新的数据与数据库212022、212024、212026中的另一者相关时(由定义数据库212022、212024、212026之间的关系的特定数据流动性规则所规定)，更新了数据的数据库212022、212024、212026可将这些更新自动共享或传输到对应的数据库212022、212024、212026。
可根据数据库212022、212024、212026所表示的部门之间的关系来定义(例如，由数据库系统212020的管理员)规定不同数据库之间的数据流的数据流动性规则集。例如，一些部门(例如，手术室部门和病理部门或者手术室部门和用品部门)定期就在医疗设施中患者发生的医疗问题进行相互协作或协商。因此，数据流动性规则可规定，当在这些协作数据库中的一个协作数据库中对特定数据类型(或数据类型集)进行更新时，可将更新的数据的大部分或全部传输或链接到其它协作数据库。此外，例如，所传输的数据可包括通过外科态势感知所确定的背景元数据和其它附加或相关联的数据。另外，一些部门(例如，账单部门)只需要某些数据类型的一小部分。因此，数据流动性规则可规定，当对数据库中的特定数据类型(或数据类型集)进行更新时，仅将更新的数据的与接收方数据库相关的一小部分传输或链接到接收方数据库。例如，如果接收方数据库为账单部门数据库，则与账单数据库共享的数据可能仅包括手术代码、时间和医疗手术期间所消耗的消耗品，因为仅账单部门需要该数据。可以看出，只有与接收方数据库相关的数据才实际上被传输或链接到接收方数据库，这限制了对敏感患者数据的访问，防止了接收方被不需要的数据所淹没，并且使所需的数据传输带宽最小化，同时仍然允许所有连接的数据库相互无缝地更新。
在一个实施方式中，第一数据库212022可包括实验室数据库，第二数据库212024可包括EHR数据库，并且第三数据库212026可包括医院管理数据库。在数据流动性范式的这个实施方式中，实验室数据库和管理数据库可在彼此之间传输212028数据212029，实验室数据库和EHR数据库可在彼此之间传输212030数据212031，并且实验室数据库和管理数据库可彼此之间传输212032数据，如定义各种数据库之间的关系的特定数据流动性规则集所规定的。例如，实验室数据库可将包括完整实验室结果的数据212031自动传输212030到EHR数据库，以将实验室结果与对应的患者相关联，此后可从EHR数据库中检索实验室结果。作为另一个示例，实验室数据库可将包括已执行测试列表和其它详细信息的数据212029自动传输212028到医院管理数据库，然后可利用医院管理数据库来更新账单信息、根据需要重新订购测试用品等。此外，各种前述数据库之间的每个连接可以是双向的。例如，如果在EHR数据库中更新了患者的EHR以包括在给定医疗设施之外执行的其它测试结果，则这些测试结果同样可自动传输到实验室数据库，以供实验室工作人员考虑和评估。
在另一个实施方式中，计算机系统和/或链接数据库的网络可被配置成能够通过经由数据流动性范式连接各种部门的数据库来自动收集和编译由特定治疗方案产生的外科结果，从而允许将所有与患者的治疗有关的数据聚集并且无缝地整合在一起。通过将患者结果数据与患者治疗数据自动编译，可更准确地跟踪患者护理，并且可针对治疗方案、外科手术和其它患者护理进行改进。在一些方面，通过以该部门的特定格式跨部门自动共享相关数据，可更轻松地传达数据，继而可使数据更轻松地呈现给患者、呈现在会议上、呈现在临床论文中等。在一些方面，数据可以标准格式记录在每个数据库中并且传输到其它连接的数据库，从而允许将任何给定数据库中的数据无缝集成到另一个兼容数据库中。
在一个方面，通过允许或使得在任何给定数据库中所收集的数据轻松地从一组专家流向另一组专家，可增强跨多个部门的协作。通过建立标准规则集，数据流动性范式允许数据在医疗设施的部门之间轻松地流动，医疗设施内的所有计算机系统都利用该标准规则集来传输或链接规定任何给定类型数据的目的地的数据、将传输到接收方数据库的数据的格式等。本文所述的结构化数据共享范式在该背景和其它背景下都是有益的，因为它们可确保收集正确的数据以供医师使用。通过允许计算机系统从相关数据库中自动检索必要的数据并且在添加或更改数据时使数据库彼此一致地进行更新，可避免在传输和转录数据时出现的人为错误、因接收部分不完整信息而出现的错误以及其它此类错误。
在一个方面，特定数据库中的一些或全部数据可响应于用户请求的流动性，而不是被自动传输或链接到另一数据库。因此，第一计算机系统可被编程为从第二计算机或数据库系统接收数据请求(例如，这可由用户发起)，然后传输所请求的数据和/或根据第二计算机系统所发送的身份或请求类型来定义由第一计算机系统和第二计算机系统存储的数据库之间的关系。例如，医师可从计算机系统发出数据请求，然后计算机系统从计算机系统链接到的相关数据库中自动收集和编译所请求的数据。这些方面可用于多种应用中，诸如个性化癌症药物。例如，计算机系统可通过允许肿瘤学家、外科医生和组织学家中的任一者检索与给定患者有关的所有治疗数据来将肿瘤学家、外科医生和组织学家联系起来，协作治疗患者。这继而允许医务人员跟踪患者的治疗情况，并且允许与患者护理相关联的个体轻松地检索和分析有关患者的数据，诸如肿瘤位置、边界、淋巴结剥离和化疗。通过让与患者治疗相关联的每个个体都能完全访问患者数据，可通过确保医务人员全面了解患者的治疗情况来改善随访和术后治疗。在一些方面，除了定义他们想要接收什么信息之外，计算机系统还可被编程为允许用户定义他们希望数据以何种格式呈现。因此，计算机系统可从对应的数据库检索所识别的信息、将数据转换为期望的格式，然后将数据呈现给用户。
