JP7334161B2 - Adjustment of equipment control programs based on stratified contextual data in addition to data - Google Patents

Description

(Cross reference to related applications)
This application is part of U.S. Provisional Patent Application Serial No. 16, filed November 6, 2018, entitled "ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED CONTEXTUAL DATA IN ADDITION TO THE DATA," the disclosure of which is incorporated herein by reference in its entirety. 182,239.

This application, under 35 U.S.C. MISSION" No. 62/729,177, filed September 10, 2018, entitled

This application is further filed under 35 U.S.C. U.S. Provisional Patent Application No. 62/692,747, filed June 30; No. 62/692,768, filed Jun. 30, 2018, entitled

This application is filed under 35 U.S.C. Priority is claimed to Provisional Application No. 62/659,900.

This application is also filed under 35 U.S.C. U.S. Provisional Patent Application No. 62/650,898, filed March 30, entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES," U.S. Provisional Patent Application No. 62/650,887, filed March 30, 2018, entitled "SMOKE EVACUATION MODULE US Provisional Patent Application No. 62/650,882, filed March 30, 2018, entitled "FOR INTERACTIVE SURGICAL PLATFORM" and US Provisional Patent Application, filed March 30, 2018, entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS." Priority benefit of 62/650,877 is claimed.

This application is also filed under 35 U.S.C. U.S. Provisional Application No. 62/640,417, filed March 8, 2018; claim the benefit of priority over

This application also qualifies under 35 U.S.C. U.S. Provisional Application No. 62/611,340, filed Dec. 28, 2017, entitled "CLOUD-BASED MEDICAL ANALYTICS"; Priority benefit of US Provisional Patent Application No. 62/611,339 filed Dec. 28 is claimed.

The present disclosure relates to various surgical systems. Surgical procedures are typically performed, for example, in an operating room or room within a medical facility, such as a hospital. A sterile field is typically created around the patient. A sterile field may include clean team members in appropriate clothing and all equipment and fixtures within the area. Various surgical devices and systems are utilized in performing surgical procedures.

Furthermore, in the digital information age, healthcare systems and facilities often utilize newer and improved technology due to a general desire to maintain patient safety and traditional practices. Or slower to implement performance. However, in many cases, healthcare systems and facilities may consequently lack communication and shared knowledge with other nearby or similarly situated facilities. It would be desirable to find ways to help interconnect healthcare systems and facilities to improve patient care.

In various embodiments, a system is disclosed for adjusting parameters of a medical device in the specific context of the patient on which the medical device is to be used, the system being in communication with a medical hub and the medical hub. and a coupled medical device. The medical hub accesses a first context data set representing a first situation associated with a particular context in which the medical device is to be used on the patient and the medical device is to be used on the patient. accessing a second context data set representing a second situation associated with a particular context; Ordering the second context data set in a priority hierarchy and determining that at least a first portion of the first context data set is associated with adjusting a parameter of the medical device. , determining that at least a second portion of the second context data set is related to adjusting a parameter of the medical device; , resolving with respect to adjusting the parameters, and programming the medical device by adjusting the parameters of the medical device according to the resolved discrepancies. The medical device utilizes the adjusted parameters such that the performance of the medical device to the patient in a particular context is more effective with the adjusted parameters than without the adjusted parameters. configured for use on a patient;

In various embodiments, a method of a system for adjusting parameters of a medical device in a particular context of a patient on which the medical device is to be used, the system comprising a medical device and a medical device in communication with the medical device. A method is disclosed comprising a medical hub operably coupled thereto. The method includes accessing, by the medical hub, a first context data set representing a first context associated with a particular context in which the medical device is to be used on a patient; and accessing a second context data set representing a second context associated with a particular context to be used in the medical hub to ensure that the first context data set is more relevant than the second context data set. Arranging the first and second context data sets in a priority hierarchy to have higher priority; and determining, by the medical hub, that at least a second portion of the second context data set is associated with adjusting a parameter of the medical device resolving, by the medical hub, the discrepancy between the first portion and the second portion in relation to adjusting the parameters; and programming the medical device by adjusting the parameters. The medical device utilizes the adjusted parameters such that the performance of the medical device to the patient in a particular context is more effective with the adjusted parameters than without the adjusted parameters. configured for use on a patient;

In various embodiments, a computer-readable medium without transient signals is disclosed that includes instructions that, when executed by a processor, cause the processor to perform operations. The actions include accessing a first context data set representing a first situation associated with a particular context in which the medical device is to be used on the patient; accessing a second context data set representing a second context associated with the context of the first and first context data sets, such that the first context data set has a higher priority than the second context data set; ordering the two context data sets in a priority hierarchy; determining that at least a first portion of the first context data set is associated with adjusting a parameter of the medical device; determining that at least a second portion of the second context data set is related to adjusting a parameter of the medical device; determining the difference between the first portion and the second portion; resolving in relation to adjusting the parameters; and programming the medical device by adjusting the parameters of the medical device according to the resolved differences. The medical device utilizes the adjusted parameters such that the performance of the medical device to the patient in a particular context is more effective with the adjusted parameters than without the adjusted parameters. configured for use on a patient;

The various aspects described herein, both as to organization and method of operation, together with further objects and advantages thereof, are best understood by reference to the following description, taken in conjunction with the accompanying drawings that follow. can do.
1 is a block diagram of a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure; FIG. A surgical system used to perform a surgical procedure in an operating room, according to at least one aspect of the present disclosure. 1 is a surgical hub paired with a visualization system, a robotic system, and an intelligent instrument according to at least one aspect of the present disclosure; FIG. 122 is a partial perspective view of a surgical hub housing and a combination generator module slidably receivable within a drawer of the surgical hub housing in accordance with at least one aspect of the present disclosure; 1 is a perspective view of a combination generator module comprising bipolar, ultrasonic, and monopolar contacts and smoke evacuation components in accordance with at least one aspect of the present disclosure; FIG. 4 illustrates individual power bus attachments for multiple lateral docking ports of a lateral modular housing configured to receive multiple modules, in accordance with at least one aspect of the present disclosure; 1 illustrates a vertical modular housing configured to receive multiple modules, according to at least one aspect of the present disclosure; Cloud modular devices located in one or more operating rooms of a healthcare facility, or any room within a healthcare facility with specialized equipment for surgical procedures, according to at least one aspect of the present disclosure. 1 illustrates a surgical data network with modular communication hubs configured to connect; 1 illustrates a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure; 1 illustrates a surgical hub comprising multiple modules coupled to a modular control tower, according to at least one aspect of the present disclosure; 1 illustrates one aspect of a Universal Serial Bus (USB) network hub device, in accordance with at least one aspect of the present disclosure; 1 is a block diagram of a cloud computing system comprising a plurality of smart surgical instruments coupled to a surgical hub that can be connected to cloud components of the cloud computing system, according to at least one aspect of the present disclosure; FIG. 1 is a functional module architecture of a cloud computing system, according to at least one aspect of the present disclosure; 1 illustrates a diagram of a situation-aware surgical system, according to at least one aspect of the present disclosure; FIG. 4 is a timeline illustrating surgical hub situational awareness in accordance with at least one aspect of the present disclosure; 1 is a block diagram of a system for automated scaling, organization, fusion and alignment of heterogeneous datasets, according to at least one aspect of the present disclosure; FIG. A first graph illustrating measured blood pressure versus time, a second graph illustrating fused blood pressure versus time, and a third graph illustrating blood pressure versus time at different sample rates, according to at least one aspect of the present disclosure. 1 is a set of graphs containing graphs of . 4 is a graph illustrating blood pressure versus high and low thresholds, according to at least one aspect of the present disclosure; 4 is a graph illustrating ultrasound system frequency versus time, in accordance with at least one aspect of the present disclosure; 4 is a graph illustrating expected blood pressure for different vessel types, in accordance with at least one embodiment of the present disclosure; FIG. 4 is a block diagram illustrating layered context information, in accordance with at least one aspect of the present disclosure; FIG. 3 is a block diagram illustrating instrument feature settings, in accordance with at least one aspect of the present disclosure; 1 is a graph illustrating force to fire (FTF) and rate of fire for patients with different complication risks.

