CN111758135A - 具有能够自主调整的控制程序的外科系统 - Google Patents
具有能够自主调整的控制程序的外科系统 Download PDFInfo
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Abstract
本发明公开了一种外科反馈系统，所述外科反馈系统包括外科器械、数据源和被配置成能够可通信地联接到所述数据源和所述外科器械的外科集线器。所述外科集线器包括控制电路，其中所述控制电路被配置成能够接收来自所述数据源的输入，针对存储的数据集分析所接收的数据以优化外科手术的结果，并且基于所分析的数据来传达推荐。
Description
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“SURGICAL SYSTEMS WITHAUTONOMOUSLY ADJUSTABLE CONTROL PROGRAMS”的美国非临时专利申请序列号16/182,233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“AUTOMATED DATA SCALING,ALIGNMENT,AND ORGANIZING BASED ON PREDEFINEDPARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION”的美国临时专利申请号62/729,177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“SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS”美国临时专利申请62/659,900的优先权，该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中。
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区。无菌区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件。在执行外科手术中利用各种外科装置和系统。
此外，在数字和信息年龄中，由于患者安全和对保持传统实践的普遍期望，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程序。然而，通常医疗系统和设施可能因此缺乏与其它相邻或处于类似位置的设施的通信和共享知识。为了改善患者实践，期望找到更好地帮助互连医疗系统和设施的方法。
发明内容
本发明公开了一种外科反馈系统。所述外科反馈系统包括外科器械、数据源和被配置成能够可通信地联接到所述数据源和所述外科器械的外科集线器。所述外科集线器包括控制电路，其中所述控制电路被配置成能够接收来自所述数据源的输入，针对存储的数据集分析所接收的数据以优化外科手术的结果，并且基于所分析的数据来传达推荐。
本发明公开了一种外科反馈系统。所述外科反馈系统包括数据源和具有控制电路的外科集线器。所述控制电路被配置成能够接收来自所述数据源的输入，针对存储的数据集分析所接收的数据以优化外科手术的结果，其中所述存储的数据集包括在先前的外科手术期间收集的数据，并且基于所分析的数据来传达推荐。
本发明公开了一种外科反馈系统。所述外科反馈系统包括数据源和具有控制电路的外科器械。所述控制电路被配置成能够接收来自所述数据源的输入，针对存储的数据集分析所接收的数据以优化外科手术的结果，其中所述存储的数据集包括在先前的外科手术期间收集的数据，并且基于所分析的数据确定推荐。
附图说明
然而，通过参考以下结合如下附图所作的说明可最好地理解本文所述的各个方面(均是有关手术的组织和方法)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接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个电力总线附接件，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示出了根据本公开的至少一个方面的计算机实现的交互式外科系统。
图10示出了根据本公开的至少一个方面的包括联接到模块化控制塔的多个模块的外科集线器。
图11示出了根据本公开的至少一个方面的通用串行总线(USB)网络集线器装置的一个方面。
图12为根据本公开的至少一个方面的云计算系统的框图，该云计算系统包括联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描绘根据计算的阈值的外科装置的例示性使用的正结果和负结果的曲线图。
图17为根据本公开的至少一个方面的描绘具有根据结果分组的各种特征的外科手术的框图。
图18为根据本公开的至少一个方面的描绘验证分析的图。
图19为根据本公开的至少一个方面的描绘验证分析的框图。
图20为根据本公开的至少一个方面的示出用于外科系统的算法的流程图。
具体实施方式
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，其标题为“SURGICAL NETWORK,INSTRUMENT,ANDCLOUD RESPONSES BASED ON VALIDATION OF RECEIVED DATASET AND AUTHENTICATION OFITS SOURCE AND INTEGRITY”；
·标题为“SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROMEXTERNAL DATA”的美国专利申请号16/182,230；
·美国专利申请16/182,239，其标题为“ADJUSTMENT OF DEVICE CONTROLPROGRAMS BASED ON STRATIFIED CONTEXTUAL DATA IN ADDITION TO THE DATA”；
·美国专利申请16/182,243，其标题为“SURGICAL HUB AND MODULAR DEVICERESPONSE ADJUSTMENT BASED ON SITUATIONAL AWARENESS”；
·美国专利申请16/182,248，其标题为“DETECTION AND ESCALATION OFSECURITY RESPONSES OF SURGICAL INSTRUMENTS TO INCREASING SEVERITY THREATS”；
·美国专利申请16/182,251，其标题为“INTERACTIVE SURGICAL SYSTEM”；
·美国专利申请16/182,260，其标题为“AUTOMATED DATA SCALING,ALIGNMENT,AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS”；
·美国专利申请16/182,267，其标题为“SENSING THE PATIENT POSITION ANDCONTACT UTILIZING THE MONO-POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONALAWARENESS TO A SURGICAL NETWORK”；
·美国专利申请16/182,249，其标题为“POWERED SURGICAL TOOL WITHPREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING END EFFECTORPARAMETER”；
·美国专利申请16/182,246，其标题为“ADJUSTMENTS BASED ON AIRBORNEPARTICLE PROPERTIES”；
·美国专利申请16/182,256，其标题为“ADJUSTMENT OF A SURGICAL DEVICEFUNCTION BASED ON SITUATIONAL AWARENESS”；
·美国专利申请16/182,242，其标题为“REAL-TIME ANALYSIS OF COMPREHENSIVECOST OF 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“USAGE AND TECHNIQUE ANALYSIS OFSURGEON/STAFF PERFORMANCE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATIONAND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES”；
·美国专利申请16/182,269，其标题为“IMAGE CAPTURING OF THE AREASOUTSIDE THE ABDOMEN TO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE INUSE”；
·美国专利申请16/182,278，其标题为“COMMUNICATION OF DATA WHERE ASURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVINGSYSTEM/USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TOESTABLISH CONTINUITY”；
·美国专利申请16/182,290，其标题为“SURGICAL NETWORK RECOMMENDATIONSFROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINEHIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION”；
·美国专利申请16/182,232，其标题为“CONTROL OF A SURGICAL SYSTEMTHROUGH A SURGICAL BARRIER”；
·美国专利申请16/182,227，其标题为“SURGICAL NETWORK DETERMINATION OFPRIORITIZATION OF COMMUNICATION,INTERACTION,OR PROCESSING BASED ON SYSTEM ORDEVICE NEEDS”；
·美国专利申请16/182,231，其标题为“WIRELESS PAIRING OF A SURGICALDEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGEAND SITUATIONAL AWARENESS OF DEVICES”；
·美国专利申请16/182,229，其标题为“ADJUSTMENT OF STAPLE HEIGHT OF ATLEAST ONE ROW OF STAPLES BASED ON THE SENSED TISSUE THICKNESS OR FORCE INCLOSING”；
·美国专利申请16/182,234，其标题为“STAPLING DEVICE WITH PREVIENT ANDDISCRETIONARY LOCKOUT BASED BASED PARAMETER”；
·美国专利申请16/182,240，其标题为“POWERED STAPLING DEVICE CONFIGUREDTO ADJUST FORCE,ADVANCEMENT SPEED,AND OVERALL STROKE OF CUTTING MEMBER BASEDON SENSED PARAMETER OF FIRING OR CLAMPING”；
·美国专利申请16/182,235，其标题为“VARIATION OF RADIO FREQUENCY ANDULTRASONIC 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“ULTRASONIC ENERGY DEVICE WHICHVARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE ATA CUT PROGRESSION 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“A CONTROL FOR A SURGICALNETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASEDON A SENSED SITUATION OR USAGE”；
·美国临时专利申请62/729,177，其标题为“AUTOMATED DATA SCALING,ALIGNMENT,AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN A SURGICALNETWORK BEFORE TRANSMISSION”；
·美国临时专利申请62/729,176，其标题为“INDIRECT COMMAND AND CONTROL OFA FIRST OPERATING ROOM SYSTEM THROUGH THE USE OF A SECOND OPERATING ROOMSYSTEM WITHIN A STERILE FIELD WHERE THE SECOND OPERATING ROOM SYSTEM HASPRIMARY AND SECONDARY OPERATING MODES”；