图18示出了根据本文讨论的结构化数据共享范式的过程212100的一个示例，其中根据与数据相关联的外科背景来共享数据。如上文在标头“外科集线器(SURGICAL HUBS)”下所述，计算机系统(诸如外科集线器106、206(图1至图11))可连接到多种外科装置诸如外科器械、发生器、排烟器、显示器等或与它们配对。通过与这些外科装置的连接，当在外科手术期间使用这些装置时，外科集线器106、206可从这些成对的外科装置接收围手术期数据的阵列。此外，如上文在标头“态势感知(SITUATIONAL AWARENESS)”下所述，外科集线器106、206可至少部分地基于从这些连接的外科装置所接收的围手术期数据来确定正在执行的外科手术的背景(例如，手术类型或正在执行的手术步骤)。由外科集线器106、206通过态势感知所确定的外科背景可用于规定将哪些类型的所收集的数据传输到特定数据库、传输所收集的数据的格式等。因此，图18为根据本公开的至少一个方面的用于在数据库之间共享数据的过程212100的逻辑流程图。过程212100可由计算机系统的处理器或控制电路(诸如图10中所示的外科集线器206的处理器244)执行。因此，过程212100可体现为存储在存储器249中的计算机可执行指令集，该计算机可执行指令集在由处理器244执行时，使得计算机系统(例如，外科集线器206)执行所描述的步骤。
因此，执行过程212100的处理器244从连接的外科装置接收212102围手术期数据，并且至少部分地基于所接收的围手术期数据来确定212104外科背景，如上文在标头“态势感知(SITUATIONAL AWARENESS)”下所讨论的。
外科集线器206对所收集的数据进行的操作由外科集线器206正实施的结构化数据规则集来规定。根据外科背景和数据类型，外科集线器206可将数据(或其子集)传输到另一个数据库，设定存储在外科集线器206的存储器249中的数据库与另一个数据库(即，链接数据库的相关数据字段)之间的关系或采取其它此类动作。在示出的方面，处理器244基于所确定的外科背景和接收方数据库的身份将所收集的手术数据的至少一部分212106传输到一个或多个接收方数据库。外科数据可包括例如从外科装置接收的围手术期数据、经由态势感知(例如，外科手术类型或正在执行的外科手术步骤)所确定的外科背景数据、与外科装置相关联的元数据和/或外科背景等。此外，处理器244基于所确定的外科背景和接收方数据库的身份来设定212108存储在外科集线器存储器249中的所收集的外科数据的至少一部分与一个或多个接收方数据库之间的关系。换句话讲，外科集线器206根据结构化数据共享规则集在其数据库与其它数据库之间传输212106数据和/或设定212108它们之间的关系，该结构化数据共享规则集定义了哪些数据库将接收某些类型的数据或基于所确定的外科背景而链接到由外科集线器206所收集的某些类型的数据库。例如，外科集线器206可经由态势感知来确定在外科手术期间使用了许多不可重复使用的外科装置，并且因此将指示已使用的不可重复使用的装置的类型和数量的数据传输212106到可通信地连接到外科集线器206的购买数据库以用于重新订购那些不可重复使用的装置。因此，结构化数据共享规则集可定义，购买数据库接收与所消耗的不可重复使用的外科装置有关的数据，并且该数据将被传输到购买数据库。作为另一个示例，外科集线器206可确定外科手术已完成或很快将完成，并且因此设定212108其存储患者履历信息和外科手术类型的数据库中的数据与复苏部门数据库之间的关系以通知复苏工作人员准备接收患者。因此，结构化数据共享规则集可定义，复苏部门数据库接收与识别患者和外科类型有关的数据，并且该数据将被链接到复苏部门数据库。
在图19中描绘了过程212100的另一例示性实施方式。图19为根据本公开的至少一个方面的数据库系统212020的示图，其中在外科集线器数据库212130、EHR数据库212132和医院管理数据库212134之间共享特定数据。外科集线器数据库212130可收集由外科集线器206和/或与外科集线器206配对的任何外科装置生成的多种数据。例如，外科集线器数据库212130可存储患者姓名(或其它履历信息或识别信息)、患者所经历的外科手术、在外科手术期间利用的外科装置和其它产品的库存和/或外科手术的时长。此外，EHR数据库212132可存储与患者相关联的药物、诊断、重要器官和测试。更进一步，医院管理数据库212134可存储包括医院工作人员、调度、医疗用品存货、库存和账单信息的数据。计算机系统中的每个计算机系统都可能正在执行过程212100，并且因此可传输存储在其相应数据库中的数据或设定其数据库与其它数据库之间的关系，如管理数据库212130、212132、212134中的每个数据库系统之间的交互作用的特定数据共享规则集所规定的。
如上面所讨论的，数据库只能与其它连接的数据库共享它们存储的数据的子集。此外，根据接收方数据库所需的数据，每个数据库所存储的数据的不同子集可与不同的数据库共享。例如，存储在每个数据库内的数据都可组织成数据类别，并且结构化数据共享规则集可规定例如哪些数据类别与其它数据库共享。例如，图20描绘了数据库系统212020的EHR数据库212052和医院管理数据库212054可存储的若干个例示性数据类别212056。在所描绘的实施方式中，包括付款人和账单数据作为子类别的营业所数据类别与医院管理数据库212054共享(即，传输到或链接到该数据库)。EHR数据库212052和医院管理数据库212054的其它数据类别212056不与其它数据库共享或与其它数据库共享，如特定结构化数据共享规则集所定义的。
存储定义数据库系统212020的数据库212130、212132、212134的计算机系统可经由例如网络可通信地链接在一起。在一些方面，计算机系统可以是云计算系统，如上文在标头“云系统硬件和功能模块(CLOUD SYSTEM HARDWARE AND FUNCTIONAL MODULES)”下所描述。在一些方面，可由单个计算机系统存储多个数据库。在一些方面，可经由分布式计算通信协议来连接计算机系统。
在一个方面，用户还可定义他们希望医疗设施的计算机系统(诸如外科集线器106、206(图1至图11))经由例如由医疗设施的网络中的计算机系统所提供的用户界面所收集的数据类型。例如，用户可规定他们希望医疗设施中的外科集线器206针对特定类型的外科器械收集特定类型的数据。因此，可将请求推送到医疗设施网络内的外科集线器206，此后外科集线器206将收集该类型的外科器械，如果它们还没有这样做的话。外科集线器206可根据用户的要求收集术中或术后数据。一旦输入了请求，如上所述，就可与用户根据结构化数据共享规则集所定义的数据库共享所收集的数据。此后，可将用户期望的数据传输、链接或以其它方式提供给用户。这些方面可用于进行外科器械性能、患者预后与外科手段之间的相关性等研究。在一些方面，可将所请求的数据转发给医疗设施网络内部或外部的其它用户。在一些方面，可根据用户的需要保存并且重复数据请求。在一些方面，数据请求可进行预定时间段或无限期地进行(直到用户终止)。在一些方面，用户可通过检索与所请求的数据相关联的元数据来跟踪所请求的数据，或者以其它方式请求与所请求的数据相关联的其它数据。例如，用户可输入要提供外科装置成功率的请求。因此，每个外科集线器206或其它计算机系统可监测每个外科手术的进程以及与其相关联的装置成功率。此外，用户可使得外科集线器206或其它计算机系统路由外科装置成功率数据以将其传输到重新订购部门(例如，使得他们知道不要重新订购成功率低的外科装置)以及任何其它期望的部门。