The applicant of this application owns the following US patent applications filed November 6, 2018, the entire disclosures of each of which are incorporated herein by reference:
- U.S. patent application Ser. No. 4,
U.S. Patent Application No. 16/182,230 entitled "SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA";
U.S. Patent Application No. 16/182,233, entitled "MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING";
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. Patent Application No. 16/182,251, entitled "INTERACTIVE SURGICAL SYSTEM";
- U.S. patent application Ser.
- U.S. Patent Application No. 1 entitled "SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO-POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO A SURGICAL NETWORK" 6/182,267,
- U.S. patent application Ser.
U.S. patent application Ser. No. 16/182,246 entitled "ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES";
- U.S. patent application Ser.
・"REAL-TIME ANALYSIS OF COMPREHENSIVE COST OF ALL INSTRUMENTATION USED IN SURGERY UTILIZING DATA FLUIDITY TO TRACK INSTRUMENTS THROUGH STOCKING AND IN-HOUSE PR US patent application Ser. No. 16/182,242 entitled OCESSES;
・"USAGE AND TECHNIQUE ANALYSIS OF SURGEON/STAFF PERFORMANCE AGAINST A BASELINE TO OPTIMIZED DEVICE UTILIZATION AND PERFORMANCE FOR BOTH AND CURRENT FUTURE U.S. Patent Application Serial No. 16/182,255 entitled PROCEDURES;
- U.S. patent application Ser.
・"COMMUNICATION OF DATA WHERE A SURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVING SYSTEM/USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY,"
- U.S. patent entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION" Application No. 16/182,290,
- U.S. Patent Application No. 16/182,232 entitled "CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER";
- U.S. patent application Ser.
・ Titled "Wireless Pairing of a Surgical Device With Another Device Without a Sterile Surgical Field Based on the Usage and Situational Awareness of Devices" U.S. patent application Ser. No. 16/182,231;
- U.S. patent application Ser.
- U.S. patent application Ser.
・"POWERED STAPLINING DEVICE CONFIGURED TO ADJUST FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER BASED ON SENSED PARAMETER OF FIRING OR CLAMP U.S. Patent Application Serial No. 16/182,240 entitled "G";
・"VARIATION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN COOPERATION WITH VARYING CLAMP ARM PRESSURE TO ACHIEVE PREDEFINED HEAT FLUX OR POWER APPLIED TO T U.S. Patent Application No. 16/182,235, entitled "ISSUE"; and "ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE"; US patent application Ser. No. 16/182,238 entitled APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION.

The applicant of this application owns the following US patent applications filed September 10, 2018, the entire disclosures of each of which are incorporated herein by reference:
- U.S. Provisional Patent Application No. entitled "A CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSED SITUATION OR USAGE" 62/729,183,
U.S. Provisional Patent Application No. 62/729,177 entitled "AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION";
・"INDIRECT COMMAND AND CONTROL OF A FIRST OPERATING ROOM SYSTEM THROUGH THE USE OF A SECOND OPERATING ROOM SYSTEM WITHIN A STERILE FIELD WHERE THE SECOND OPERATING ROOM U.S. Provisional Patent Application No. 62/729,176, entitled "ING ROOM SYSTEM HAS PRIMARY AND SECONDARY OPERATING MODES"issue,
・"POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER OF THE DEVICE BASED ON SENSED PARAMETERS" U.S. Provisional Patent Application No. 62/729,185 entitled ER OF FIRING OR CLAMPING;
・"POWERED SURGICAL TOOL WITH A PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE END EFFECTOR PARAMETER AND A MEANS FOR LIMITING THE AD U.S. Provisional Patent Application No. 62/729,184 entitled JUSTMENT;
- U.S. Provisional Patent Application No. 62/729,18 entitled "SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE HUB" No. 2,
- U.S. patent entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION" Provisional Application No. 62/729,191,
- U.S. Provisional Patent Application No. 62/729, entitled "ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION"; 195, and "WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN U.S. Provisional Patent Application No. 62/729,186, entitled "A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES".

The applicant of this application owns the following US patent applications filed Aug. 28, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Patent Application No. 16/115,214, entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR"
U.S. Patent Application No. 16/115,205, entitled "TEMPERATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR";
- US patent application Ser.
U.S. Patent Application No. 16/115,208 entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION";
- U.S. patent application Ser.
U.S. patent application Ser. No. 16/115,232 entitled "DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM";
- U.S. patent application Ser.
U.S. patent application Ser. No. 16/115,247 entitled "DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR";
U.S. patent application Ser.
- U.S. patent application Ser.
U.S. Patent Application No. 16/115,240, entitled "DETECTION OF END EFFECTOR IMMERSION IN LIQUID";
U.S. patent application Ser. No. 16/115,249 entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING";
- US patent application Ser.
U.S. Patent Application No. 16/115,223 entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY"; 6/115,238.

The applicant of this application owns the following US patent applications, filed August 23, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/721,995 entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION";
- U.S. Provisional Patent Application No. 62/721,998 entitled "SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS";
U.S. Provisional Patent Application No. 62/721,999 entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING";
U.S. Provisional Patent Application No. 62/721,994 entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY"; U.S. Provisional Patent Application Serial No. 62, entitled ELIVERING COMBINED ELECTRICAL SIGNALS 721,996.

The applicant of the present application owns the following US patent applications filed June 30, 2018, the entire disclosures of each of which are incorporated herein by reference:
- U.S. Provisional Patent Application No. 62/692,747 entitled "SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE";
• US Provisional Patent Application No. 62/692,748, entitled "SMART ENERGY ARCHITECTURE"; and • US Provisional Patent Application No. 62/692,768, entitled "SMART ENERGY DEVICES."

The applicant of this application owns the following US patent applications filed June 29, 2018, the entire disclosures of each of which are incorporated herein by reference:
- U.S. Patent Application No. 16/024,090 entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS";
- U.S. patent application Ser.
U.S. patent application Ser.
U.S. Patent Application No. 16/024,075 entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING";
- U.S. Patent Application No. 16/024,083 entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING";
- U.S. Patent Application No. 16/024,094 entitled "SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES";
U.S. patent application Ser.
U.S. Patent Application No. 16/024,150 entitled "SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES";
- U.S. Patent Application No. 16/024,160 entitled "VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY";
- U.S. Patent Application No. 16/024,124 entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE";
- U.S. Patent Application No. 16/024,132 entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT";
- U.S. Patent Application No. 16/024,141 entitled "SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY";
- U.S. Patent Application No. 16/024,162 entitled "SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES";
- U.S. Patent Application No. 16/024,066 entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL";
- U.S. Patent Application No. 16/024,096 entitled "SURGICAL EVACUATION SENSOR ARRANGEMENTS";
- U.S. Patent Application No. 16/024,116 entitled "SURGICAL EVACUATION FLOW PATHS";
U.S. Patent Application No. 16/024,149 entitled "SURGICAL EVACUATION SENSING AND GENERATOR CONTROL";
- U.S. Patent Application No. 16/024,180 entitled "SURGICAL EVACUATION SENSING AND DISPLAY";
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser. L IN-SERIES LARGE AND SMALL DROPLET FILTERS. Application Serial No. 16/024,273.