·美国临时专利申请62/729,185，其标题为“POWERED STAPLING DEVICE THAT ISCAPABLE OF ADJUSTING FORCE,ADVANCEMENT SPEED,AND OVERALL STROKE OF CUTTINGMEMBER OF THE DEVICE BASED ON SENSED PARAMETER OF FIRING OR CLAMPING”；
·美国临时专利申请62/729,184，其标题为“POWERED SURGICAL TOOL WITH APREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE ENDEFFECTOR PARAMETER AND A MEANS FOR LIMITING THE ADJUSTMENT”；
·美国临时专利申请62/729,182，其标题为“SENSING THE PATIENT POSITIONAND CONTACT UTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDESITUATIONAL AWARENESS TO THE HUB”；
·美国临时专利申请62/729,191，其标题为“SURGICAL NETWORKRECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST ABASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION”；
·美国临时专利申请62/729,195，其标题为“ULTRASONIC ENERGY DEVICE WHICHVARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE ATA CUT PROGRESSION LOCATION”；以及
·美国临时专利申请62/729,186，其标题为“WIRELESS PAIRING OF A SURGICALDEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGEAND SITUATIONAL 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“ESTIMATING STATE OF ULTRASONIC ENDEFFECTOR AND CONTROL SYSTEM THEREFOR”；
·美国专利申请16/115,205，其标题为“TEMPERATURE CONTROL OF ULTRASONICEND EFFECTOR AND CONTROL SYSTEM THEREFOR”；
·美国专利申请16/115,233，其标题为“RADIO FREQUENCY ENERGY DEVICE FORDELIVERING COMBINED ELECTRICAL SIGNALS”；·美国专利申请16/115,208，其标题为“CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION”；
·美国专利申请16/115,220，其标题为“CONTROLLING ACTIVATION OF ANULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE”；
·美国专利申请16/115,232，其标题为“DETERMINING TISSUE COMPOSITION VIAAN ULTRASONIC SYSTEM”；
·美国专利申请16/115,239，其标题为“DETERMINING THE STATE OF ANULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TO FREQUENCY SHIFT”；
·美国专利申请16/115,247，其标题为“DETERMINING THE STATE OF ANULTRASONIC END EFFECTOR”；
·美国专利申请16/115,211，其标题为“SITUATIONAL AWARENESS OFELECTROSURGICAL SYSTEMS”；
·美国专利申请16/115,226，其标题为“MECHANISMS FOR CONTROLLINGDIFFERENT ELECTROMECHANICAL SYSTEMS OF AN ELECTROSURGICAL INSTRUMENT”；
·美国专利申请16/115,240，其标题为“DETECTION OF END EFFECTOR IMMERSIONIN LIQUID”；
·美国专利申请16/115,249，其标题为“INTERRUPTION OF ENERGY DUE TOINADVERTENT CAPACITIVE COUPLING”；
·美国专利申请16/115,256，其标题为“INCREASING RADIO FREQUENCY TOCREATE PAD-LESS MONOPOLAR LOOP”；
·美国专利申请16/115,223，其标题为“BIPOLAR COMBINATION DEVICE THATAUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY”；以及
·美国专利申请16/115,238，其标题为“ACTIVATION OF ENERGY DEVICES”。
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“CONTROLLING AN ULTRASONICSURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION”；
·美国临时专利申请62/721,998，其标题为“SITUATIONAL AWARENESS OFELECTROSURGICAL SYSTEMS”；
·美国临时专利申请62/721,999，其标题为“INTERRUPTION OF ENERGY DUE TOINADVERTENT CAPACITIVE COUPLING”；
·美国临时专利申请62/721,994，其标题为“BIPOLAR COMBINATION DEVICE THATAUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY”；以及
·美国临时专利申请62/721,996，其标题为“RADIO FREQUENCY ENERGY DEVICEFOR 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“SMART ACTIVATION OF AN ENERGYDEVICE BY ANOTHER DEVICE”；
·美国临时专利申请62/692,748，其标题为“SMART ENERGY ARCHITURE”；以及
·美国临时专利申请62/692,768，其标题为“SMART ENERGY DEVICES”。
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“CAPACITIVE COUPLED RETURNPATH PAD WITH SEPARABLE ARRAY ELEMENTS”；
·美国专利申请序列号16/024,057，其标题为“CONTROLLING A SURGICALINSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS”；
·美国专利申请序列号16/024,067，其标题为“SYSTEMS FOR ADJUSTING ENDEFFECTOR PARAMETERS BASED ON PERIOPERATIVE INFORMATION”；
·美国专利申请序列号16/024,075，其标题为“SAFETY SYSTEMS FOR SMARTPOWERED SURGICAL STAPLING”；
·美国专利申请序列号16/024,083，其标题为“SAFETY SYSTEMS FOR SMARTPOWERED SURGICAL STAPLING”；
·美国专利申请序列号16/024,094，其标题为“SURGICAL SYSTEMS FORDETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES”；
·美国专利申请序列号16/024,138，其标题为“SYSTEMS FOR DETECTINGPROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE”；
·美国专利申请序列号16/024,150，其标题为“SURGICAL INSTRUMENT CARTRIDGESENSOR ASSEMBLIES”；
·美国专利申请序列号16/024,160，其标题为“VARIABLE OUTPUT CARTRIDGESENSOR ASSEMBLY”；
·美国专利申请序列号16/024,124，其标题为“(SURGICAL INSTRUMENT HAVING AFLEXIBLE ELECTRODE”；
·美国专利申请序列号16/024,132，其标题为“SURGICAL INSTRUMENT HAVING AFLEXIBLE CIRCUIT”；
·美国专利申请序列号16/024,141，其标题为“SURGICAL INSTRUMENT WITH ATISSUE MARKING ASSEMBLY”；
·美国专利申请序列号16/024,162，其标题为“SURGICAL SYSTEMS WITHPRIORITIZED DATA TRANSMISSION CAPABILITIES”；
·美国专利申请序列号16/024,066，其标题为“SURGICAL EVACUATION SENSINGAND MOTOR CONTROL；
·美国专利申请序列号16/024,096，其标题为“SURGICAL EVACUATION SENSORARRANGEMENTS”；
·美国专利申请序列号16/024,116，其标题为“SURGICAL EVACUATION FLOWPATHS”；
·美国专利申请序列号16/024,149，其标题为“SURGICAL EVACUATION SENSINGAND GENERATOR CONTROL”；
·美国专利申请序列号16/024,180，其标题为“SURGICAL EVACUATION SENSINGAND DISPLAY”；
·美国专利申请序列号16/024,245，其标题为“COMMUNICATION OF SMOKEEVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FORINTERACTIVE SURGICAL PLATFORM”；
·美国专利申请序列号16/024,258，其标题为“SMOKE EVACUATION SYSTEMINCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM”；
·美国专利申请序列号16/024,265，其标题为“SURGICAL EVACUATION SYSTEMWITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKEEVACUATION DEVICE”；以及
·美国专利申请序列号16/024,273，其标题为“DUAL IN-SERIES LARGE ANDSMALL 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：
·美国临时专利申请序列号62/691,228，其标题为“A METHOD OF USINGREINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH electrosurgical DEVICES”；
·美国临时专利申请序列号62/691,227，其标题为“CONTROLLING A SURGICALINSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS”；
·美国临时专利申请序列号62/691,230，其标题为“SURGICAL INSTRUMENTHAVING A FLEXIBLE ELECTRODE”；
·美国临时专利申请序列号62/691,219，其标题为“SURGICAL EVACUATIONSENSING AND MOTOR CONTROL”；
·美国临时专利申请序列号62/691,257，其标题为“COMMUNICATION OF SMOKEEVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FORINTERACTIVE SURGICAL 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“DUAL IN-SERIES LARGE ANDSMALL 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，这些临时专利申请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62/659,900，其标题为“METHOD OF HUBCOMMUNICATION”。
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日提交的美国临时专利申请62/650,898，其标题为“CAPACITIVECOUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS”；