在各种方面，执行结构化数据共享范式的数据库系统可通过其中的外科集线器206监测发生在手术室中的活动，并且将相关数据自动路由到相关部门，以便提高医疗设施的效率和功能。在一个方面，外科集线器206可被配置成能够经由例如状况感知来监测外科手术的进程、外科装置成功率以及其它手术室数据。外科集线器206与医疗设施中的其它数据库无缝地共享和传达数据的能力可能具有很多有益效果。例如，外科集线器206可通过结构化数据共享与重新订购部门自动共享关于外科器械利用率的数据，使得他们知道例如不要重新订购成功率低的外科装置。作为另一个示例，外科集线器206可与药房自动共享关于外科结果的数据，使得他们知道例如由于延长的外科手术，患者可能需要额外的止痛药。作为又一个示例，外科集线器206可自动共享关于在外科手术期间采用的任何活检样本或需要由病理部分进行测试的其它组织样本的数据，使得他们知道例如要准备接收组织。作为又一个示例，外科集线器206可与医疗用品部门自动共享关于外科手术期间流体(例如，血液)的消耗的数据，使得他们知道在手术室用品耗尽时要订购备用用品。作为又一个示例，外科集线器206可与医疗用品部门自动共享有关即将进行的手术的数据，使得他们在手术之前知道例如要准备好手术室特异性药物、止血剂和愈合影响剂(例如，基质金属蛋白酶抑制剂)。在提前准备好用品的情况下，可及时将它们送到手术室，从而使外科手术能够按时进行，并且医疗用品也能保持在正确的使用温度。对于某些类型的药物(诸如纤维蛋白和凝血酶)，使用温度可能很重要。纤维蛋白和凝血酶是必须在室温下分配的冷藏生物活性剂。如果外科手术需要药剂，那么对于该手术而言，将助剂保持在手术所需的正确温度就很关键。通过结构化数据共享，调度数据库可与医疗设施中的所有其它相关数据库共享调度的外科手术时间，从而确保所有相关部门对于每个手术的开始时间都是最新的。如果在手术开始时需要药剂，则可向医疗设施人员提供外科手术开始的精确时间，因此能够知道在那个时间递送药剂。如果在手术期间需要药剂，则执行态势感知系统的外科集线器206可在手术开始后进一步监测外科手术的进程并且通过结构化数据共享来更新有关外科手术状态的其它相关数据库，使得医疗设施人员知道应将期望的药剂送至手术室的准确时间，以便将它们保持在适当的使用温度下。因此，手术室背景中的结构化数据共享可确保在正确的时间、正确的温度下准备好试剂，而不会对试剂造成任何损害。作为又一个示例，外科集线器206可监测外科手术的进程(例如，经由态势感知)并且与清洁部门自动共享手术进程，使得他们知道预计何时移交手术室以便进行下一手术，这继而通过促进清洁过程以及为后续手术准备外科设施，来帮助整个医院的物流和调度。
在一个方面，计算机系统(例如，外科集线器206)可被编程为跟踪外科装置的使用及其在医疗设施中的移动，以例如收集外科装置在其整个生命周期中的数据。此类数据可包括外科装置已灭菌、修复和/或保持在库存中的次数，或者外科装置在每个相应部门保持的时间。通过从每个相关部门的数据库中接收外科装置的位置数据(例如，当将外科装置带到部门时，可将其扫描到该部门中，这会生成外科装置位置的记录)、外科装置的修复和维护记录等，计算机系统可通过结构化数据共享来以这种方式跟踪外科装置。此类数据可用于评估医疗设施中利用的所有医疗产品的价值、成本和效率。
在一个方面，计算机系统可被编程为允许患者提供自我报告的数据。在各种方面，可经由计算机终端将自我报告的数据直接输入到医疗设施计算机系统的数据库中，或者患者可使得个人电子装置(或另一个人数据收集装置)将所收集的信息自动传输到指定的接收方数据库。自我报告的数据可包括例如来自测试设备的血糖记录，诸如连续血糖监测器、胰岛素泵、人工胰腺数据等。自我报告的数据还可包括例如来自活动监测器(例如，Fitbit或Apple Watch)的数据，这些活动监测器被配置成能够收集活动数据、位置数据和其它类型的数据。活动监测器可提供例如活动水平数据(例如，行进的距离、活动的分钟数、采取的步数、经过的楼梯的飞行数)、睡眠数据(例如，睡眠周期、持续时间和阶段)、心率监测数据(例如，静息心率、指定心率区中的时间百分比，其可由年龄和心率变异性确定)、营养信息、水摄入量、卡路里燃烧量等。当上载到接收方数据库时，接收方数据库然后可在某些方面根据结构化数据共享规则集与其它连接的装置自动共享相关的自我报告的患者数据。
对于结构化数据共享，一个问题是数据访问权限只被授予适当的接收方。因此，所有数据请求和所有链接数据库的请求都必须经过验证和授权，以防止未经授权的接收方访问数据。图21为根据本公开的至少一个方面的示出了用于医疗设施计算机网络212203的安全和授权系统212200的示图。安全和授权系统212200可包括例如防火墙212202，以调节传入和传出的数据通信，诸如来自试图连接到医疗设施计算机网络212203的计算机系统的通信请求212201。通信请求212201可包括例如对于从医疗设施计算机网络212203传输特定数据或数据类型的请求、在医疗设施计算机网络212203中的数据库与外部数据库之间建立关系或链接的请求等。在一个方面，通信请求212201可要求授予安全密钥访问医疗设施计算机网络212203的权限。在一种实施方式中，当医疗设施计算机网络212203接收到通信请求212201时，防火墙212202仅在例如安全密钥对应于授权数据库212208中存储的有效安全性的情况下才允许访问医疗设施计算机网络212203。因此，具有有效安全密钥的授权请求212204将被授予访问医疗设施计算机网络212203的权限，而缺乏有效安全密钥的未授权请求212206将被防火墙212202拒绝访问。