The applicant of this application owns the following US provisional patent applications filed June 28, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/691,228 entitled "A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES";
- U.S. Provisional Patent Application No. 62/691,227, entitled "CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS";
- U.S. Provisional Patent Application No. 62/691,230 entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE";
- U.S. Provisional Patent Application No. 62/691,219 entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL";
"Communication OF SMOKE Evacutations to Hub or Cloud IN SMOKE EVACUATION MODULE FORGIVE SURGICAL SURGICAL PLATFORM "US Patent Open application No. 62/691, 257,
U.S. Provisional Patent Application No. 62/691,262 entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE"; AL IN-SERIES LARGE AND SMALL DROPLET FILTERS Provisional Patent Application No. 62/691,251.

The applicant of this application owns the following US provisional patent application filed April 19, 2018, the entire disclosures of which are incorporated herein by reference:
• US Provisional Patent Application No. 62/659,900 entitled "METHOD OF HUB COMMUNICATION".

The applicant of this application owns the following US provisional patent applications filed March 30, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/650,898, filed March 30, 2018, entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS";
- U.S. Provisional Patent Application No. 62/650,887 entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES";
U.S. Provisional Patent Application No. 62/650,882, entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM," and U.S. Provisional Patent Application No. 62/650, entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS." , 877.

The applicant of the present application owns the following US patent applications filed March 29, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Patent Application No. 15/940,641, entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES";
- U.S. patent application Ser.
U.S. Patent Application No. 15/940,656 entitled "SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES";
- U.S. patent application Ser.
U.S. Patent Application No. 15/940,670 entitled "COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS";
- U.S. Patent Application No. 15/940,677 entitled "SURGICAL HUB CONTROL ARRANGEMENTS";
- U.S. patent application Ser.
- U.S. Patent Application No. entitled "COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS" 15/940,640,
U.S. Patent Application No. 15/940,645, entitled "SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT";
U.S. Patent Application No. 15/940,649, entitled "DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME";
- U.S. Patent Application No. 15/940,654 entitled "SURGICAL HUB SITUATIONAL AWARENESS";
- U.S. Patent Application No. 15/940,663 entitled "SURGICAL SYSTEM DISTRIBUTED PROCESSING";
- U.S. Patent Application No. 15/940,668, entitled "AGGREGATION AND REPORTING OF SURGICAL HUB DATA";
- U.S. Patent Application No. 15/940,671 entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER"
U.S. Patent Application No. 15/940,686, entitled "DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINE STAPLE LINE";
- U.S. Patent Application No. 15/940,700, entitled "STERILE FIELD INTERACTIVE CONTROL DISPLAYS";
U.S. Patent Application No. 15/940,629 entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS";
- U.S. patent application Ser.
- U.S. patent application Ser.
• US patent application Ser. No. 15/940,742, entitled "DUAL CMOS ARRAY IMAGING."
U.S. patent application Ser. No. 15/940,636 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES";
U.S. patent application Ser. No. 15/940,653 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS";
- U.S. Patent Application No. 15/940,660 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER"
- U.S. patent application Ser.
U.S. patent application Ser.
- U.S. Patent Application No. 15/940,634 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES"
U.S. Patent Application No. 15/940,706 entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK";
U.S. Patent Application No. 15/940,675, entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES";
- US patent application Ser.
- U.S. Patent Application No. 15/940,637, entitled "COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";
- US patent application Ser.
- US patent application Ser.
- US patent application Ser.
U.S. patent application Ser.
U.S. Patent Application No. 15/940,690, entitled "DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS," and US patent application Ser. No. 15/940,711.

The applicant of this application owns the following US provisional patent applications, filed March 28, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/649,302 entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES";
U.S. Provisional Patent Application No. 62/649,294 entitled "DATA STRIPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD";
U.S. Provisional Patent Application No. 62/649,300 entitled "SURGICAL HUB SITUATIONAL AWARENESS";
- U.S. Provisional Patent Application No. 62/649,309 entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER";
U.S. Provisional Patent Application No. 62/649,310 entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS";
U.S. Provisional Patent Application No. 62/649,291 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT";
U.S. Provisional Patent Application No. 62/649,296 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES";
- U.S. Provisional Patent Application No. 62/649,333 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER";
U.S. Provisional Patent Application No. 62/649,327 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES";
U.S. Provisional Patent Application No. 62/649,315 entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK";
- U.S. Provisional Patent Application No. 62/649,313 entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES";
- U.S. Provisional Patent Application No. 62/649,320, entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";
- U.S. Provisional Patent Application No. 62/649,307 entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT - ASSISTED SURGICAL PLATFORMS"; U.S. Provisional Patent Application Serial No. 62/649,323 entitled "ORMS" issue.

The applicant of this application owns the following US provisional patent applications filed March 8, 2018, the entire disclosures of each of which are incorporated herein by reference:
- U.S. Provisional Patent Application No. 62/640,417 entitled "TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR"; U.S. Provisional Patent Application Serial No. 62/640 entitled EM THEREFOR , No. 415.

The applicant of this application owns the following US provisional patent applications, filed December 28, 2017, the entire disclosures of each of which are incorporated herein by reference:
- U.S. Provisional Patent Application No. U.S. Provisional Application No. 62/611,341 entitled "INTERACTIVE SURGICAL PLATFORM";
• US Provisional Patent Application No. 62/611,340, entitled "CLOUD-BASED MEDICAL ANALYTICS," and • US Provisional Patent Application No. 62/611,339, entitled "ROBOT ASSISTED SURGICAL PLATFORM."

Before describing various aspects of surgical devices and generators in detail, it is noted that the illustrative embodiments are not limited in application or use to the details of construction and arrangement of parts set forth in the accompanying drawings and description. It should be noted. Example embodiments may be implemented or incorporated in other aspects, variations, and modifications, and may be practiced or carried out in various ways. Further, unless otherwise stated, the terms and expressions used herein have been chosen for the convenience of the reader for the purpose of describing the exemplary embodiments and not for purposes of limitation thereof. . Also, one or more of the aspects, implementations of aspects and/or examples described below may be combined with other aspects, implementations of aspects and/or examples described below. It should be understood that any one or more may be combined.

Surgical Hub Referring to FIG. 1, a computer-implemented interactive surgical system 100 may include one or more surgical systems 102 and a cloud-based system (e.g., remote server 113 coupled to storage 105). 104), and Each surgical system 102 includes at least one surgical hub 106 that communicates with cloud 104 that may include remote servers 113 . In one example, as shown in FIG. 1, surgical system 102 includes visualization system 108, robotic system 110, and handheld intelligent surgical instrument 112 configured to communicate with each other and/or hub 106. and including. In some aspects, the surgical system 102 may include M hubs 106, N visualization systems 108, O robotic systems 110, and P handheld intelligent surgical instruments 112. , where M, N, O, and P are integers of 1 or greater.

FIG. 2 illustrates an example of surgical system 102 used to perform a surgical procedure on a patient lying on operating table 114 within surgical operating room 116 . Robotic system 110 is used as part of surgical system 102 in a surgical procedure. Robotic system 110 includes a surgeon's console 118 , a patient-side cart 120 (surgical robot), and a surgical robot hub 122 . The patient-side cart 120 is capable of manipulating at least one removably coupled surgical tool 117 while the surgeon views the surgical site via the surgeon's console 118 during minimally invasive incisions in the patient's body. . Images of the surgical site may be acquired by a medical imaging device 124 , which may be manipulated by the patient-side cart 120 to orient the imaging device 124 . The robotic hub 122 can be used to process images of the surgical site for subsequent display to the surgeon via the surgeon's console 118 .