·美国临时专利申请序列号62/650,887，其标题为“SURGICAL SYSTEMS WITHOPTIMIZED SENSING CAPABILITIES”；
·美国专利申请序列号62/650,882，其标题为“SMOKE EVACUATION MODULE FORINTERACTIVE SURGICAL PLATFORM”；以及
·美国专利申请序列号62/650,877，其标题为“SURGICAL SMOKE EVACUATIONSENSING 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“INTERACTIVE SURGICAL SYSTEMSWITH ENCRYPTED COMMUNICATION CAPABILITIES”；
·美国专利申请序列号15/940,648，其标题为“INTERACTIVE SURGICAL SYSTEMSWITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES”；
·美国专利申请序列号15/940,656，其标题为“SURGICAL HUB COORDINATION OFCONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES”；
·美国专利申请序列号15/940,666，其标题为“SPATIAL AWARENESS OF SURGICALHUBS IN OPERATING ROOMS”；
·美国专利申请序列号15/940,670，其标题为“COOPERATIVE UTILIZATION OFDATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS”；
·美国专利申请序列号15/940,677，其标题为“SURGICAL HUB CONTROLARRANGEMENTS”；
·美国专利申请序列号15/940,632，其标题为“DATA STRIPPING METHOD TOINTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD”；
·美国专利申请序列号15/940,640，其标题为“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“SELF DESCRIBING DATA PACKETSGENERATED AT AN ISSUING INSTRUMENT”；
·美国专利申请序列号15/940,649，其标题为“DATA PAIRING TO INTERCONNECTA DEVICE MEASURED PARAMETER WITH AN OUTCOME”；
·美国专利申请序列号15/940,654，其标题为“SURGICAL HUB SITUATIONALAWARENESS”；
·美国专利申请序列号15/940,663，其标题为“SURGICAL SYSTEM DISTRIBUTEDPROCESSING”；
·美国专利申请序列号15/940,668，其标题为“AGGREGATION AND REPORTING OFSURGICAL HUB DATA”；
·美国专利申请序列号15/940,671，其标题为“SURGICAL HUB SPATIALAWARENESS TO DETERMINE DEVICES IN OPERATING THEATER”；
·美国专利申请序列号15/940,686，其标题为“DISPLAY OF ALIGNMENT OFSTAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE”；
·美国专利申请序列号15/940,700，其标题为“STERILE FIELD INTERACTIVECONTROL DISPLAYS”；
·美国专利申请序列号15/940,629，其标题为“COMPUTER IMPLEMENTEDINTERACTIVE SURGICAL SYSTEMS”；
·美国专利申请序列号15/940,704，其标题为“USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES 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“DUAL CMOS ARRAY IMAGING”。
·美国专利申请序列号15/940,636，其标题为“ADAPTIVE CONTROL PROGRAMUPDATES FOR SURGICAL DEVICES”；
·美国专利申请序列号15/940,653，其标题为“ADAPTIVE CONTROL PROGRAMUPDATES FOR SURGICAL HUBS”；
·美国专利申请序列号15/940,660，其标题为“CLOUD-BASED MEDICAL ANALYTICSFOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER”；
·美国专利申请序列号15/940,679，其标题为“CLOUD-BASED MEDICAL ANALYTICSFOR LINKING 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“CLOUD-BASED MEDICAL ANALYTICSFOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION”；
·美国专利申请序列号15/940,634，其标题为“CLOUD-BASED MEDICAL ANALYTICSFOR SECURITY AND AUTHENTICATION 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“CLOUD INTERFACE FOR COUPLEDSURGICAL DEVICES”；
·美国专利申请序列号15/940,627，其标题为“DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”；
·美国专利申请序列号15/940,637，其标题为“COMMUNICATION ARRANGEMENTSFOR ROBOT-ASSISTED SURGICAL PLATFORMS”；
·美国专利申请序列号15/940,642，其标题为“CONTROLS FOR ROBOT-ASSISTEDSURGICAL PLATFORMS”；
·美国专利申请序列号15/940,676，其标题为“AUTOMATIC TOOL ADJUSTMENTSFOR ROBOT-ASSISTED SURGICAL PLATFORMS”；
·美国专利申请序列号15/940,680，其标题为“CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”；
·美国专利申请序列号15/940,683，其标题为“COOPERATIVE SURGICAL ACTIONSFOR 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“SENSING ARRANGEMENTS FORROBOT-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全文以引用方式并入本文：
·美国临时专利申请序列号62/649,302，其标题为“INTERACTIVE SURGICALSYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES”；
·美国临时专利申请序列号62/649,294，其标题为“DATA STRIPPING METHOD TOINTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD”；
·美国临时专利申请序列号62/649,300，其标题为“SURGICAL HUB SITUATIONALAWARENESS”；
·美国临时专利申请序列号62/649,309，其标题为“SURGICAL HUB SPATIALAWARENESS TO DETERMINE DEVICES IN OPERATING THEATER”；
·美国临时专利申请序列号62/649,310，其标题为“COMPUTER IMPLEMENTEDINTERACTIVE SURGICAL SYSTEMS”；
·美国临时专利申请序列号62/649,291，其标题为“USE OF LASER LIGHT ANDRED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT”；
·美国临时专利申请序列号62/649,296，其标题为“ADAPTIVE CONTROL PROGRAMUPDATES FOR SURGICAL DEVICES”；
·美国临时专利申请序列号62/649,333，其标题为“CLOUD-BASED MEDICALANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER”；
·美国临时专利申请序列号62/649,327，其标题为“CLOUD-BASED MEDICALANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES”；
·美国临时专利申请序列号62/649,315，其标题为“DATA HANDLING ANDPRIORITIZATION IN A CLOUD ANALYTICS NETWORK”；
·美国临时专利申请序列号62/649,313，其标题为“CLOUD INTERFACE FORCOUPLED SURGICAL DEVICES”；
·美国临时专利申请序列号62/649,320，其标题为“DRIVE ARRANGEMENTS FORROBOT-ASSISTED SURGICAL PLATFORMS”；
·美国临时专利申请序列号62/649,307，其标题为“AUTOMATIC TOOLADJUSTMENTS 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“SENSING ARRANGEMENTS FORROBOT-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全文以引用方式并入本文：
·美国临时专利申请序列号62/640,417，其标题为“TEMPERATURE CONTROL INULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR”；以及
·美国临时专利申请序列号62/640,415，其标题为“ESTIMATING STATE OFULTRASONIC END EFFECTOR AND CONTROL SYSTEM 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全文以引用方式并入本文：
·美国临时专利申请序列号62/611,341，其标题为“INTERACTIVE SURGICALPLATFORM”；
·美国临时专利申请序列号62/611,340，其标题为“CLOUD-BASED MEDICALANALYTICS”；以及
·美国专利申请序列号62/611,339，其标题为“ROBOT ASSISTED SURGICALPLATFORM”。
在详细说明外科装置和发生器的各个方面之前，应该指出的是，示例性示例的应用或使用并不局限于附图和具体实施方式中所示出的部件的配置和布置方式的细节。示例性示例可以单独实施，或与其它方面、变更形式和修改形式结合在一起实施，并可以通过多种方式实践或执行。此外，除非另外指明，否则本文所用的术语和表达是为了方便读者而对示例性实施例进行描述而所选的，并非为了限制性的目的。而且，应当理解，以下描述的方面中的一个或多个、方面和/或示例的表达可以与以下描述的其它方面、方面和/或示例的表达中的任何一个或多个组合。
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，可包括联接到存储装置105的远程服务器113的云104)。每个外科系统102包括与可包括远程服务器113的云104通信的至少一个外科集线器106。在一个示例中，如图1中所示，外科系统102包括可视化系统108、机器人系统110和手持式智能外科器械112，其被配置成能够彼此通信并且/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联接的外科工具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。
在各个方面，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以及不可见光谱中的电磁能。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。