因此，本文所述的结构化数据共享范式(即数据流动性和数据互操作性)可促进数据在整个医疗设施(或互连医疗设施的网络)中的移动。通过无缝地共享数据，使得每个互连的数据库始终能够访问在医疗设施中生成的与其部门相关的所有数据，结构化数据共享范式允许医疗设施更有效地操作并且提供更好的患者结果。
外科手术成本分析
在一些方面，本文所述的计算机系统被编程为诸如通过计算与在外科手术或治疗期间使用的所有物品相关联的总成本来提供对与任何给定的外科手术或治疗相关联的总成本的清晰全面分析。此类功能可提供一系列有益效果，包括允许管理员准确地了解医疗设施的支出情况和支出方式、针对特定类型的外科手术提供具有成本效益的产品组合的建议、识别何时应更换可重复使用的物品、确定外科器械和外科手术期间使用的其它物品的磨损程度等。此外，该经济数据可与有关治疗或外科结果的数据集成在一起，使得用户能够提供额外的分析，或者使系统可向用户提供建议。有关治疗或外科结果的数据可通过例如结合图12至图13所述的云计算系统来确定或可从医学文献上载到计算机系统。例如，Daniel L.Miller等人的Impact of Powered and Tissue-Specific EndoscopicStapling Technology on Clinical and Economic Outcomes of Video-AssistedThoracic Surgery Lobectomy Procedures:A Retrospective,Observational Study,Advances in Therapy，2018年5月，35(5)，第707-723页展示了若干种能够同时考虑经济数据和结果数据的方式。例如，Miller等人证明电动缝合器伴随有较少的止血相关并发症和较低的手术成本，与其它器械类型(例如，手动缝合器)相比，特定器械类型(例如，电动缝合器)伴随有更低的止血相关并发症，并且患有慢性阻塞性肺疾病(COPD)的患者的效应量更大。因此，计算机系统可被编程为呈现经济数据，该经济数据示出了与给定手术的特定产品组合相关联的成本以及与不同产品组合相关联的所得结果数据，以考虑到与不同器械和患者病史相关的结果，允许外科医生和医院管理者做出明智的决定，即决定应利用哪些外科器械和其它外科装置进行外科手术。
因此，本文描述了用于分析用于外科手术的外科器械和外科装置的总成本(包括内部成本和维修成本两者)的系统和方法。在一个方面，计算机系统(例如，外科集线器)可被编程为提供对在外科手术中使用的所有器械和装置的综合成本的实时分析，包括与两个可重复使用的器械相关联的成本(例如，维护、清洁和重新灭菌成本)以及和不可重复使用的装置相关联的成本(例如，更换成本)。在一些方面，计算机系统可利用例如上文在标头“结构化数据共享(STRUCTURED DATA SHARING)”下所描述的数据共享范式以例如通过在购买数据库之间接收或共享数据来确定不可重复使用的外科装置的更换成本。在一些方面，计算机系统可利用例如上文在标头“结构化数据共享(STRUCTURED DATA SHARING)”下所描述的数据共享范式以例如通过在多种医疗设施数据库之间接收或共享数据以跟踪整个医疗设施中的装置来确定可重复使用的外科装置的实际维护成本。通过跟踪装置在整个医疗设施中运输过程中的存货、灭菌和其它内部维护过程，计算机系统可根据维护外科装置实际花费的时间和资源来计算维护成本。
在一个方面，在医疗设施中的各种计算机系统(例如，外科集线器)可生成、存储和共享指示每个外科装置何时以及如何与各种计算机系统中的每一个相互作用的元数据。例如，当将外科装置带入手术室并且连接到定位在该OR内的外科集线器时，外科集线器可生成与该手术器械相关联的指示外科器械的日期、时间和位置的元数据，然后存储该元数据并且与网络中的其它计算机系统共享该元数据。因此，本文所述的计算机系统可根据其相关联的元数据来跟踪外科器械。在一个方面，计算机系统(例如，外科集线器)可被编程为检索或以其它方式接收在外科手术的过程期间利用的所有外科装置的元数据，以在整个术前和术后过程中跟踪它们，包括它们的位置、状态、安装在其中的更换零件、已应用的修复以及清洁时间。因此，计算机系统可跟踪在医疗设施中流通的外科装置的成本和利用率。
在一个方面，计算机系统(例如，外科集线器)可被编程为跟踪经重新灭菌或以其它方式重复使用的装置的使用次数。计算机系统还可被编程为根据使用次数是否达到或超过使用阈值来确定装置何时达到其使用寿命。在另一个方面，计算机系统(例如，外科集线器)可被编程为确定外科装置的维护成本，确定外科装置的更换成本(例如，通过从购买数据库获取更换成本)以及然后根据维护成本是否超过更换成本来确定是否应更换手术装置。因此，计算机系统可执行成本分析算法以用于在整个医疗设施中跟踪外科装置、分析与外科装置相关的成本并且向用户提供建议。
图22为根据本公开的至少一个方面的可由计算机系统(诸如外科集线器210504)执行的成本分析算法的框图210500。在一个方面，外科中心210504(或另一计算机系统)可执行成本分析模块210502。成本分析模块210502可包括例如体现为存储在外科集线器210504的存储器249(图10)中的计算机指令集的算法，该计算机指令集可由处理器244(图10)或其控制电路执行以执行所描述的过程。成本分析模块210502可被配置成能够通过访问或接收来自各种数据源的数据(诸如经由上文在标头“结构化数据共享(STRUCTUREDDATA SHARING)”下所讨论的数据共享范式)来在医疗设施的整个清洁、修复和重新灭菌过程中跟踪可重复使用的装置(例如，外科器械)。在一个方面，成本分析模块210502针对每个外科装置接收多种跟踪数据210506。如图22中所指出的，跟踪数据210506可包括多种不同类别的数据，包括购买数据、灭菌数据、修复和维护数据、手术室历史数据、库存数据、再处理数据、器械是被丢弃还是退出使用等。前述类别的跟踪数据210506还可包括定时数据(例如，外科装置在医疗设施内的特定位置处所花费的时间)、零件数据(例如，外科装置是否已修复以及外科器械的哪些零件得到维修)、成本数据(例如，外科装置、用于维护外科装置的零件或产品的成本)等。此外，成本分析模块210504可基于来自跟踪数据210506的输入输出一个或多个建议210508(诸如手术室建议)(例如，给定外科手术的特定产品组合是否比当前产品组合更具成本效益)、价值分析委员会(VAC)的建议(例如，当存在一种经济有效的替代方案来代替医生的首选项目时)、医院财务建议(例如，需要订购多少特定产品)和装置制造商(例如，特定制造商的外科器械是否更具成本效益)。