Other types of robotic systems can be readily adapted for use with surgical system 102 . Various examples of robotic systems and surgical tools suitable for use with the present disclosure can be found in US patent application Ser. See US Provisional Patent Application No. 62/611,339.

Various examples of cloud-based analytics performed by the cloud 104 and suitable for use with the present disclosure can be found in 2017 entitled "CLOUD-BASED MEDICAL ANALYTICS," the entire disclosure of which is incorporated herein by reference in its entirety. No. 62/611,340, filed Dec. 28, 2002.

In various aspects, imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, Charge-Coupled Device (CCD) sensors and Complementary Metal-Oxide Semiconductor (CMOS) sensors.

The optical components of imaging device 124 may include one or more illumination sources and/or one or more lenses. One or more illumination sources may be directed to illuminate portions of the surgical field. One or more image sensors can receive light reflected or refracted from the surgical field, including light reflected or refracted from tissue and/or surgical instruments.

One or more illumination sources may be configured to emit electromagnetic energy within the visible and invisible spectrums. The visible spectrum, sometimes referred to as the optical spectrum or emission spectrum, is the portion of the electromagnetic spectrum that is visible to the human eye (i.e., can be detected by the human eye) and can be referred to as visible light, or simply light. is sometimes called A typical human eye responds to wavelengths in air from about 380 nm to about 750 nm.

The invisible spectrum (ie, non-emissive spectrum) is the portion of the electromagnetic spectrum that lies below and above the visible spectrum (ie, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths above about 750 nm are longer than the red visible spectrum and these become invisible infrared (IR), microwave, and radio electromagnetic radiation. Wavelengths less than about 380 nm are shorter than the violet spectrum and become invisible ultraviolet, X-ray, and gamma-ray electromagnetic radiation.

In various aspects, imaging device 124 is configured for use in minimally invasive surgery. Examples of imaging devices suitable for use with the present disclosure include arthroscopes, angioscopes, bronchoscopes, cholangoscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophagogastroduodenoscopes (gastroscopes) , endoscopes, laryngoscopes, nasopharyngo-neproscopes, sigmoidoscopes, thoracoscopes, and ureteroscopes.

In one aspect, the imaging device uses multispectral monitoring to distinguish between topography and underlying structure. Multispectral imaging captures image data within specific wavelength ranges across the electromagnetic spectrum. Wavelengths can be separated by filters or by using instruments sensitive to specific wavelengths, including light from frequencies above the visible light range, such as IR and UV. Spectral imaging can allow extraction of additional information that the human eye cannot capture with its red, green, and blue receptors. The use of multispectral imaging is described in the "Advanced Imaging Acquisition Module” section. Multispectral monitoring can be a useful tool for repositioning the surgical field to perform one or more of the above-described tests on the treated tissue after one surgical task is completed.

It is self-evident that any surgical procedure requires rigorous sterilization of the operating room and surgical instruments. The stringent hygiene and sterilization conditions required in the "surgical theater", ie operating room or procedure room, require maximum sterility of all medical devices and equipment. Part of that sterilization process is the need to sterilize anything that comes in contact with the patient or enters the sterile field, including imaging device 124 and its accessories and components. A sterile field may be considered a specific area considered free of microorganisms, such as in a tray or on a sterile towel, or a sterile field may be considered an area immediately surrounding a patient prepared for a surgical procedure. It will be appreciated that this can be done. A sterile field may include clean team members in appropriate clothing and all equipment and fixtures within the area.

In various aspects, the visualization system 108 includes one or more imaging sensors strategically placed relative to the sterile field and one or more image processing units, as shown in FIG. , one or more storage arrays, and one or more displays. In one aspect, the visualization system 108 includes HL7, PACS, and EMR interfaces. The various components of the visualization system 108 are described in U.S. Provisional Patent Application No. 62/611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed December 28, 2017, the entire disclosure of which is incorporated herein by reference. , "Advanced Imaging Acquisition Module" section.

As shown in FIG. 2, primary display 119 is positioned within the sterile field so as to be visible to the operator of operating table 114 . Additionally, the visualization tower 111 is positioned outside the sterile field. The visualization tower 111 includes a first non-sterile display 107 and a second non-sterile display 109 facing away from each other. A visualization system 108 guided by hub 106 is configured to coordinate information flow to operators inside and outside the sterile field utilizing displays 107, 109, and 119. FIG. For example, hub 106 may cause visualization system 108 to display a snapshot of the surgical site recorded by imaging device 124 on non-sterile display 107 or 109 while maintaining a live image of the surgical site on primary display 119. can be done. A snapshot on a non-sterile display 107 or 109 can, for example, allow a non-sterile operator to perform diagnostic steps related to a surgical procedure.

In one aspect, hub 106 may also be configured such that diagnostic input or feedback entered by a non-sterile operator at visualization tower 111 is sent to primary display 119 within the sterile field, where hub 106 is operated. It may be viewed by a sterile operator at the table. In one example, the input may be in the form of modifications to the snapshot displayed on non-sterile display 107 or 109 that can be sent by hub 106 to primary display 119 .

Referring to FIG. 2, surgical instrument 112 is being used as part of surgical system 102 in a surgical procedure. Hub 106 is also configured to coordinate information flow to the display of surgical instrument 112 . For example, coordinate information is further described in U.S. Provisional Patent Application No. 62/611,341, filed Dec. 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," the entire disclosure of which is incorporated herein by reference. there is Diagnostic input or feedback entered by a non-sterile operator at visualization tower 111 may be sent by hub 106 to surgical instrument display 115 within the sterile field, where diagnostic input or feedback is provided to the operator of surgical instrument 112. may be viewed by An exemplary surgical instrument suitable for use with surgical system 102 is, for example, US Pat. This is described in provisional patent application Ser. No. 62/611,341 under the heading "Surgical Instrument Hardware."

Referring now to FIG. 3 , hub 106 is shown in communication with visualization system 108 , robotic system 110 and handheld intelligent surgical instrument 112 . Hub 106 includes hub display 135, imaging module 138, generator module 140 (which may include monopolar generator 142, bipolar generator 144, and/or ultrasonic generator 143), communication module 130, processor module 132, and Includes storage array 134 . In certain aspects, the hub 106 further includes a smoke evacuation module 126, an aspiration/irrigation module 128, and/or an OR mapping module 133, as shown in FIG.

During surgical procedures, the application of energy to tissue for sealing and/or cutting generally involves venting smoke, aspirating excess fluid, and/or irrigating tissue. Fluid, power, and/or data lines from different sources often become entangled during surgical procedures. Valuable time may be lost in addressing this issue during a surgical procedure. Untangling the lines may require uncoupling the lines from their respective modules, which may require resetting the modules. The hub's modular housing 136 provides a unified environment for managing power, data, and fluid lines, reducing the frequency of tangling between such lines.

Aspects of the present disclosure present a surgical hub for use in surgical procedures involving the application of energy to tissue at a surgical site. The surgical hub includes a hub housing and a combination generator module slidably receivable within a docking station of the hub housing. The docking station contains data and power contacts. A combination generator module combines two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a unipolar RF energy generator component housed within a single unit. include. In one aspect, the combination generator module also includes a smoke evacuation component, at least one energy delivery cable for connecting the combination generator module to a surgical instrument, smoke generated by application of therapeutic energy to tissue; At least one smoke evacuation component configured to evacuate fluids and/or particulates, and a fluid line extending from the remote surgical site to the smoke evacuation component.