在各个方面，成像装置124被配置用于微创手术中。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，在任何外科手术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区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，无菌区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，或者无菌区可被认为是已准备用于外科手术的患者周围的区域。无菌区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，其相对于无菌区进行策略布置，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被定位在无菌区中，以对在手术台114处的操作者可见。此外，可视化塔111被定位在无菌区之外。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区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进一步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区内的主显示器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路由至主显示器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进一步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“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路由至无菌区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例如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“Surgical Instrument Hardware”下，该临时专利申请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能会浪费宝贵的时间。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接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部件，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部件、以及从远程外科部位延伸至排烟部件的流体管线。
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接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和第一对接底座，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，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运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运动出与第一功率和数据触点的电接合，
除上述之外，模块化外科壳体还包括第二能量发生器模块和第二对接底座，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，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可滑动地运动出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部件、双极部件和超声部件的发生器模块，该部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接纳模块140、126、128。图4示出了可滑动地接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滑动到集线器模块化壳体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。
在各个方面，排烟模块126包括流体管线154，该流体管线154将捕集/收集的烟雾和/或流体从外科部位传送到例如排烟模块126。源自排烟模块126的真空抽吸可将烟雾吸入外科部位处的公用导管的开口中。联接到流体管线的公用导管可以是端接在排烟模块126处的柔性管的形式。公用导管和流体管线限定朝向接纳在集线器壳体136中的排烟模块126延伸的流体路径。
在各个方面，抽吸/冲洗模块128联接到包括吸出流体管线和抽吸流体管线的外科工具。在一个示例中，吸出流体管线和抽吸流体管线为从外科部位朝向抽吸/冲洗模块128延伸的柔性管的形式。一个或多个驱动系统可被配置成能够冲洗到外科部位的流体和从外科部位抽吸流体。
在一个方面，外科工具包括轴，该轴具有在其远侧端部处的端部执行器以及与端部执行器、吸出管和冲洗管相关联的至少一种能量处理。吸出管可在其远侧端部处具有入口，并且吸出管延伸穿过轴。类似地，吸出管可延伸穿过轴并且可具有邻近能量递送工具的入口。能量递送工具被配置成能够将超声能量和/或RF能量递送至外科部位，并且通过初始延伸穿过轴的缆线联接到发生器模块140。
冲洗管可与流体源流体连通，并且吸出管可与真空源流体连通。流体源和/或真空源可座置在抽吸/冲洗模块128中。在一个示例中，流体源和/或真空源可独立于抽吸/冲洗模块128座置在集线器壳体136中。在此类示例中，流体接口能够将抽吸/冲洗模块128连接到流体源和/或真空源。
在一个方面，集线器模块化壳体136上的模块140、126、128和/或其对应的对接底座可包括对准特征件，该对准特征部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整为接纳在抽屉151中。例如，侧支架155和/或156可根据模块的大小而更大或更小。在其它方面，抽屉151的大小不同，并且各自被设计成容纳特定模块。
此外，可对特定模块的触点进行键控以与特定抽屉的触点接合，以避免将模块插入到具有不匹配触点的抽屉中。
如图4中所示，一个抽屉151的对接端口150可通过通信链路157联接到另一个抽屉151的对接端口150，以有利于座置在集线器模块化壳体136中的模块之间的交互式通信。另选地或附加地，集线器模块化壳体136的对接端口150可有利于座置在集线器模块化壳体136中的模块之间的无线交互通信。可采用任何合适的无线通信，诸如例如Air Titan-Bluetooth。
图6示出了用于横向模块化外壳160的多个横向对接端口的单个功率总线附接件，该横向模块化外壳160被配置成能够接纳外科集线器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。
在各个方面，成像模块138包括集成视频处理器和模块化光源，并且适于与各种成像装置一起使用。在一个方面，成像装置由可装配有光源模块和相机模块的模块化外壳构成。外壳可为一次性外壳。在至少一个示例中，一次性外壳可移除地联接到可重复使用的控制器、光源模块和相机模块。光源模块和/或相机模块可根据外科手术的类型选择性地选择。在一个方面，相机模块包括CCD传感器。在另一方面，相机模块包括CMOS传感器。在另一方面，相机模块被配置用于扫描波束成像。同样，光源模块可被配置成能够递送白光或不同的光，具体取决于外科手术。
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接纳相机模块，该相机模块可被配置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，该光源模块可被配置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。在各个方面，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”的美国专利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2014/0243597，以上专利中的每个全文以引用方式并入本文。
图8示出了包括模块化通信集线器203的外科数据网络201，该模块化通信集线器203被配置成能够将位于医疗设施的一个或多个手术室中的模块化装置或专门配备用于外科操作的医疗设施中的任何房间连接到基于云的系统(例如，可包括联接到存储装置205的远程服务器213的云204)。在一个方面，模块化通信集线器203包括与网络路由器通信的网络集线器207和/或网络交换机209。模块化通信集线器203还可联接到本地计算机系统210以提供本地计算机处理和数据操纵。外科数据网络201可被配置成无源的、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部，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可联接到模块化通信集线器203。网络集线器207和/或网络交换机209可联接到网络路由器211以将装置1a-1n连接至云204或本地计算机系统210。与装置1a-1n相关联的数据可经由路由器传输到基于云的计算机，用于远程数据处理和操纵。与装置1a-1n相关联的数据也可被传输至本地计算机系统210以用于本地数据处理和操纵。位于相同手术室中的模块化装置2a-2m也可联接到网络交换机209。网络交换机209可联接到网络集线器207和/或网络路由器211以将装置2a-2m连接至云204。与装置2a-2n相关联的数据可经由网络路由器211传输到云204以用于数据处理和操纵。与装置2a-2m相关联的数据也可被传输至本地计算机系统210以用于本地数据处理和操纵。
应当理解，可通过将多个网络集线器207和/或多个网络交换机209与多个网络路由器211互连来扩展外科数据网络201。模块化通信集线器203可被容纳在模块化控制塔中，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。在各个方面，装置1a-1n/2a-2m可包括例如各种模块，诸如联接到内窥镜的成像模块138、联接到基于能量的外科装置的发生器模块140、排烟模块126、抽吸/冲洗模块128、通信模块130、处理器模块132、存储阵列134、连接到显示器的外科装置、和/或可连接到外科数据网络201的模块化通信集线器203的其它模块化装置中的非接触传感器模块。
在一个方面，外科数据网络201可包括将装置1a-1n/2a-2m连接至云的网络集线器、网络交换机和网络路由器的组合。联接到网络集线器或网络交换机的装置1a-1n/2a-2m中的任何一个或全部可实时收集数据并将数据传输到云计算机中以进行数据处理和操纵。应当理解，云计算依赖于共享计算资源，而不是使用本地服务器或个人装置来处理软件应用程序。可使用“云”一词作为“互联网”的隐喻，尽管该术语不受此限制。因此，本文可使用术语“云计算”来指“基于互联网的计算的类型”，其中将不同的服务(诸如服务器、存储装置和应用程序)递送至位于外科室(例如，固定、移动、临时或现场手术室或空间)中的模块化通信集线器203和/或计算机系统210以及通过互联网连接至模块化通信集线器203和/或计算机系统210的装置。云基础设施可由云服务提供方维护。在这种情况下，云服务提供方可以是协调位于一个或多个手术室中的装置1a-1n/2a-2m的使用和控制的实体。云计算服务可基于由智能外科器械、机器人和位于手术室中的其它计算机化装置所收集的数据来执行大量计算。集线器硬件使多个装置或连接能够连接到与云计算资源和存储装置通信的计算机。
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泄漏或灌注。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至网络集线器的配置。在一个方面，网络集线器207可被实现为在开放式系统互连(OSI)模型的物理层上工作的本地网络广播装置。该网络集线器提供与位于同一手术室网络中的装置1a-1n的连接。网络集线器207以包的形式收集数据，并以半双工模式将其发送至路由器。网络集线器207不存储用于传输装置数据的任何媒体访问控制/因特网协议(MAC/IP)。装置1a-1n中的仅一个可一次通过网络集线器207发送数据。网络集线器207没有关于在何处发送信息并在每个连接上广播所有网络数据以及通过云204向远程服务器213(图9)广播所有网络数据的路由表或智能。网络集线器207可以检测基本网络错误诸如冲突，但将所有信息广播到多个端口可带来安全风险并导致瓶颈。
在另一个具体实施中，手术室装置2a-2m可通过有线信道或无线信道连接到网络交换机209。网络交换机209在OSI模型的数据链路层中工作。网络交换机209是用于将位于相同手术室中的装置2a-2m连接到网络的多点广播装置。网络交换机209以帧的形式向网络路由器211发送数据并且以全双工模式工作。多个装置2a-2m可通过网络交换机209同时发送数据。网络交换机209存储并使用装置2a-2m的MAC地址来传输数据。
网络集线器207和/或网络交换机209联接到网络路由器211以连接到云204。网络路由器211在OSI模型的网络层中工作。网络路由器211创建用于将从网络集线器207和/或网络交换机211接收的数据包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、配置和维护，使得其成为对手术室装置1a-1n/2a-2m进行联网的良好选项。