跟踪与每个外科装置相关联的总护理和维护相关联的所有各种成本，允许成本分析模块210502在外科产品的不同混合物之间提供真正的一对一比较。因此，用户可利用成本分析模块210502进行成本分析，或者成本分析模块210502可自动执行此类分析并且向用户提出建议，以更有效地利用医院资源，确定医疗设施系统内的瓶颈并且提供有关如何改进它们的建议、确定耗费时间或金钱的特定产品太少或太多的时间等。
如上所述，医疗设施内的各种计算机系统(例如，外科集线器)可通过生成、存储和共享指示每个外科装置何时以及如何与各种计算机系统中的每一个进行交互的元数据来在每个单独的外科装置通过医疗设施的工作流进行处理时跟踪这些外科装置。例如，图23为根据本公开的至少一个方面的示出了用于通过医疗设施210700的外科装置210702的工作流的框图。例示性医疗设施210700包括各种部门，包括外科手术部门210706、灭菌部门210708、维护部门210710和库存或储存部门210712。特定外科装置210702(例如，其可为可重复使用的外科装置)的工作流规定，一旦外科装置210702在外科手术之后离开外科手术部门210706，就将外科装置带到灭菌部门210708，然后带到维护部门210710，然后带到储存部门210712，此后可将其再次用于外科手术中。每个部门都具有它们自己的计算机系统210704，以用于在外科装置210702移动穿过医疗设施210700时监测外科装置。计算机系统210704可利用多种不同的技术来识别外科装置210702的存在。在一个方面，计算机系统210704可包括诸如RFID读取器的扫描仪，当它们被带到每个部门或与每个部门交互作用时，可被用于识别外科装置210702。在另一个方面，计算机系统210704可包括集线器诸如外科集线器106、206、7006(图1至图13)或机器人集线器222(图9)，这些集线器被配置成能够在外科装置210702被带到每个集线器的附近时与这些外科装置自动配对并且识别这些外科装置。在这些方面中的任一方面，每个计算机系统210704都能够在其与外科装置210702配对或以其它方式识别它们时，生成与这些外科装置相关联的元数据。然后，可利用上文在标头“结构化数据共享(STRUCTURED DATA SHARING)”下所述的数据流动性和其它数据共享技术，与整个医疗设施210700中的其它计算机系统210704共享该元数据，使得计算机系统210704可在其整个工作流中跟随外科装置210702。此外，可根据装置类型或其它参数来聚集每个给定外科装置210702的元数据。用户可使用根据数据流动性范式在彼此之间共享数据的计算机系统210704来分析单独或某些类型的外科装置210702的元数据，以显示外科装置210702的位置、在特定部门的工作时间、外科手术装置210702已经过处理的次数(例如，从其最后位置到达其当前位置)等。
然后，其它过程或算法可利用此位置的外科装置元数据。例如，计算机系统210704可确定特定外科装置210702位于外科装置210702的工作流中的前一部门的时间，然后自动提示或通知工作人员准备接收外科装置210702(例如，当外科手术装置210702处于外科手术部门210706中并且预计被送到灭菌部门210708时，准备好灭菌用品)。作为另一个示例，计算机系统210704可确定在外科手术中使用外科装置210702的时间或清洗的阈值次数，然后通知工作人员订购外科装置210702的更换零件或处置外科装置210702。另选地，计算机系统210704可在阈值使用次数之后自动为外科装置210702订购更换零件。此类过程减少或消除了医疗设施210700在现场过多存放更换零件、清洁产品和其它此类产品的需要。
在另一个方面，计算机系统210704可被编程为结合成本分析模块210502生成的经济数据，比较和分析实际的术后结果与预测的术后结果。例如，可基于预测的外科结果来计算预测的再次手术成本。更具体地，计算机系统210704可被编程为检索数据(例如，医学文献数据外科结果，其被上载到计算机系统210704可访问的数据库)或确定(例如，通过结合图12至图13所描述的云计算系统)从外科手术中获得的预期结果，然后基于其针对每个潜在结果所跟踪的成本，计算与结果范围相关的成本。然后，当用户请求帮助与任何给定外科手术相关联的总成本分析时，可将与外科手术的结果相关联的成本范围呈现给用户。作为另一个示例，计算机系统210704还可被编程为建议改进外科手术和/或外科装置210702，以减少再次手术的可能性，并且因此减少额外的成本。作为又一个示例，计算机系统210704可被编程为通过跟踪每个给定手术类型之后的平均术后患者住院时间以及与之相关联的总成本、在每个给定手术类型之后施用给患者的平均药物类型数量、与处理和提供这些药物相关联的总成本等来评估与预测的术后结果治疗相关的成本。
图24为根据本公开的至少一个方面的用于计算与外科手术相关联的总成本的过程210600的逻辑流程图。在以下对过程210600的描述中，还应当参考图10和图22至图23。过程210600可由计算机系统的处理器或控制电路(诸如图10中所示的外科集线器206的处理器244)执行。因此，过程210600可体现为存储在存储器249中的计算机可执行指令集，该计算机可执行指令集在由处理器244执行时使得计算机系统(例如，外科集线器206)执行所描述的步骤。