In one aspect, the fluid line is a first fluid line and a second fluid line extends from a remote surgical site to an aspiration and irrigation module slidably received within the hub housing. In one aspect, the hub housing includes a fluidic interface.

Certain surgical procedures may require the application of more than one type of energy to tissue. One energy type may be more beneficial for cutting tissue, while another different energy type may be more beneficial for sealing tissue. For example, a bipolar generator can be used to seal tissue, while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution in which the hub's modular housing 136 is configured to house different generators and facilitate two-way communication between them. One advantage of the hub's modular housing 136 is that it allows for quick removal and/or replacement of various modules.

Aspects of the present disclosure present a modular surgical housing for use in surgical procedures involving the application of energy to tissue. A modular surgical housing includes a first energy generator module configured to generate a first energy for application to tissue and a first docking port including first data and power contacts. a first docking station comprising: a first energy generator module slidably moveable into electrical engagement with the power and data contacts; and the first energy generator module comprising: Slidably moveable out of electrical engagement with the first power and data contact.

Further to the above, the modular surgical housing also includes a second energy generator module configured to generate a second energy for application to tissue, different from the first energy; a second docking station comprising a second docking port including two data and power contacts, wherein the second energy generator module is slidably moved into electrical engagement with the power and data contacts. Yes, and the second energy generator module is slidably moveable out of electrical engagement with the second power and data contacts.

Additionally, the modular surgical housing also includes a first docking port and a second docking port configured to facilitate communication between the first energy generator module and the second energy generator module. Contains the communication bus to and from the docking port.

Referring to FIGS. 3-7, aspects of the present disclosure are presented for a hub modular housing 136 that allows for modular integration of the generator module 140, the smoke evacuation module 126, and the aspiration/irrigation module 128. be done. The modular housing 136 of the hub further facilitates two-way communication between the modules 140,126,128. As shown in FIG. 5, the generator module 140 is an integrated monopolar, bipolar, and ultra polar generator supported within a single housing unit 139 that is slidably insertable into the hub's modular housing 136 . It may be a generator module comprising an acoustic wave component. As shown in FIG. 5, the generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147, and an ultrasound device 148. FIG. Alternatively, the generator module 140 may comprise a series of monopolar, bipolar and/or ultrasonic generator modules interacting through the hub modular housing 136 . The hub modular housing 136 allows for the insertion of multiple generators and two-way communication between generators docked in the hub modular housing 136 so that the generators function as a single generator. , may be configured to facilitate

In one aspect, the hub's modular housing 136 is a modular power and power module with external and wireless communication headers to allow removable attachment of modules 140, 126, 128 and bi-directional communication therebetween. A communications backplane 149 is provided.

In one aspect, the hub modular housing 136 includes a docking station or drawer 151, also referred to herein as a drawer, configured to slidably receive the modules 140,126,128. FIG. 4 shows a partial perspective view of surgical hub housing 136 and combination generator module 145 slidably receivable in docking station 151 of surgical hub housing 136 . A docking port 152 with power and data contacts on the rear side of the combination generator module 145 is slid into position within the corresponding docking station 151 of the hub modular housing 136. Corresponding docking ports 150 are configured to engage power and data contacts of corresponding docking stations 151 of hub modular housing 136 . In one aspect, the combination generator module 145 includes bipolar, ultrasonic, and monopolar modules and a smoke evacuation module integrated with a single housing unit 139, as shown in FIG.

In various aspects, the smoke evacuation module 126 includes a fluid line 154 that carries entrained/collected smoke and/or fluid away from the surgical site, eg, to the smoke evacuation module 126 . The vacuum suction generated by the smoke evacuation module 126 can draw smoke into the openings of utility conduits at the surgical site. A utility conduit coupled to the fluid line may be in the form of flexible tubing that terminates in the smoke evacuation module 126 . The utility conduits and fluid lines define fluid pathways that extend toward the smoke extraction module 126 received within the hub housing 136 .

In various aspects, aspiration/irrigation module 128 is coupled to a surgical tool including an aspiration fluid line and a suction fluid line. In one example, the aspiration and aspiration fluid lines are in the form of flexible tubing that extends from the surgical site toward aspiration/irrigation module 128 . One or more drive systems may be configured to cause irrigation and aspiration of fluid to and from the surgical site.

In one aspect, a surgical tool includes a shaft having an end effector at its distal end, at least one energy treatment portion associated with the end effector, a suction tube, and an irrigation tube. A suction tube can have an inlet port at its distal end and the suction tube extends through the shaft. Similarly, an irrigation tube can extend through the shaft and have an inlet port proximate to the energy delivery device. The energy delivery instrument is configured to deliver ultrasonic and/or RF energy to the surgical site and is initially connected to generator module 140 by a cable extending through the shaft.

The irrigation tube can be in fluid communication with a fluid source and the suction tube can be in fluid communication with a vacuum source. A fluid source and/or a vacuum source may be housed within the aspiration/irrigation module 128 . In one example, the fluid and/or vacuum source may be housed within hub housing 136 separately from aspiration/irrigation module 128 . In such examples, the fluid interface may be configured to connect the aspiration/irrigation module 128 to a fluid source and/or a vacuum source.

In one aspect, the modules 140, 126, 128 and/or their corresponding docking stations on the hub modular housing 136 align the docking ports of the modules to the docking stations of the hub modular housing 136. may include alignment features configured to engage their counterparts therein. For example, as shown in FIG. 4, combination generator module 145 has side brackets configured to slidably engage corresponding brackets 156 of corresponding docking stations 151 of hub modular housing 136 . 155 included. The brackets cooperate to guide the docking port contacts of the combination generator module 145 into electrical engagement with the docking port contacts of the hub modular housing 136 .

In some aspects, the drawers 151 of the hub modular housing 136 are the same or substantially the same size, and the modules are sized to be received within the drawers 151 . For example, side brackets 155 and/or 156 may be larger or smaller depending on the size of the module. In other aspects, drawers 151 vary in size, each designed to accommodate a particular module.

Additionally, the contacts of a particular module may be keyed to engage the contacts of a particular drawer to avoid inserting a module into a drawer with incompatible contacts.

As shown in FIG. 4, the docking port 150 of one drawer 151 is coupled to the docking port 150 of another drawer 151 via a communication link 157 to accommodate modules contained within the modular housing 136 of the hub. can facilitate two-way communication between Alternatively or additionally, docking ports 150 of hub modular housing 136 may facilitate wireless two-way communication between modules housed within hub modular housing 136 . Any suitable wireless communication may be used, such as, for example, Air Titan-Bluetooth.

FIG. 6 illustrates individual power bus attachments of multiple lateral docking ports of lateral modular housing 160 configured to receive multiple modules of surgical hub 206 . Lateral modular housing 160 is configured to laterally receive and interconnect modules 161 . Modules 161 are slidably inserted into docking stations 162 of lateral modular housings 160 that contain backplanes for interconnecting modules 161 . As shown in FIG. 6, the modules 161 are laterally arranged within the lateral modular housing 160 . Alternatively, modules 161 may be arranged vertically within a lateral modular housing.

FIG. 7 shows a vertical modular housing 164 configured to receive multiple modules 165 of surgical hub 106 . Modules 165 are slidably inserted into docking stations or drawers 167 of vertical modular housings 164 that contain backplanes for interconnecting modules 165 . Although the drawers 167 of the vertical modular housing 164 are vertically oriented, in certain examples the vertical modular housing 164 may include laterally oriented drawers. Additionally, modules 165 may interact with each other via docking ports in vertical modular housing 164 . In the embodiment of FIG. 7, a display 177 is provided for displaying data relating to the operation of module 165 . Additionally, vertical modular housing 164 includes master module 178 that houses a plurality of sub-modules that are slidably received within master module 178 .