图9示出了计算机实现的交互式外科系统200。计算机实现的交互式外科系统200在许多方面类似于计算机实现的交互式外科系统100。例如，计算机实现的交互式外科系统200包括在许多方面类似于外科系统102的一个或多个外科系统202。每个外科系统202包括与可包括远程服务器213的云204通信的至少一个外科集线器206。在一个方面，计算机实现的交互式外科系统200包括模块化控制塔236，该模块化控制塔236连接到多个手术室装置，诸如例如智能外科器械、机器人和位于手术室中的其它计算机化装置。如图10中所示，模块化控制塔236包括联接到计算机系统210的模块化通信集线器203。如图9的示例中所示，模块化控制塔236联接到联接到内窥镜239的成像模块238、联接到能量装置241的发生器模块240、排烟器模块226、抽吸/冲洗模块228、通信模块230、处理器模块232、存储阵列234、任选地联接到显示器237的智能装置/器械235、和非接触传感器模块242。手术室装置经由模块化控制塔236联接到云计算资源和数据存储。机器人集线器222也可连接到模块化控制塔236和云计算资源。装置/器械235、可视化系统208等等可经由有线或无线通信标准或协议联接到模块化控制塔236，如本文所述。模块化控制塔236可联接到集线器显示器215(例如，监测器、屏幕)以显示和叠加从成像模块、装置/器械显示器和/或其它可视化系统208接收的图像。集线器显示器还可结合图像和叠加图像来显示从连接到模块化控制塔的装置接收的数据。
图10示出了包括联接到模块化控制塔236的多个模块的外科集线器206。模块化控制塔236包括模块化通信集线器203(例如，网络连接性装置)和计算机系统210，以提供例如本地处理、可视化和成像。如图10中所示，模块化通信集线器203可以分层配置连接以扩展可连接到模块化通信集线器203的模块(例如，装置)的数量，并将与模块相关联的数据传输至计算机系统210、云计算资源或两者。如图10中所示，模块化通信集线器203中的网络集线器/交换机中的每个包括三个下游端口和一个上游端口。上游网络集线器/交换机连接至处理器以提供与云计算资源和本地显示器217的通信连接。与云204的通信可通过有线或无线通信信道进行。
外科集线器206采用非接触传感器模块242来测量手术室的尺寸，并且使用超声或激光型非接触测量装置来生成外科室的标测图。基于超声的非接触传感器模块通过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整蓝牙配对距离限制。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整蓝牙配对距离限制。
计算机系统210包括处理器244和网络接口245。处理器244经由系统总线联接到通信模块247、存储装置248、存储器249、非易失性存储器250和输入/输出接口251。系统总线可为若干类型的总线结构中的任一者，该总线结构包括存储器总线或存储器控制器、外围总线或外部总线、和/或使用任何各种可用总线架构的本地总线，包括但不限于9位总线、工业标准架构(ISA)、微型Charmel架构(MSA)、扩展ISA(EISA)、智能驱动电子器件(IDE)、VESA本地总线(VLB)、外围部件互连(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Texas Instruments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Texas Instruments的LM4F230H5QR ARM Cortex-M4F处理器核心，其包括256KB的单循环闪存或其它非易失性存储器(最多至40MHz)的片上存储器、用于改善高于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Texas Instruments生产的商品名为Hercules ARMCortex R4。安全控制器可被配置成能够专门用于IEC 61508和ISO 26262安全关键应用等等，以提供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，诸如例如磁盘存储装置。磁盘存储装置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，磁盘存储装置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。
用户通过联接到I/O接口251的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、数字视频相机、幅材相机等。这些和其它输入装置经由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。输出装置使用与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(诸如云计算机)或本地计算机的逻辑连接在联网环境中操作。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，仅示出了具有远程计算机的存储器存储装置。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/IEEE802.3、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。
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Texas Instruments的TUSB2036集成电路集线器。USB网络集线器300是根据USB 2.0规范提供上游USB收发器端口302和多达三个下游USB收发器端口304、306、308的CMOS装置。上游USB收发器端口302为差分根数据端口，其包括与差分数据正(DM0)输入配对的差分数据负(DP0)输入。三个下游USB收发器端口304、306、308为差分数据端口，其中每个端口包括与差分数据负(DM1-DM3)输出配对的差分数据正(DP1-DP3)输出。
USB网络集线器300装置用数字状态机而不是微控制器来实现，并且不需要固件编程。完全兼容的USB收发器集成到用于上游USB收发器端口302和所有下游USB收发器端口304、306、308的电路中。下游USB收发器端口304、306、308通过根据附接到端口的装置的速度自动设置转换速率来支持全速度装置和低速装置两者。USB网络集线器300装置可被配置成能够处于总线供电模式或自供电模式，并且包括用于管理功率的集线器功率逻辑312。
USB网络集线器300装置包括串行接口引擎310(SIE)。SIE 310是USB网络集线器300硬件的前端，并处理USB规范第8章中描述的大多数协议。SIE 310通常包括多达交易级别的信令。其处理的功能可包括：包识别、事务排序、SOP、EOP、RESET和RESUME信号检测/生成、时钟/数据分离、不返回到零反转(NRZI)数据编码/解码和数位填充、CRC生成和校验(令牌和数据)、包ID(PID)生成和校验/解码、和/或串行并行/并行串行转换。310接收时钟输入314并且联接到暂停/恢复逻辑和帧定时器316电路以及集线器中继器电路318，以通过端口逻辑电路320、322、324控制上游USB收发器端口302和下游USB收发器端口304、306、308之间的通信。SIE 310经由接口逻辑328联接到命令解码器326，以经由串行EEPROM接口330来控制来自串行EEPROM的命令。
在各个方面，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“METHOD OF HUB COMMUNICATION”的美国临时专利申请62/659,900，该临时专利申请据此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有关的数据，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。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联接到云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联接到一个或多个外科器械7012。集线器7006还经由网络7001通信地联接到计算机实现的交互式外科系统的云7004。云7004是用于存储、操纵和传达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它合适的计算机网络。联接到云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中的每一个包括联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、推荐和其它操作。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中的汇总医疗数据的数据库2212。
基于经由网络7001到各种外科集线器7006的连接，云7004可汇总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。此类汇总数据可存储在云7004的汇总医疗数据库7011内。具体地，云7004可有利地对汇总数据执行数据分析和操作，以产生见解和/或执行各个集线器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通信地联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和汇总医疗数据的数据库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可以管理集线器应用程序通过集线器7006提出的请求、控制对汇总医疗数据的数据库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，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管理向汇总医疗数据数据库7011中存储和检索数据或从该汇总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)并且联接到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、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推荐。
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)，包括显著特征部或配置(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，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)。汇总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汇总元数据或其它组织数据。为此，处理器7008可以操作地联接到集线器应用程序7014和汇总医疗数据的数据库7011以用于执行数据分析模块7034。数据收集和汇总模块7022可以将汇总组织数据存储到汇总医疗数据的数据库2212中。
资源优化模块7020可被配置成能够分析该汇总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它操作配置以确定是否可改善资源使用。类似地，推荐模块7030可被配置成能够分析来自数据收集和汇总模块7022的汇总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错误率向医疗设施(例如，医疗服务提供商，诸如医院)推荐应将特定外科器械7012升级至改善的版本。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它潜在操作参数。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)来推荐使用这些其它潜在操作参数。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推荐(有利地基于汇总数据来确定)。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/或汇总数据，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收集和分析的汇总性能数据。另外，患者结果分析模块7028和推荐模块7030可基于汇总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实现的安全特征部。这些安全特征部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的汇总医疗数据的数据库7011可以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，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可以转变成能够用于接收医疗数据以存储到汇总医疗数据的数据库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可分析与各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它医疗设施相关联的其它数据汇总。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推荐。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。这种分类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)，诸如加速响应的升级、特殊处理、汇总医疗数据的数据库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。