如上文在标头“外科集线器(SURGICAL HUBS)”下所述，外科集线器206可连接到多种外科装置，诸如外科器械、发生器、排烟器、显示器等。通过它们与这些外科装置的连接，当在外科手术期间使用这些装置时，外科集线器206可从这些成对的外科装置接收围手术期数据的阵列。此外，如上文在标头“态势感知(SITUATIONAL AWARENESS)”下所述，外科集线器206可至少部分地基于从这些连接的外科装置接收的围手术期数据来确定所执行的外科手术的背景(例如，手术类型或正在执行的手术步骤)。因此，执行过程210600的处理器244确定210602是否正在经由例如由外科集线器206执行的态势感知系统来执行外科手术。因此，处理器244确定210604在外科手术期间正在利用哪些外科装置。在一个方面，处理器244可通过检测哪些外科装置连接到外科集线器206、哪些装置正在被主动供电(例如，是否向超声或RF电外科器械提供能量)、通过在整个手术室中设置的相机系统在视觉上识别外科医生正在握持或操纵哪些装置、通过确定外科工作人员正在执行手术的哪一步并且由此推断出当前正在利用哪些装置等等来确定210604在任何给定时间正在使用哪些外科装置。
因此，对于在外科手术期间正在或已经使用的每个外科装置，处理器244确定210606该外科装置是可重复使用的还是不可重复使用的。处理器244可通过查询列出每个特定物品是否可重复使用的数据库、检索针对该外科装置的制造商规格或检索与该外科装置相关联的元数据以例如探知该物品是先前已被使用还是旨在多次使用来确定210606外科装置是否是可重复使用的。如果给定的外科装置是可重复使用的，则该过程沿着“是”分支进行，并且处理器244确定210608该装置的维护成本。维护成本可包括修复成本、重新灭菌成本、清洁成本等。处理器244可使用上面讨论的技术来确定210608维护成本，即跟踪与给定外科装置相关联的元数据以确定外科装置在其工作流期间进行维护步骤多长时间以及采取哪种类型的维护步骤。如果给定的外科装置是不可重复使用的，则该过程沿着“否”分支进行，并且处理器244确定20610装置的更换成本。处理器244可通过查询与医疗设施210700相关联的购买数据库以检索例如给定外科装置的购买价格来确定210610更换成本。
在各种方面，过程210600计算与在外科手术期间所使用的每个外科装置相关联的成本，以便计算与外科手术相关联的完整成本。因此，如上面所讨论的，处理器244确定210612是否经由例如态势感知系统来完成外科手术。如果该手术没有完成，则过程210600沿着“否”分支进行，并且处理器244继续监测正在利用或消耗哪些外科装置的循环，直到该手术完成为止。如果该手术完成，则过程210600沿着“是”分支进行，并且处理器244基于在外科手术期间利用的外科装置的聚集的维护和更换成本来确定210614外科手术的总成本。
实施例
本文所述主题的各种方面在以下编号的实施例中陈述：
实施例1：一种计算机系统，该计算机系统被配置成能够可通信地耦接到多个外科装置。该计算机系统包括处理器和耦接到该处理器的存储器。该存储器存储指令，这些指令在由处理器执行时使得计算机系统：至少部分地基于从多个外科装置中的一个或多个外科装置接收的围手术期数据来确定在外科手术期间利用多个外科装置中的哪些外科装置；确定在所述外科手术期间利用的所述多个外科装置中的每个外科装置是可重复使用的外科装置还是不可重复使用的外科装置；确定每个可重复使用的外科装置的维护成本；确定每个不可重复使用的外科装置的更换成本；以及根据每个可重复使用的外科装置的维护成本和每个不可重复使用的外科装置的更换成本来确定用于外科手术的多个外科装置的总成本。
实施例2：根据实施例1所述的计算机系统，其中，维护成本包括以下中的至少一项：清洁成本、重新灭菌成本、修复成本或它们的任何组合。
实施例3：根据实施例1或2所述的计算机系统，其中，该存储器还存储指令，这些指令在由处理器执行时使得计算机系统：确定维护成本是否超过每个可重复使用的外科装置的更换成本；以及为维护成本超过更换成本的每个可重复使用的外科装置提供更换建议。
实施例4：根据实施例1至3中任一项所述的计算机系统，其中，该存储器还存储指令，这些指令在由处理器执行时使得计算机系统：确定每个可重复使用的外科装置的使用次数；以及为使用次数超过阈值的每个可重复使用的外科装置提供更换建议。
实施例5：根据实施例1至4中任一项所述的计算机系统，其中，该存储器还存储指令，这些指令在由处理器执行时使得计算机系统：检索与每个可重复使用的外科装置相关联的元数据，该元数据存储以下至少一项：可重复使用的外科装置的位置、针对位置的时间长度、可重复使用的外科装置的使用次数或它们的任何组合；以及根据元数据来确定每个可重复使用的外科装置的维护成本。
实施例6：根据实施例1至5中任一项所述的计算机系统，其中，该存储器还存储指令，这些指令在由处理器执行时使得计算机系统从购买数据库中检索与每个不可重复使用的外科装置相关联的购买价格，其中更换成本对应于购买价格。
实施例7：根据实施例1至6中任一项所述的计算机系统，其中，该计算机系统包括外科集线器。
实施例8：一种计算机系统，包括处理器和耦接到该处理器的存储器。该存储器存储指令，这些指令在由处理器执行时使得计算机系统：根据从一个或多个外科装置接收的围手术期数据来识别在外科手术期间利用的一个或多个外科装置；以及根据与一个或多个外科装置中的每个外科装置相关联的维护成本或更换成本来确定用于外科手术的一个或多个外科装置的总成本。
实施例9：根据实施例8所述的计算机系统，其中，维护成本包括以下中的至少一项：清洁成本、重新灭菌成本、修复成本或它们的任何组合。
实施例10：根据实施例8或9所述的计算机系统，其中，该存储器还存储指令，这些指令在由处理器执行时使得计算机系统：确定维护成本是否超过每个可重复使用的外科装置的更换成本；以及为维护成本超过更换成本的每个可重复使用的外科装置提供更换建议。
实施例11：根据实施例8至10中任一项所述的计算机系统，其中，该存储器还存储指令，这些指令在由处理器执行时使得计算机系统：确定每个可重复使用的外科装置的使用次数；以及为使用次数超过阈值的每个可重复使用的外科装置提供更换建议。
实施例12：根据实施例8至11中任一项所述的计算机系统，其中，该存储器还存储指令，这些指令在由处理器执行时使得计算机系统：检索与每个可重复使用的外科装置相关联的元数据，该元数据存储以下中的至少一项：可重复使用的外科装置的位置、针对位置的时间长度、可重复使用的外科装置的使用次数、或它们的任何组合；以及根据元数据来确定每个可重复使用的外科装置的维护成本。