In various aspects, the imaging module 138 includes a built-in video processor and modular light sources and is adapted for use with various imaging devices. In one aspect, the imaging device consists of a modular housing that can be assembled with a light source module and a camera module. The housing may be a disposable housing. In at least one embodiment, the disposable housing is removably coupled with the reusable controller, light source module, and camera module. The light source module and/or camera module can be selectively selected depending on the type of surgical procedure. In one aspect, the camera module includes a CCD sensor. In another aspect, the camera module includes a CMOS sensor. In another aspect, the camera module is configured for scanning beam imaging. Similarly, the light source module can be configured to deliver white light or different light depending on the surgical procedure.

During a surgical procedure, it can be inefficient to remove a surgical device from the surgical field and replace it with another surgical device that includes a different camera or different light source. Temporary loss of vision in the surgical field can have undesirable consequences. The modular imaging device of the present disclosure is configured to allow replacement of a light source module or camera module midstream during a surgical procedure without having to remove the imaging device from the surgical field.

In one aspect, an imaging device comprises a tubular housing containing a plurality of channels. The first channel is configured to slidably receive a camera module that may be configured for snap fit engagement with the first channel. The second channel is configured to slidably receive a light source module that may be configured for snap fit engagement with the second channel. In another example, the camera module and/or the light source module can be rotated to their final positions within their respective channels. A threaded engagement may be used instead of a snap-fit engagement.

In various embodiments, multiple imaging devices are positioned at different locations within the surgical field to provide multiple views. Imaging module 138 may be configured to switch between imaging devices to provide an optimal field of view. In various aspects, imaging module 138 can be configured to integrate images from different imaging devices.

Various image processors and imagers suitable for use with the present disclosure are described in U.S. Patent No. 9, 2011, entitled "COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR," which is incorporated herein by reference in its entirety. 7,995,045. In addition, U.S. Patent No. 7,982,776, issued Jul. 19, 2011, entitled "SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD," which is incorporated herein by reference in its entirety, discloses motion artifact detection from image data. Various systems for removal are described. Such systems may be integrated with imaging module 138 . See also U.S. Patent Application Publication No. 2011/0306840, published December 15, 2011, entitled "CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS" and "SYSTEM FOR PERFORMING A MINIMALLY INVASIVE August 28, 2014 entitled "SURGICAL PROCEDURE" Published US Patent Application Publication No. 2014/0243597, each of which is incorporated herein by reference in its entirety.

FIG. 8 illustrates a cloud-based system (e.g., storage) of modular devices located in one or more operating rooms of a medical facility, or any room within a medical facility with specialized equipment for surgical procedures. A surgical data network 201 is shown comprising a modular communication hub 203 configured to connect to a cloud 204 ), which may include a remote server 213 coupled to devices 205 . In one aspect, modular communication hub 203 comprises network hub 207 and/or network switch 209 that communicate with network routers. Modular communication hub 203 can also be coupled to local computer system 210 to provide local computer processing and data manipulation. Surgical data network 201 may be configured as passive, intelligent, or switched. A passive surgical data network acts as a conduit for data, allowing data to go from one device (or segment) to another and to cloud computing resources. The intelligent surgical data network includes additional features that allow traffic to pass through the monitored surgical data network and configure each port within network hub 207 or network switch 209 . An intelligent surgical data network may be referred to as a manageable hub or switch. The switching hub reads the destination address of each packet and then forwards the packet to the correct port.

Modular devices 1 a - 1 n located in the operating room may be coupled to modular communication hub 203 . Network hub 207 and/or network switch 209 may be coupled to network router 211 to connect devices 1 a - 1 n to cloud 204 or local computer system 210 . Data associated with the devices 1a-1n may be transferred via routers to cloud-based computers for remote data processing and manipulation. Data associated with devices 1a-1n may also be transferred to local computer system 210 for local data processing and manipulation. Modular devices 2 a - 2 m located in the same operating room may also be linked to network switch 209 . Network switch 209 may be coupled to network hub 207 and/or network router 211 to connect devices 2 a - 2 m to cloud 204 . Data associated with devices 2a-2n may be transferred to cloud 204 via network router 211 for data processing and manipulation. Data associated with devices 2a-2m may also be transferred to local computer system 210 for local data processing and manipulation.

It will be appreciated that surgical data network 201 may be expanded by interconnecting multiple network hubs 207 and/or multiple network switches 209 with multiple network routers 211 . Modular communication hub 203 may be housed in a modular control tower configured to receive multiple devices 1a-1n/2a-2m. A local computer system 210 may also be housed in the modular control tower. Modular communication hub 203 is connected to display 212 to display images acquired by some of devices 1a-1n/2a-2m, eg, during a surgical procedure. In various aspects, the devices 1a-1n/2a-2m include, among other modular devices that can be connected to the modular communication hub 203 of the surgical data network 201, an imaging module 138 coupled to, for example, an endoscope. , a generator module 140 coupled to an energy-based surgical device, a smoke evacuation module 126, an aspiration/irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a surgical device coupled to a display, and/or Or various modules such as a non-contact sensor module.

In one aspect, the surgical data network 201 comprises a combination of network hub(s), network switch(es), and network router(s) that connect the devices 1a-1n/2a-2m to the cloud. may contain. any one or all of the devices 1a-1n/2a-2m coupled to a network hub or network switch to collect data in real time and transfer the data to a cloud computer for data processing and manipulation; can be done. It will be appreciated that cloud computing relies on shared computing resources to handle software applications rather than having local servers or personal devices. The term "cloud" may be used as a metaphor for "Internet," but the term is not so limited. Accordingly, the term "cloud computing" can be used herein to refer to "a type of Internet-based computing" in which different services such as servers, storage devices, and applications are to modular communication hub 203 and/or computer system 210 located at the surgical site (e.g., fixed, mobile, temporary, or on-site operating room or space) and via the Internet. /or delivered to a device connected to computer system 210; A cloud infrastructure may be maintained by a cloud service provider. In this context, a cloud service provider may be an entity that coordinates the use and control of devices 1a-1n/2a-2m located in one or more operating rooms. Cloud computing services can perform numerous calculations based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. Hub hardware allows multiple devices or connections to connect to a computer that communicates with cloud computing resources and storage devices.

By applying cloud computer data processing techniques to data collected by devices 1a-1n/2a-2m, surgical data networks provide improved surgical outcomes, reduced costs, and improved patient satisfaction. At least some of the devices 1a-1n/2a-2m can be used to monitor the condition of the tissue after the tissue sealing and cutting procedure to assess leakage or perfusion of the sealed tissue. . at least one of the devices 1a-1n/2a-2m for diagnostic examination of data comprising images of body tissue samples to identify medical conditions such as disease effects using cloud-based computing; Several can be used. This includes tissue and phenotype localization and margin confirmation. Devices 1a-1n/2a- to identify body anatomy using various sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. At least some of the 2m can be used. Data collected by devices 1a-1n/2a-2m, including image data, may be transferred to cloud 204 or local computer system 210, or both, for data processing and manipulation, including image processing and manipulation. . The data will help guide surgical interventions by determining whether additional therapies such as endoscopic interventions, emerging technologies, targeted radiation, targeted interventions, and precision robotic applications for tissue-specific sites and conditions can be performed. Can be analyzed to improve results. Such data analysis may further employ prognostic analysis processing, using a standardized approach to confirm or suggest modifications to surgical treatment and surgeon behavior. You can provide useful feedback for either.