关于云分析系统的附加细节可见于2018年4月19日提交的标题为“METHOD OF HUBCOMMUNICATION”的美国临时专利申请62/659,900，该临时专利申请据此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，在许多方面，可类似于集线器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的特定控制调整或一组控制调整相关联。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整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整。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整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可调整发生器的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整超声外科器械或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疗成像装置接收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，来自可通信地联接到外科集线器5104的医疗成像装置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特征部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的医疗成像装置提供)，使得在整个外科手术中自动调整显示器。
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可被配置成能够将例如用于由合适的扫描仪扫描的手术的物品列表、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整外科器械(和其它模块化装置5102)(诸如针对不同的组织类型进行调整)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、提供数据以及调整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分段切除手术的过程中将采取的典型步骤，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)，基于背景调整模块化装置(例如，激活监测器，调整医疗成像装置的视场(FOV)，或者改变超声外科器械或RF电外科器械的能量水平)，以及采取上述任何其它此类动作。
作为该示例性手术中的第一步5202，医院工作人员从医院的EMR数据库中检索患者的EMR。基于EMR中的选择的患者数据，外科集线器106、206确定待执行的手术是胸腔手术。
第二步5204，工作人员扫描用于手术的进入的医疗用品。外科集线器106、206与在各种类型的手术中使用的用品列表交叉引用扫描的用品，并确认供应的混合物对应于胸腔手术。另外，外科集线器106、206还能够确定手术不是楔形手术(因为进入的用品缺乏胸腔楔形手术所需的某些用品，或者在其它方面不对应于胸腔楔形手术)。
第三步5206，医疗人员经由可通信地连接到外科集线器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、吹入器和医疗成像装置。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，楔形手术已经通过外科集线器106、206基于在手术的第二步5204处接收的数据而排除)。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，监测所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)，以及监测所利用的可视化装置的类型。例如，一种用于执行VATS叶切除术的技术将相机放置在患者的隔膜上方的胸腔的下前拐角中，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。作为又一个示例，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联接到外科集线器)以可视化不用于VATS肺部切除术中的分段裂隙。通过从医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械臂的能量工具。
第十步5220，外科团队继续进行手术的结扎步骤。外科集线器106、206可推断外科医生正在结扎动脉和静脉，因为其从外科缝合和切割器械接收指示器械正在被击发的数据。与先前步骤相似，外科集线器106、206可通过将来自外科缝合和切割器械的数据的接收与该过程中的检索步骤进行交叉引用来推导该推论。在某些情况下，外科器械可以是安装到机器人外科系统的机器人臂的外科工具。
第十一步5222，执行手术的分段切除术部分。外科集线器106、206可推断外科医生正在基于来自外科缝合和切割器械的数据(包括来自其仓的数据)横切软组织。仓数据可对应于例如由器械击发的钉的大小或类型。由于不同类型的钉用于不同类型的组织，因此仓数据可指示正被缝合和/或横切的组织的类型。在这种情况下，被击发的钉的类型用于软组织(或其它类似的组织类型)，这允许外科集线器106、206推断手术的分段切除术部分正在进行。
第十二步5224中，执行节点解剖步骤。外科集线器106、206可基于从发生器接收的指示正在击发RF或超声器械的数据来推断外科团队正在解剖节点并且执行泄漏测试。对于该特定手术，在横切软组织后使用的RF或超声器械对应于节点解剖步骤，该步骤允许外科集线器106、206进行此类推论。应当指出的是，外科医生根据手术中的具体步骤定期在外科缝合/切割器械和外科能量(即，RF或超声)器械之间来回切换，因为不同器械更好地适于特定任务。因此，其中使用缝合/切割器械和外科能量器械的特定序列可指示外科医生正在执行的手术的步骤。此外，在某些情况下，机器人工具可用于外科手术中的一个或多个步骤，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可根据从可通信地联接到外科集线器106、206的各种数据源接收的数据来确定或推断给定外科手术的每个步骤何时发生。
态势感知进一步描述于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。
用以从数据仓库提取信息的机器学习
在各个方面，可以基于涉及监督式和/或无监督式学习技术的远程分析来调整OR系统的控制程序，包括在相关性搜索中对不同变量组合的重复多变量分析，以及针对原始分析中未使用的单独数据组对分析结果的预测能力的评估。
在一个方面，外科集线器(例如，102、202)和/或模块化装置(例如，1a-1n/2a-2m)的控制程序可基于在多于一个手术上记录的性能和结果的机器学习分析来修改。在一个方面，外科集线器(例如，102、202)和/或模块化装置(例如，1a-1n/2a-2m)的程序响应改变可以基于装置相关影响的识别。在一个示例中，这些影响来自患者特定原因。在另一个示例中，这些影响来自所使用的模块化装置(例如，1a-1n/2a-2m)的交互。
在一个方面，外科集线器的程序响应变化可以是更新装置的控制程序或调整其操作参数。在一个方面，外科集线器的程序响应改变可以是向外科医生指示的建议或其它过程修改。在一个方面，模块化装置的程序响应变化可以是致动速度、等待时间或模块化装置的另一个操作参数的改编。
在一个方面，机器学习分析可以基于监督式或无监督式学习。在一个方面，分析可在设施链接设备的本地网络内进行，或者可被导出到远程位置进行编译并返回到网络。
在各个方面，机器学习系统可被编程为执行计算语言、自然语言处理和/或人种学分析。
监督式学习
在各个方面，本公开的机器学习系统利用监督式学习方法不仅基于结果而且还基于元数据背景将数据对聚类成非预定义的类别。在一个方面，可以对来自外科集线器(例如，102、202)的云数据执行监督式机器学习，以找到未识别的数据组。机器学习云数据分析可以识别例如外科手术结果和患者结果的区域差异。
监督式学习的方法可包括例如参数学习方法或非参数学习方法。参数学习方法可包括例如回归(例如，预测连续数据、离散数据或梯度下降，这是用于确定模型的最小值的顺序过程)、分类和矢量聚类。矢量聚类是在给定一组训练示例的情况下创建系统采取新示例并将其置于由训练示例定义的分组内的能力的过程。矢量聚类还可以包括边缘定义，其使组之间的边缘最大化，以使边缘数据点的错误分组最小化。非参数学习方法可包括例如决策树和k-NN算法。
数据编译方法可包括例如奇异值分解、归一化和维度减小。
图16为根据本公开的至少一个方面的描绘根据计算的阈值的模块化装置(例如，1a-1n、2a-2m)的例示性使用的正结果和负结果的曲线图。图17为根据本公开的至少一个方面的描绘具有根据结果分组的各种特征的外科手术的框图。机器学习可用于识别数据中的相关原因和影响，然后可用于自主开发外科器械、外科集线器和/或其它模块化装置的控制程序更新。
元数据背景
在各个方面，数据的元数据背景可用于加宽至少两个组之间的区域，并且因此基于结果和它们的贡献因素将数据拟合到它们的组。监督式机器学习技术可用于根据数据组的结果和贡献因素来定义数据组。
监督方法可以根据分组验证和敏感性进行调整。
图18为根据本公开的至少一个方面的描绘验证分析的图。图19为根据本公开的至少一个方面的描绘验证分析的框图。在各个方面，分析系统可以利用能够调节的验证集来执行验证测试。通过提供一组训练示例来训练学习算法，然后学习算法使用该组训练示例将学习分组应用于新数据。验证数据集允许算法随后检查所创建的数据集是否包含预期数据，然后移除任何意料不到的数据。如图18和19所示，能够调整该验证集将允许对分组过程进行细调。
可以调整监督方法的敏感性以控制机器学习模型的过学习和阈值/概率截止值。过学习是可调节性或算法灵活性与偏差的比率。高度灵活的算法将所有可变数据拟合到数据集中，而高度偏差的算法将非常有限的数据点集固定到数据集中。阈值和概率截止值是机器学习模型对假阳性相对假阴性的容忍度。
无监督式学习
在各个方面，可使用无监督式(或“未经训练的”)学习技术来确定来自外科集线器的数据对的关系，该数据对包含由并发症或发病率引起的联动或结果，而不是直接确定治疗步骤。换句话讲，可利用机器学习来识别非装置原因并相应地调整外科集线器响应。
无监督式学习是在无标签数据上训练机器学习模型的过程。利用基于时间或基于顺序次序的学习结果，程序可基于预定义数量的初始响应来确定最有可能成功的后续步骤。这些响应可能是遇到的问题、患者术前状况或外科手术中遇到的问题。可使用多种无监督式学习技术，包括例如聚类(例如，分层聚类和k均值聚类)，该聚类提供对“正常”学习行为之外的潜在威胁的防护，以及对试图对程序的另一实例进行跳动的程序的一个实例的无监督式模拟。无监督式学习技术还可包括深度学习和神经网络，这些网络是在不考虑数据含义的情况下分析趋势和连接的分析技术。人工神经网络可用于例如图像处理，以通过识别具有先前在图像上标注的区域的图像来改善识别基础关键结构的能力，同时不具有结构本身的参数的信息。
这些数据点可用于向用户标识存在基础原因以进行将来评估，或者需要进行额外的治疗加强，这不是因为该装置无法以预测的方式进行验证，而是因为组织或患者需要特殊护理。
结果可以是向外科医生识别需要附加的手术步骤，并且考虑辅助治疗，或者需要另选的更稳健的产品。例如，在结肠直肠下部前切除手术期间，成像系统可检测在活动之后对区域的血液供应的过度限制作为由手术生成的元数据的一部分。因此，由于暗示不能维持对横切组织的足够血液供应，因此可以保证血管再生产品或药物。
又如，在结肠直肠下前切除手术期间，并存病或化疗可在由手术生成的元数据中指示组织太容易碎裂。因此，可保证压力分布可吸收辅助缝合产品以便应力减小吻合，可能需要形成转移以防止肠内容物对新的吻合施加撤销应力，和/或可能需要施用过缝或纤维蛋白/凝血酶密封剂以确保在愈合的第一天不发生撤销泄露。外科系统200可被编程为在手术完成之后向医师推荐适当的产品、药物或治疗。
因此，可根据经由无监督式学习技术确定的关系来设置仪器、装置或机器设置，以提供更好的结果。在至少一个示例中，根据组织类型、推动刀的阻力等，外科缝合器械被更新以更慢或更快地运行。在另一个示例中，更新能量装置(例如，超声外科器械和电外科器械)以改变横切上施加的电流(即，缓慢地上升或下降或采取其它此类动作)。此外，在各种示例中，本公开的模块化装置(例如，1a-1n、2a-2m)中的一个或多个被编程为基于由基于云的系统(例如，104、204)执行的机器学习所学习的相关性来自动更新其设置。
在一些方面，外科医生可具有超控学习设置的能力。在一个方面，学习设置可以是默认设置。在一个方面，模块化装置(例如，1a-1n、2a-2m)可以建议新设置并允许外科医生在接受新设置和保持先前默认值之间进行选择。
本文描述了一种外科系统(例如，100、200)，该外科系统被配置成能够通过机器学习优化外科手术的一个或多个结果。治疗模式可在许多手术的过程中被识别，这些手术在实施时导致特定患者的成功和/或安全结果。此类治疗模式可包括例如在手术期间使用的外科器械的类型、待执行的附加手术和/或需要进一步监测的任何问题。在每个特定手术期间收集的数据、执行的治疗和/或特定手术的结果可存储在数据库(例如，远程服务器113)中以供将来分析。所收集的数据可用于支持和/或更新现有的治疗推荐。根据所识别的模式分析患者的各种健康统计结果，例如患者的病历和/或当前重要统计数据，可以进一步优化特定手术成功的可能性。