实施例13：根据实施例8至12中任一项所述的计算机系统，其中，该存储器还存储指令，这些指令在由处理器执行时使得计算机系统从购买数据库中检索与每个不可重复使用的外科装置相关联的购买价格，其中更换成本对应于购买价格。
实施例14：根据实施例8至13中任一项所述的计算机系统，其中，该计算机系统包括外科集线器。
实施例15：一种用于确定外科手术的外科装置成本的由计算机实现的方法。该方法包括：由计算机系统至少部分地基于从多个外科装置中的一个或多个外科装置接收的围手术期数据来确定在外科手术期间利用多个外科装置中的哪些外科装置；由所述计算机系统确定在所述外科手术期间利用的所述多个外科装置中的每个外科装置是可重复使用的外科装置还是不可重复使用的外科装置；由所述计算机系统确定每个可重复使用的外科装置的维护成本；由所述计算机系统确定每个不可重复使用的外科装置的更换成本；以及由计算机系统根据每个可重复使用的外科装置的维护成本和每个不可重复使用的外科装置的更换成本来确定用于外科手术的多个外科装置的总成本。
实施例16：根据实施例15所述的由计算机实现的方法，其中，维护成本包括以下中的至少一项：清洁成本、重新灭菌成本、修复成本或它们的任何组合。
实施例17：根据实施例15或16所述的由计算机实现的方法，还包括：由计算机系统确定维护成本是否超过每个可重复使用的外科装置的更换成本；以及由计算机系统为维护成本超过更换成本的每个可重复使用的外科装置提供更换建议。
实施例18：根据实施例15至17中任一项所述的由计算机实现的方法，还包括：由计算机系统确定每个可重复使用的外科装置的使用次数；以及由计算机系统为使用次数超过阈值的每个可重复使用的外科装置提供更换建议。
实施例19：根据实施例15至18中任一项所述的由计算机实现的方法，还包括：由计算机系统检索与每个可重复使用的外科装置相关联的元数据，该元数据存储以下中的至少一项：可重复使用的外科装置的位置、针对位置的时间长度、可重复使用的外科装置的使用次数或它们的任何组合；以及由计算机系统根据元数据确定每个可重复使用的外科装置的维护成本。
实施例20：根据实施例15至19中任一项所述的由计算机实现的方法，还包括由计算机系统从购买数据库中检索与每个不可重复使用的外科装置相关联的购买价格，其中更换成本对应于购买价格。
实施例21：根据实施例15至20中任一项所述的由计算机实现的方法，其中，该计算机系统包括外科集线器。
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，也可使用其它材料。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)可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)、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、形成由计算机程序构造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构造的通用计算机，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构造的微处理器)、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，通信装置可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，收发器可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它此类信息存储、传输或显示装置内的物理量的其它数据。
一个或多个部件在本文中可被称为“被配置成能够”、“可被配置成能够”、“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“被配置成能够”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量为预期的，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量，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量(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，或其它改变的排序。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、陈述或其它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)
1.一种计算机系统，所述计算机系统被配置成能够可通信地耦接到多个外科装置，所述计算机系统包括：
处理器；以及
存储器，所述存储器耦接到所述处理器，所述存储器存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
至少部分地基于从所述多个外科装置中的一个或多个外科装置接收的围手术期数据来确定在外科手术期间利用所述多个外科装置中的哪些外科装置；
确定在所述外科手术期间利用的所述多个外科装置中的每个外科装置是可重复使用的外科装置还是不可重复使用的外科装置；
确定每个可重复使用的外科装置的维护成本；
确定每个不可重复使用的外科装置的更换成本；以及
根据每个可重复使用的外科装置的所述维护成本和每个不可重复使用的外科装置的所述更换成本来确定用于所述外科手术的所述多个外科装置的总成本。
2.根据权利要求1所述的计算机系统，其中，所述维护成本包括以下中的至少一项：清洁成本、重新灭菌成本、修复成本或它们的任何组合。
3.根据权利要求1所述的计算机系统，其中，所述存储器还存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
确定所述维护成本是否超过每个可重复使用的外科装置的所述更换成本；以及
为所述维护成本超过所述更换成本的每个可重复使用的外科装置提供更换建议。
4.根据权利要求1所述的计算机系统，其中，所述存储器还存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