In one implementation, the operating room devices 1a-1n may be connected to the modular communication hub 203 via wired or wireless channels, depending on the configuration of the devices 1a-1n relative to the network hub. Network hub 207 may, in one aspect, be implemented as a local network broadcast device that functions on top of the physical layer of the Open System Interconnection (OSI) model. Network hubs provide connectivity to devices 1a-1n located within the same operating room network. Network hub 207 collects the data in packet form and sends them to the router in half-duplex mode. Network hub 207 does not store any media access control/Internet Protocol (MAC/Internet Protocol, IP) for transferring device data. Only one of the devices 1a-1n can transmit data through the network hub 207 at a time. Network hub 207 does not have routing tables or intelligence about where to send information, it broadcasts all network data across each connection and to remote server 213 (FIG. 9) on cloud 204 . Although the network hub 207 can detect basic network errors such as collisions, broadcasting all information to multiple ports can be a security risk and create bottlenecks.

In another implementation, the operating room devices 2a-2m may be connected to the network switch 209 via wired or wireless channels. Network switch 209 functions within the data link layer of the OSI model. The network switch 209 is a multicast device for connecting the devices 2a to 2m arranged in the same operating room to the network. Network switch 209 sends data in the form of frames to network router 211 and functions in full-duplex mode. Multiple devices 2 a - 2 m can transmit data simultaneously through network switch 209 . Network switch 209 stores and uses the MAC addresses of devices 2a-2m to transfer data.

Network hub 207 and/or network switch 209 are coupled to network router 211 to connect to cloud 204 . Network router 211 functions within the network layer of the OSI model. The network router 211 may use data packets received from the network hub 207 and/or network switch 211 to further process and manipulate the data collected by any one or all of the devices 1a-1n/2a-2m. to a cloud-based computing resource. The network router 211 connects two or more different networks located in different locations, such as different operating rooms in the same medical facility, or different networks located in different operating rooms in different medical facilities. may be used for Network router 211 transmits data in packet form to cloud 204 and functions in full-duplex mode. Multiple devices can transmit data simultaneously. Network routers 211 use IP addresses to transfer data.

In one embodiment, network hub 207 may be implemented as a USB hub that allows multiple USB devices to be connected to a host computer. A USB hub can expand a single USB port into several layers so that there are many ports available for connecting devices to a host system computer. Network hub 207 may include wired or wireless capabilities for receiving information over wired or wireless channels. In one aspect, a wireless USB short-range high-bandwidth wireless communication protocol may be used for communication between devices 1a-1n and devices 2a-2m located in the operating room.

In another embodiment, operating room devices 1a-1n/2a-2m exchange data from fixed and mobile devices over short distances (using short wavelength UHF radio waves in the 2.4-2.485 GHz ISM band). ), and can communicate with the modular communication hub 203 via the Bluetooth wireless technology standard to build a personal area network (PAN). In another aspect, the operating room devices 1a-1n/2a-2m support Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution, LTE), and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and their Ethernet derivatives, as well as any designated 3G, 4G, 5G, and later can communicate with modular communication hub 203 via numerous wireless or wired communication standards or protocols, including but not limited to other wireless and wired protocols. A computing module may include multiple communication modules. For example, a first communication module may be dedicated to short-range wireless communication such as Wi-Fi and Bluetooth, and a second communication module may be dedicated to GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, etc. may be dedicated to long-range wireless communication.

The modular communication hub 203 can serve as a central connection for one or all of the operating room devices 1a-1n/2a-2m and handles data types known as frames. The frames carry data generated by the devices 1a-1n/2a-2m. As frames are received by modular communication hub 203, the frames are amplified and transmitted to network router 211, which uses a number of wireless or wired communication standards or protocols described herein to transmit the frames. Transfer this data to cloud computing resources.

Modular communication hub 203 may be used as a stand-alone device or may be connected to compatible network hubs and network switches to form a larger network. Modular communication hubs 203 are generally easy to install, configure, and maintain, making them a good choice for networking operating room devices 1a-1n/2a-2m.

FIG. 9 shows a computer-implemented interactive surgical system 200 . Computer-implemented interactive surgical system 200 is similar in many respects to computer-implemented interactive surgical system 100 . For example, computer-implemented interactive surgical system 200 includes one or more surgical systems 202 that are similar in many respects to surgical system 102 . Each surgical system 202 includes at least one surgical hub 206 that communicates with cloud 204 that may include remote servers 213 . In one aspect, the computer-implemented interactive surgical system 200 includes a modular control tower 236 connected to multiple operating room devices such as, for example, intelligent surgical instruments, robots, and other computerized devices located in the operating room. Prepare. As shown in FIG. 10, modular control tower 236 comprises modular communication hub 203 coupled to computer system 210 . As shown in the embodiment of FIG. 9, modular control tower 236 includes imaging module 238 coupled to endoscope 239, generator module 240 coupled to energy device 241, smoke evacuator module 226, aspiration/ Coupled to an irrigation module 228 , a communications module 230 , a processor module 232 , a storage array 234 , a smart device/instrument 235 optionally coupled to a display 237 , and a contactless sensor module 242 . Operating room equipment is coupled to cloud computing resources and data storage via modular control towers 236 . Robotic hub 222 may also be connected to modular control tower 236 and cloud computing resources. Devices/instruments 235, visualization system 208, among others, may be coupled to modular control tower 236 via wired or wireless communication standards or protocols described herein. Modular control tower 236 may be coupled to hub display 215 (e.g., monitor, screen) for displaying and overlaying images received from imaging modules, device/instrument displays, and/or other visualization systems 208. . The hub display may also display data received from devices connected to the modular control tower along with images and overlay images.

FIG. 10 shows surgical hub 206 comprising multiple modules coupled to modular control tower 236 . Modular control tower 236 includes a modular communication hub 203, eg, a network connection device, and a computer system 210, eg, for providing local processing, visualization, and imaging. As shown in FIG. 10, modular communication hubs 203 are connected in a hierarchical configuration to expand the number of modules (e.g., devices) that can be connected to modular communication hub 203 to store data associated with the modules. can be transferred to computer system 210, cloud computing resources, or both. As shown in FIG. 10, each of the network hubs/switches within modular communication hub 203 includes three downstream ports and one upstream port. An upstream network hub/switch is connected to the processor to provide communication connections to cloud computing resources and local displays 217 . Communication to cloud 204 can be via either wired or wireless communication channels.

Surgical hub 206 uses non-contact sensor module 242 to measure the dimensions of the operating room and to generate a map of the surgical field using either ultrasonic or laser-based non-contact measurement devices. "Surgical Hub Spatial Awareness Within an Operating Room," in U.S. Provisional Patent Application No. 62/611,341, filed Dec. 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," which is hereby incorporated by reference in its entirety. The ultrasonic-based non-contact sensor module scans the operating room by transmitting bursts of ultrasonic waves and receiving echoes when the bursts of ultrasonic waves reflect off the outer walls of the operating room, as described in Section 1. and where the sensor module is configured to determine the size of the operating room and adjust the distance limit of the Bluetooth pairing. A laser-based non-contact sensor module, for example, transmits a laser light pulse, receives a laser light pulse that reflects off the outer wall of an operating room, compares the phase of the transmitted pulse with the received pulse, and compares the phase of the operating room. Scan the operating room by determining the size and adjusting the Bluetooth pairing distance limit.

Computer system 210 includes processor 244 and network interface 245 . Processor 244 is coupled to communication module 247, storage device 248, memory 249, non-volatile memory 250, and input/output interface 251 through a system bus. The system bus is a 9-bit bus, Industrial Standard Architecture (ISA), Micro-Charmel Architecture (MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE). , VESA Local Bus (VLB), Peripheral Component Interconnect (PCI), USB, Advanced Graphics Port (AGP), Personal Computer Memory Card International Bus Association bus, PCMCIA), Small Computer Systems Interface (SCSI), or any other proprietary bus, using any of a variety of available bus architectures. may be any of several types of bus structure(s) including a memory bus or memory controller, a peripheral or external bus, and/or a local bus.