如上文更详细所述，外科系统(例如，100,
)包括信息集线器或外科集线器(例如，106、206)。外科集线器被配置成能够有利于在外科手术中使用的任何外科器械、数据源和/或临床医生之间的通信。信息集线器(诸如例如，本文所述的外科集线器)可存储在每个特定手术期间收集的数据。在各种情况下，外科集线器可本地存储针对特定手术和/或特定患者的数据。外科集线器可将与不同手术相关的附加数据存储在外部服务器中(例如，移除服务器113)。
在各种示例中，参见图10，外科集线器206包括控制电路，该控制电路包括被配置成能够接收来自数据源的输入的处理器244。数据源被配置成向外科集线器206提供与特定外科手术和/或特定患者相关的数据。例如，数据源可为外科集线器206提供患者的病史和/或当前的重要统计数据，诸如例如血压。数据源还可以为外科集线器206提供由外科器械和/或外科可视化系统从外科部位收集的数据。
适用于外科集线器206的示例性外科器械在2017年12月28日提交的名称为“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341的标题“Surgical Instrument Hardware”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。外科可视化系统(诸如可视化系统108)的各种部件在2017年12月28日提交的名称为“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据此全文以引用方式并入。
在接收来源于数据源的输入或数据时，外科集线器206针对存储的数据集分析所接收的数据。在各种示例中，存储的数据集存储在存储器249中。执行此类分析的目的是优化外科手术的结果。在各种示例中，数据存储和/或机器学习分析可在外科集线器级别本地执行。除此之外或另选地，例如，数据存储和/或机器学习分析可在云204处执行。
在各种情况下，外科集线器206使用一个或多个未经训练的机器学习技术针对存储的数据集分析所接收的数据。使用未经训练或无监督式机器学习技术可允许确定数据对之间的关系和/或识别由所执行的外科手术产生的并发症。
外科集线器206识别所接收的数据和存储的数据中的共性，并且基于每个分析的数据片中此类共性的存在或不存在来作出反应。未经训练的机器学习中的主要技术包括例如聚类。聚类的目的是创建数据点的组，使得不同聚类中的点是相异的，而聚类内的点是相似的。换句话讲，聚类提供针对“正常”学习行为之外的潜在威胁的保护。在各种情况下，控制电路被配置成能够在针对所存储的数据分析所接收的数据中利用聚类。聚类技术包括例如k均值聚类和分级聚类。在k均值聚类中，数据点被聚类成k组。较大k产生具有较大粒度的较小组，而较小k表示较大组和较大粒度。通过为每个组创建质心来定义每个组，其中聚类捕获最靠近它的点并将它们添加到聚类。在分层聚类中，类似的数据点被分组为聚类。为了决定应将哪些聚类组合，或者应将聚类划分在何处，需要测量数据集之间的相异性。这通过使用适当的度量或数据对之间的距离的量度以及指定数据对之间的相异水平的链接标准来实现。
未经训练的机器学习技术可基于人工神经网络的创建来开发推荐。例如，外科成像系统诸如外科可视化系统108可收集表示外科部位内的结构的数据。在接收到所收集的结构数据之后，外科集线器206针对所存储的结构数据集来分析所收集的数据。未经训练的机器学习中的技术在不考虑数据含义的情况下分析趋势和连接。此类分析允许处理器244通过利用具有先前识别的区域的图像而在没有关键结构本身的参数的信息的情况下推荐外科部位中潜在的关键结构的标识。
基于未经训练的机器学习分析，外科集线器206被配置为推荐动作。所推荐的动作可以提示的形式指向临床医生。分析的数据可用于向临床医生识别是否有必要进行附加的过程步骤、应考虑辅助治疗和/或需要另选的治疗。另选的治疗可包括使用不同的外科器械和/或在外科器械上实施更稳健的操作程序。
例如，临床医生可对患者执行结肠直肠下前切除手术。在外科手术期间，外科可视化系统(诸如外科可视化系统108)可检测在活动之后对该区域的血液供应的过度限制。一旦外科成像系统或另选的数据源将检测到的血液供应的过度限制传达给外科集线器206，处理器244就针对先前收集的数据分析检测的对血液供应的过度限制。使用未经训练的机器学习技术，处理器244评估检测的对血液供应的过度限制与先前收集的数据之间的共性。基于所评估的共性，处理器244被配置成开发优化外科手术的结果的推荐。由于不能够维持对横切组织的足够血液供应的暗示，可能的推荐可以是例如使用血管再生产品和/或药物。
在另一个示例中，临床医生可执行与上述相同的结肠直肠下前切除手术。在手术之前和/或期间，患者的病历可包括指示患者患有并存病、或同时存在另一种慢性疾病或病症、和/或先前接受过化学疗法的信息。一旦数据源将患者的医疗记录中包括的数据传达给外科集线器206，处理器244就针对先前收集的数据分析当前的医疗记录。
使用未经训练的机器学习技术，处理器244评估当前患者的病历与先前收集的数据之间的共性。基于所评估的共性，处理器244开发推荐以优化外科手术的结果。可能的推荐可包括例如：(1)使用压力分布吸收性辅助缝合产品以便应力减小吻合；(2)形成转向以防止肠内容物对新的吻合施加撤销应力；和/或(3)施加过度缝合或纤维蛋白/凝血酶密封剂以防止在愈合的前几天内发生泄露。
使用未经训练或无监督式机器学习技术可允许确定数据对之间的关系和/或识别由所执行的外科手术产生的并发症。处理器244识别所接收的数据和存储的数据中的共性，并且基于每个分析的数据片中此类共性的存在或不存在来作出反应。基于该分析，处理器244推荐动作。推荐的动作可以操作程序和/或参数的形式指向外科器械。换句话讲，所推荐的动作可以是修改的机器和/或装置(例如，模块化装置1a-1n、2a-2m)设置的形式，以提供改善的结果。例如，各种外科器械可接收对器械的操作程序的以下改变和/或更新：(1)外科手术缝合器可根据诸如组织类型、刀感觉到的阻力等因素较慢或较快地运行；以及(2)外科能量装置可通过缓慢地上升或下降等来改变流过横切的电流。在各种情况下，外科集线器206被配置成能够基于无监督式机器学习分析自动更新外科器械的设置。
虽然外科器械的操作程序可利用外科集线器206的推荐自动更新和/或改变，但是临床医生也可具有超控所实现的推荐的能力。在各种情况下，外科集线器206可通过对外科器械的操作程序的推荐改变来提示临床医生。然后临床医生能够接受所推荐的改变或保持先前的操作参数。在其它情况下，推荐的改变可自动生效，并且如果临床医生需要，临床医生能够切换回先前的操作参数。
如上所述，在接收来源于数据源的输入或数据时，外科集线器206的处理器244针对存储的数据集分析所接收的数据。执行此类分析的目的是优化外科手术的结果。在各种情况下，外科集线器244使用一个或多个经训练的机器学习技术针对存储的数据集分析所接收的数据。在监督式学习中，当给定其中输入和输出未知的新示例时，处理器244尽可能准确地预测参数。
经训练的机器学习中的主要技术包括例如参数学习和非参数学习。回归、分类和矢量聚类是参数学习中涉及的两个任务。回归预测连续的目标变量，从而允许处理器244基于所接收的输入数据来估计值。连续变量，诸如例如患者的身高、体重、肺气肿空气泄漏速率等，意味着预测参数可具有的值没有间断。另一方面，离散变量可仅呈现有限数量的值-例如，端部执行器内的钉仓的颜色。
例如，临床医生可能希望基于诸如患者体内存在的肺气肿的阶段、外科缝合器的击发速度、闭合端部执行器的钳口所需的力、端部执行器内的钉仓的类型和/或颜色等因素来预测肺气肿空气泄漏速率。外科缝合器用于缝合肺气肿患者中的肺组织。基于患者的状况和/或待由外科缝合器缝合的肺组织的状况来选择合适的钉仓。钉仓颜色可反映例如外科缝合器的尺寸。
在各种示例中，外科集线器206建立逼近上述因素与对应的肺气肿空气泄漏速率之间的关系f的模型。如图18所示，在监督式学习中，处理器244尝试通过学习算法运行标记的训练数据250810来学习例如肺气肿空气泄漏速率与先前识别的因素之间的关系。处理器244可使用所学习的功能来估计其肺气肿空气泄漏速率未知的患者的肺气肿空气泄漏速率。该估计基于各种输入，包括肺气肿的阶段、外科缝合器的击发速度、闭合端部执行器的钳口所需的力、和/或端部执行器内的钉仓的类型和/或颜色。
图16表示在先前的外科手术期间收集的示例性数据。在图16中，患者被诊断为患有肺气肿的特定阶段。计算的阈值250700表示外科手术的结果可接受所处的点。正(+)侧表示外科手术的良好或有益结果，而负(-)侧表示外科手术的不良或不利结果。已观察到，辐射使肺组织硬化，而肺气肿使肺组织软化。这种观察对外科器械(诸如外科缝合器)的操作程序有影响。例如，过快地推进击发构件穿过患病组织可能对外科手术的结果具有不利影响。
第2阶段肺气肿的第一位患者由线250710表示，并且第2阶段肺气肿的第二位患者由线250715表示。外科缝合器的击发构件在第一患者250710的外科手术期间以慢速推进，并且击发构件在第二患者250715的外科手术期间以快速推进。如相应的虚线250710、250715所示，当患者患有第2阶段肺气肿时，击发构件的速度似乎无关紧要，因为两个患者都具有良好或有益的结果。值得注意的是，击发构件的快速使得第二患者250715更接近外科手术的可接受结果的阈值。
第3阶段肺气肿的第一位患者由线250720表示，并且第3阶段肺气肿的第二位患者由线250725表示。外科缝合器的击发构件在第一患者250720的外科手术期间以慢速推进，并且击发构件在第二患者250725的外科手术期间以快速推进。如虚线250725所示，击发构件在第3阶段肺气肿的患者中的快速推进对外科手术产生不可接受的和/或不利的结果，而虚线250720示出，击发构件在第3阶段肺气肿患者中的缓慢推进导致对相同外科手术的可接受的和/或有益的结果。第4阶段肺气肿的第一位患者由线250730表示，并且第4阶段肺气肿的第二位患者由线250735表示。外科缝合器的击发构件在第一患者250730的外科手术期间以慢速推进，并且击发构件在第二患者250735的外科手术期间以快速推进。如相应的虚线250730、250735所示，当患者患有第4阶段肺气肿时，击发构件的速度似乎无关紧要，因为两个患者都具有不良或不利的结果。
如图17所示，关于许多参数，收集与图16中收集的数据类似的数据，所述参数包括例如：(1)肺气肿的阶段250750；(2)如果患者已接受过辐射250752；(3)外科缝合器推进其击发构件所需的力250754；(4)患者的血压250756；(5)以低速推进击发构件250758；和/或(6)以高速推进击发构件250759。如所测量的参数沿阈值线250700的位置所表示，每个参数对外科手术的结果具有积极效应或消极效应。如虚线250755所示，患者接受过辐射250752以及外科缝合器推进其击发构件所需的力250754高两者都对外科手术的结果具有相互关联的因果关系和效应。高血压250756和击发构件的低推进速度的250758对外科手术的结果具有积极效应，而击发构件高推进速度250759和肺气肿的更大阶段250750对外科手术的结果具有消极效应。虚线250757表示基于未学习分组的外科器械控制程序变化。
框250760表示从个体患者检测到的测量参数，这些个体患者的组合导致对外科手术的不良或不利结果。框250770表示从个体患者检测到的测量参数，这些个体患者的组合导致对外科手术的良好或有益结果。如相对于图19更详细地描述，框250765表示从个体患者检测到的测量参数，这些个体患者的组合导致不代表其他患者的意料不到的结果。在各种情况下，某些情有可原的情况(extenuating circumstances)影响由250765表示的患者的外科手术的结果。
如图16所示，将先前收集的数据分成训练数据集250810和测试数据集250820、250830。训练数据集250810具有标签，因此外科集线器206可从这些标记的示例中学习。此类标签可包括例如各种确定的肺气肿空气泄漏速率及其对应的肺气肿阶段、外科缝合器的击发速度、闭合端部执行器的钳口所需的力以及端部执行器内的仓的类型和/或颜色。测试集250820、250830包括不具有标签的数据，即，处理器244还不知道其试图预测的值。换句话讲，处理器244必须一般化到其之前未遇到的情况，使得这可为测试数据250820、250830提供最准确的预测。
外科集线器206基于先前收集的标记为训练数据集250810的数据创建数学模型250840。训练数据集由大样本量构成，即n＝1000，以定义函数。测试集250820、250830或验证集允许外科集线器206检查测试集250820、250830是否适合所确定的数学模型。测试集250820、250830包括较小的样本量，即n＝50。测试集250820、250830的分析250835产生验证模型250850以用于与所生成的数学模型250840进行比较。在各种情况下，这为外科集线器206提供了保持预期数据并移除任何未预期的数据的机会。调整数学模型250840的能力允许对分组过程进行微调以填充250855最终数学模型以用于数据分析。所开发的模型可应用于所收集的数据的分析以估计例如肺气肿空气泄漏速率。