确定每个可重复使用的外科装置的使用次数；以及
为所述使用次数超过阈值的每个可重复使用的外科装置提供更换建议。
5.根据权利要求1所述的计算机系统，其中，所述存储器还存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
检索与每个可重复使用的外科装置相关联的元数据，所述元数据存储以下中的至少一项：所述可重复使用的外科装置的位置、针对所述位置的时间长度、所述可重复使用的外科装置的使用次数或它们的任何组合；以及
根据所述元数据来确定每个可重复使用的外科装置的所述维护成本。
6.根据权利要求1所述的计算机系统，其中，所述存储器还存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
从购买数据库中检索与每个不可重复使用的外科装置相关联的购买价格；
其中所述更换成本对应于所述购买价格。
7.根据权利要求1所述的计算机系统，其中，所述计算机系统包括外科集线器。
8.一种计算机系统，包括：
处理器；以及
存储器，所述存储器耦接到所述处理器，所述存储器存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
根据从所述一个或多个外科装置接收的围手术期数据来识别在外科手术期间利用的一个或多个外科装置；以及
根据与所述一个或多个外科装置中的每个外科装置相关联的维护成本或更换成本来确定用于所述外科手术的所述一个或多个外科装置的总成本。
9.根据权利要求8所述的计算机系统，其中，所述维护成本包括以下中的至少一项：清洁成本、重新灭菌成本、修复成本或它们的任何组合。
10.根据权利要求8所述的计算机系统，其中，所述存储器还存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
确定所述维护成本是否超过每个可重复使用的外科装置的所述更换成本；以及
为所述维护成本超过所述更换成本的每个可重复使用的外科装置提供更换建议。
11.根据权利要求8所述的计算机系统，其中，所述存储器还存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
确定每个可重复使用的外科装置的使用次数；以及
为所述使用次数超过阈值的每个可重复使用的外科装置提供更换建议。
12.根据权利要求8所述的计算机系统，其中，所述存储器还存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
检索与每个可重复使用的外科装置相关联的元数据，所述元数据存储以下中的至少一项：所述可重复使用的外科装置的位置、针对所述位置的时间长度、所述可重复使用的外科装置的使用次数或它们的任何组合；以及
根据所述元数据来确定每个可重复使用的外科装置的所述维护成本。
13.根据权利要求8所述的计算机系统，其中，所述存储器还存储指令，所述指令在由所述处理器执行时使得所述计算机系统：
从购买数据库中检索与每个不可重复使用的外科装置相关联的购买价格；
其中所述更换成本对应于所述购买价格。
14.根据权利要求8所述的计算机系统，其中，所述计算机系统包括外科集线器。
15.一种用于确定外科手术的外科装置成本的由计算机实现的方法，所述方法包括：
由计算机系统至少部分地基于从多个外科装置中的一个或多个外科装置接收的围手术期数据来确定在所述外科手术期间利用所述多个外科装置中的哪些外科装置；
由所述计算机系统确定在所述外科手术期间利用的所述多个外科装置中的每个外科装置是可重复使用的外科装置还是不可重复使用的外科装置；
由所述计算机系统确定每个可重复使用的外科装置的维护成本；
由所述计算机系统确定每个不可重复使用的外科装置的更换成本；以及
由所述计算机系统根据每个可重复使用的外科装置的所述维护成本和每个不可重复使用的外科装置的所述更换成本来确定用于所述外科手术的所述多个外科装置的总成本。
16.根据权利要求15所述的由计算机实现的方法，其中，所述维护成本包括以下中的至少一项：清洁成本、重新灭菌成本、修复成本或它们的任何组合。
17.根据权利要求15所述的由计算机实现的方法，还包括：
由所述计算机系统确定所述维护成本是否超过每个可重复使用的外科装置的所述更换成本；以及
由所述计算机系统为所述维护成本超过所述更换成本的每个可重复使用的外科装置提供更换建议。
18.根据权利要求15所述的由计算机实现的方法，还包括：
由所述计算机系统确定每个可重复使用的外科装置的使用次数；以及
由所述计算机系统为所述使用次数超过阈值的每个可重复使用的外科装置提供更换建议。
19.根据权利要求15所述的由计算机实现的方法，还包括：
由所述计算机系统检索与每个可重复使用的外科装置相关联的元数据，所述元数据存储以下中的至少一项：所述可重复使用的外科装置的位置、针对所述位置的时间长度、所述可重复使用的外科装置的使用次数或它们的任何组合；以及
由所述计算机系统根据所述元数据确定每个可重复使用的外科装置的所述维护成本。
20.根据权利要求15所述的由计算机实现的方法，还包括：
由所述计算机系统从购买数据库中检索与每个不可重复使用的外科装置相关联的购买价格；
其中所述更换成本对应于所述购买价格。
21.根据权利要求15所述的由计算机实现的方法，其中，所述计算机系统包括外科集线器。
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| EP3506311A1 (en) | 2019-07-03 |
| JP2021509329A (ja) | 2021-03-25 |
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| US11257589B2 (en) | 2022-02-22 |
| US20220230738A1 (en) | 2022-07-21 |
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| US20190206556A1 (en) | 2019-07-04 |
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