如上所述，一些数据点是异常值并且必须从数据池中移除以对数学模型进行微调。如图19所示，并且如关于图17所讨论的，框250760表示从个体患者检测到的测量参数，这些个体患者的组合导致对外科手术的不良或不利结果。框250770表示从个体患者检测到的测量参数，这些个体患者的组合导致对外科手术的良好或有益结果。框250765表示从个体患者检测到的测量参数，这些个体患者的组合导致不代表其他患者的意料不到的结果。在各种情况下，某些情有可原的情况(extenuating circumstances)影响由250765表示的患者的外科手术的结果。异常值框250765的存在改变了中值阈值，因为数学模型试图解释它们的结果。从数学模型中排除异常值数据250765，从而将实际阈值250700调整到其正当位置。异常值框250765最初将通过算法与其它有害结果框250760进行分组250900，因为它们都不产生可接受的外科手术结果。这将导致对未来结果的不一致且不准确的预测。对不利结果有贡献的参数的实际分组由250910表示，并且对有益结果有贡献的参数的实际分组由250920表示。机器学习中的常见问题是过拟合。过拟合是学习完美解释模型从其学习的训练数据，但不能很好地推广到看不见的测试数据的某一功能。当模型从训练数据过学习到其开始拾取不表示所收集的数据中的模式的特征的点时，发生过拟合。欠拟合是所生成的模型不够复杂而无法捕获数据中的基础趋势的相关问题。
现在参见图20，示出了用于外科排抽系统200的算法250950。算法250950旨在允许基于涉及监督式和/或无监督式学习技术的远程分析来调整外科系统200的外科器械和/或其它部件的控制程序。如上文更详细地描述，此类技术包括在相关性搜索中对不同变量组合的重复多变量分析，以及针对原始分析中未使用的单独数据组对分析结果的预测能力的评估。
本文所公开的各种外科系统(诸如例如，外科系统100、200)可利用图20的算法250950。此外，读者将容易理解，在某些情况下，图20的算法250950可与本文所述的一个或多个附加算法组合。由外科系统200作出的决定可例如通过包括处理器244的控制电路来实现。控制电路被配置成能够接收来自数据源的数据250952。所接收的数据可包括例如与患者的生命统计、患者的病史、正在执行的外科手术的类型、正在使用的外科器械的类型、由外科器械和/或外科可视化系统检测的任何数据等有关的数据。
外科系统200的控制电路被配置成能够针对存储的数据集分析所接收的数据250954。此类分析250954可基于监督式或无监督式学习。此类分析250954可在设施链接设备的本地网络内执行，或者可被导出到远程位置进行编译并返回到网络。
在分析250954之后，控制电路被配置成能够基于该分析来传达推荐250956。该推荐可基于对装置相关影响、患者特定影响和/或所使用装置的交互的识别。该推荐可以提示的形式传达给临床医生和/或可以更新的操作参数的形式传达给特定外科器械。在一个示例中，推荐由云204直接或通过外科集线器206传达给模块化装置(例如，1a-1n、2a-2m)。在一个示例中，推荐被传达给外科集线器206。在任何情况下，推荐可包括例如更新模块化装置的控制程序或调整模块化装置的操作参数的提示。在各种情况下，推荐可包括向临床医生指示的建议或其它过程修改。在某些情况下，这些推荐包括例如对模块化装置的致动速度、等待时间和/或其它操作参数的调整。
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-公开了一种外科反馈系统。所述外科反馈系统包括外科器械、数据源和被配置成能够可通信地联接到所述数据源和所述外科器械的外科集线器。所述外科集线器包括控制电路，其中所述控制电路被配置成能够接收来自所述数据源的输入，针对存储的数据集分析所接收的数据以优化外科手术的结果，并且基于所分析的数据来传达推荐。
实施例2-根据实施例1所述的外科反馈系统，其中，所述控制电路还被配置成能够基于所传达的推荐来调整所述外科器械的操作参数。
实施例3-根据实施例1和2中任一项所述的外科反馈系统，其中，所述控制电路还被配置成能够基于所传达的推荐来更新所述外科器械的控制程序。
实施例4-根据实施例1至3中任一项所述的外科反馈系统，其中，所述控制电路被配置成能够通过向用户建议过程修改来传达所述推荐。
实施例5-根据实施例1至4中任一项所述的外科反馈系统，其中，所述控制电路被配置成能够使用监督式学习技术来分析所接收的数据和所述存储的数据集。
实施例6-根据实施例1至5中任一项所述的外科反馈系统，其中，所述控制电路被配置成能够使用无监督式学习技术来分析所接收的数据和所述存储的数据集。
实施例7-根据实施例1至6中任一项所述的外科反馈系统，其中，所述控制电路被配置成能够在本地网络内分析所接收的数据。
实施例8-根据实施例1-7中任一项所述的外科反馈系统，其中，所述控制电路被配置成能够通过将所述数据导出到远程位置进行编译来分析所接收的数据。
实施例9-根据实施例1至8中任一项所述的外科反馈系统，其中，所述存储的数据集包括在先前的外科手术期间采集的数据。
实施例10-根据实施例1至9中任一项所述的外科反馈系统，其中，所述数据源包括针对特定患者的数据。
实施例11-根据实施例1至10中任一项所述的外科反馈系统，其中，所述控制电路还被配置成能够利用所传达的推荐来更新所述存储的数据集。
实施例12-公开了一种外科反馈系统。所述外科反馈系统包括数据源和具有控制电路的外科集线器。所述控制电路被配置成能够接收来自所述数据源的输入，针对存储的数据集分析所接收的数据以优化外科手术的结果，其中所述存储的数据集包括在先前的外科手术期间收集的数据，并且基于所分析的数据来传达推荐。
实施例13-根据实施例12所述的外科反馈系统，其中，所传达的推荐基于定位在外科部位内的特定外科器械。
实施例14-根据实施例12和13中任一项所述的外科反馈系统，其中，所述控制电路还被配置成能够基于所传达的推荐来调整所述外科器械的操作参数。
实施例15-根据实施例12至14中任一项所述的外科反馈系统，其中所述控制电路被配置成能够使用监督式学习技术来针对所存储的数据集分析所接收的数据。
实施例16-根据实施例12至15中任一项所述的外科反馈系统，其中所述控制电路被配置成能够使用无监督式学习技术来针对所存储的数据集来分析所接收的数据。
实施例17-根据实施例12至16中任一项所述的外科反馈系统，其中所述控制电路被配置成能够通过向用户建议过程修改来传达所述推荐。
实施例18-公开了一种外科反馈系统。所述外科反馈系统包括数据源和具有控制电路的外科器械。所述控制电路被配置成能够接收来自所述数据源的输入，针对存储的数据集分析所接收的数据以优化外科手术的结果，其中所述存储的数据集包括在先前的外科手术期间收集的数据，并且基于所分析的数据确定推荐。
实施例19-根据实施例18所述的外科反馈系统，其中，所述控制电路还被配置成能够基于所确定的推荐来调整所述外科器械的操作参数。
实施例20-根据实施例18至19中任一项所述的外科反馈系统，其中，所述控制电路还被配置成能够利用所确定的推荐来更新所述存储的数据集。
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装置。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“部件”、“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目为预期的，则这样的意图将在权利要求中明确叙述，并且在不存在这样的叙述的情况下，不存在这样的意图。例如，为有助于理解，下述所附权利要求可含有对介绍性短语“至少一个”和“一个或多个”的使用以引入权利要求。然而，对此类短语的使用不应视为暗示通过不定冠词“一个”或“一种”引入权利要求表述将含有此类引入权利要求表述的任何特定权利要求限制在含有仅一个这样的表述的权利要求中，甚至当同一权利要求包括介绍性短语“一个或多个”或“至少一个”和诸如“一个”或“一种”(例如，“一个”和/或“一种”通常应解释为意指“至少一个”或“一个或多个”)的不定冠词时；这也适用于对用于引入权利要求表述的定冠词的使用。
另外，即使明确叙述引入权利要求叙述的特定数目，本领域的技术人员应当认识到，此种叙述通常应解释为意指至少所叙述的数目(例如，在没有其它修饰语的情况下，对“两个叙述”的裸叙述通常意指至少两个叙述、或两个或更多个叙述)。此外，在其中使用类似于“A、B和C中的至少一者等”的惯例的那些情况下，一般而言，这种结构意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B和C中的至少一者的系统”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。在其中使用类似于“A、B或C中的至少一者等”的惯例的那些情况下，一般而言，这种结构意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B或C中的至少一者的系统”应当包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。本领域的技术人员还应当理解，通常，除非上下文另有指示，否则无论在具体实施方式、权利要求或附图中呈现两个或更多个替代术语的转折性词语和/或短语应理解为涵盖包括所述术语中的一者、所述术语中的任一个或这两个术语的可能性。例如，短语“A或B”通常将被理解为包括“A”或“B”或“A和B”的可能性。
对于所附的权利要求，本领域的技术人员将会理解，其中表述的操作通常可以任何顺序进行。另外，尽管以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，具体特征部、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 (20)
1.一种外科反馈系统，包括：
外科器械；
数据源；以及
外科集线器，所述外科集线器被配置成能够可通信地联接到所述数据源和所述外科器械，其中所述外科集线器包括控制电路，并且其中所述控制电路被配置成能够：
接收来自所述数据源的输入；
针对存储的数据集分析所接收的数据以优化外科手术的结果；
并且
基于分析出的数据来传达推荐。
2.根据权利要求1所述的外科反馈系统，其中，所述控制电路还被配置成能够基于所传达的推荐来调整所述外科器械的操作参数。
3.根据权利要求1所述的外科反馈系统，其中，所述控制电路还被配置成能够基于所传达的推荐来更新所述外科器械的控制程序。
4.根据权利要求1所述的外科反馈系统，其中，所述控制电路被配置成能够通过向用户建议过程修改来传达所述推荐。
5.根据权利要求1所述的外科反馈系统，其中，所述控制电路被配置成能够使用监督式学习技术来分析所接收的数据和所述存储的数据集。
6.根据权利要求1所述的外科反馈系统，其中，所述控制电路被配置成能够使用无监督式学习技术来分析所接收的数据和所述存储的数据集。
7.根据权利要求1所述的外科反馈系统，其中，所述控制电路被配置成能够在本地网络内分析所接收的数据。
8.根据权利要求1所述的外科反馈系统，其中，所述控制电路被配置成能够通过将所述数据导出到远程位置进行编译来分析所接收的数据。
9.根据权利要求1所述的外科反馈系统，其中，所述存储的数据集包括在先前的外科手术期间采集的数据。
10.根据权利要求1所述的外科反馈系统，其中，所述数据源包括针对特定患者的数据。
11.根据权利要求1所述的外科反馈系统，其中，所述控制电路还被配置成能够利用所传达的推荐来更新所述存储的数据集。
12.一种外科反馈系统，包括：
数据源；以及
外科集线器，所述外科集线器包括控制电路，其中所述控制电路被配置成能够：
接收来自所述数据源的输入；
针对存储的数据集分析所接收的数据以优化外科手术的结果，其中所述存储的数据集包括在先前的外科手术期间收集的数据；并且
基于所分析的数据来传达推荐。
13.根据权利要求12所述的外科反馈系统，其中，所传达的推荐基于定位在外科部位内的特定外科器械。
14.根据权利要求12所述的外科反馈系统，其中，所述控制电路还被配置成能够基于所传达的推荐来调整所述外科器械的操作参数。
15.根据权利要求12所述的外科反馈系统，其中，所述控制电路被配置成能够使用监督式学习技术来针对所述存储的数据集分析所接收的数据。
16.根据权利要求12所述的外科反馈系统，其中，所述控制电路被配置成能够使用无监督式学习技术来针对所述存储的数据集分析所接收的数据。
17.根据权利要求12所述的外科反馈系统，其中，所述控制电路被配置成能够通过向用户建议过程修改来传达所述推荐。
18.一种外科反馈系统，包括：
数据源；以及
外科器械，所述外科器械包括控制电路，其中所述控制电路被配置成能够：
接收来自所述数据源的输入；
针对存储的数据集分析所接收的数据以优化外科手术的结果，其中所述存储的数据集包括在先前的外科手术期间收集的数据；并且
基于所分析的数据来确定推荐。
19.根据权利要求18所述的外科反馈系统，其中，所述控制电路还被配置成能够基于所确定的推荐来调整所述外科器械的操作参数。
20.根据权利要求18所述的外科反馈系统，其中，所述控制电路还被配置成能够利用所确定的推荐来更新所述存储的数据集。
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| US11832899B2 (en) | 2023-12-05 |
| JP7309721B2 (ja) | 2023-07-18 |
| BR112020013013A2 (pt) | 2020-11-24 |
| WO2019133136A1 (en) | 2019-07-04 |
| EP3506306A1 (en) | 2019-07-03 |
| JP2021509203A (ja) | 2021-03-18 |
| WO2019133136A8 (en) | 2020-08-06 |
| US20190201123A1 (en) | 2019-07-04 |
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