Processor 244 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In one aspect, the processor has on-chip memory, e.g., 256 KB of single-cycle flash memory or other non-volatile memory at up to 40 MHz, details of which are available in the product datasheet, to improve performance beyond 40 MHz. Prefetch buffer, 32 KB single-cycle serial random access memory (SRAM), internal read-only memory (ROM) with StellarisWare® software, 2 KB electrical erase erasable programmable read-only memory (EEPROM) and/or one or more pulse width modulation (PWM) modules, one or more quadrature encoder inputs ( quadrature encoder input (QEI) analog, LM4F230H5QR available from Texas Instruments containing one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels It may be an ARM Cortex-M4F processor core.

In one aspect, the processor 244 may include a safety controller that includes two controller family families, such as the TMS570 and RM4x, also known by the trade designation Hercules ARM Cortex R4, also manufactured by Texas Instruments. Safety controllers are purpose-built for IEC61508 and ISO26262 safety limit applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options. may

System memory includes both volatile and non-volatile memory. The basic input/output system (BIOS), containing the basic routines to transfer information between elements within the computer system, such as during start-up, is stored in nonvolatile memory. For example, non-volatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random-access memory (RAM), which acts as external cache memory. Furthermore, RAM includes SRAM, dynamic RAM (dynamic RAM, DRAM), synchronous DRAM (synchronous DRAM, SDRAM), double data rate SDRAM (double data rate, DDR SDRAM), enhanced SDRAM (enhanced SDRAM, ESDRAM), sync link It is available in many forms such as DRAM (Synchlink DRAM, SLDRAM) and direct Rambus RAM (DRRAM).

Computer system 210 also includes removable/non-removable, volatile/non-volatile computer storage media, such as disk storage devices. Disk storage devices include, but are not limited to, devices such as magnetic disk drives, floppy disk drives, tape drives, Jaz drives, Zip drives, LS-60 drives, flash memory cards, or memory sticks. In addition, disc storage may be used to store storage media independently or as a compact disc ROM device (compact disc ROM, CD-ROM), a compact disc recordable drive (CD-R Drive), a compact disc. and other storage media including, but not limited to, a compact disc rewritable drive (CD-RW Drive), or an optical disc drive such as a digital versatile disc ROM drive (DVD-ROM). can be included in any combination of A removable or non-removable interface may be used to facilitate connection of disk storage devices to the system bus.

It should be appreciated that computer system 210 includes software that acts as an intermediary between users and basic computer resources as described in the preferred operating environment. Such software includes an operating system. An operating system, which may be stored on the disk storage device, functions to control and allocate the computer system's resources. System applications take advantage of resource management by the operating system through program modules and program data stored either in system memory or on disk storage devices. It should be appreciated that the various components described herein can be implemented on various operating systems or combinations of operating systems.

A user enters commands or information into computer system 210 through input device(s) coupled to I/O interface 251 . Input devices include pointing devices such as mice, trackballs, styluses, and touchpads, keyboards, microphones, joysticks, gamepads, satellite dishes, scanners, TV tuner cards, digital cameras, digital video cameras, and webcams. include but are not limited to: These and other input devices connect to the processor through the system bus via the interface port(s). Interface port(s) include, for example, serial port, parallel port, game port, and USB. Output device(s) use some of the same types of ports as input device(s). Thus, for example, a USB port may be used to provide input to the computer system and output information from the computer system to an output device. Output adapters are provided to illustrate that there are some output devices such as monitors, displays, speakers, and printers, among other output devices that require special adapters. Output adapters include, by way of example and not limitation, video and sound cards that provide a means of connection between output devices and the system bus. Note that other devices and/or systems of devices, such as remote computer(s), provide both input and output functionality.

Computer system 210 can operate in a networked environment using logical connections to one or more remote or local computers, such as cloud computer(s). The remote cloud computer(s) may be personal computers, servers, routers, network PCs, workstations, microprocessor-based appliances, peer devices, or other general network nodes, etc., and are typically computers Includes many or all of the elements described for the system. For simplicity, only the memory storage device is shown along with the remote computer(s). The remote computer(s) are logically connected to the computer system through a network interface and then physically connected via a communications connection. The network interface encompasses communication networks such as local area networks (LAN) and wide area networks (WAN). LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE 802.5, and so on. WAN technologies include point-to-point links, circuit-switched networks such as Integrated Services Digital Networks (ISDN) and variations thereof, packet-switched networks, and Digital Subscriber Lines (DSL). are not limited to these.

In various aspects, the computer system 210 of FIG. 10, the imaging module 238 of FIGS. 9-10, and/or the visualization system 208, and/or the processor module 232 are image processors, image processing engines, media processors, or digital image processors. may include any dedicated digital signal processor (DSP) used to process the Image processors can increase speed and efficiency using parallel computing using single instruction multiple data (SIMD) or multiple instruction multiple data (MIMD) techniques. A digital image processing engine can perform a variety of tasks. The image processor may be a system on chip with a multi-core processor architecture.

Communication connection(s) refers to hardware/software used to connect a network interface to a bus. Although communication connections are shown internal to the computer system for clarity of illustration, the communication connections may be external to computer system 210 . By way of example only, the hardware/software required to connect to the network interface includes internal and external technologies such as modems, including regular telephone grade modems, cable modems, and DSL modems, ISDN adapters, and Ethernet cards. mentioned.

FIG. 11 illustrates a functional block diagram of one aspect of a USB network hub 300 device, in accordance with at least one aspect of the present disclosure. In the illustrated embodiment, USB network hub device 300 uses a TUSB2036 integrated circuit hub manufactured by Texas Instruments. The USB network hub 300 is a CMOS device that provides an upstream USB transmit/receive port 302 and up to three downstream USB transmit/receive ports 304, 306, 308 conforming to the USB 2.0 standard. The upstream USB transmit/receive port 302 is a differential root data port that includes a differential data minus (data minus, DM0) input paired with a differential data plus (DP0) input. The three downstream USB transmit/receive ports 304, 306, 308 are differential data ports, each port including differential data plus (DP1-DP3) outputs paired with differential data minus (DM1-DM3) outputs.

The USB network hub 300 device is implemented with a digital state machine instead of a microcontroller and does not require firmware programming. A fully compliant USB transceiver is integrated into the circuitry of the upstream USB transmit/receive port 302 and all downstream USB transmit/receive ports 304 , 306 , 308 . Downstream USB transmit and receive ports 304, 306, 308 support both high speed and low speed devices by automatically setting the slew rate according to the speed of the device attached to the port. The USB network hub 300 device may be configured in either bus-powered mode or self-powered mode and includes hub power logic 312 for managing power.

The USB network hub 300 device includes a serial interface engine 310 (SIE). The SIE 310 is the front end of the USB network hub 300 hardware and handles most of the protocols described in Chapter 8 of the USB specification. SIE 310 typically understands signaling down to the transaction level. The functions it handles include packet recognition, transaction reordering, detection/generation of SOP, EOP, RESET and RESUME signals, clock/data separation, non-return-to-zero invert (NRZI) data Encoding/decoding and bit stuffing, CRC generation and checking (tokens and data), packet ID (PID) generation and checking/decoding, and/or serial-parallel-parallel-serial conversion may be mentioned. 310 receives a clock input 314 and via port logic 320 , 322 , 324 suspend/suspend to control communication between the upstream USB transmit/receive port 302 and the downstream USB transmit/receive ports 304 , 306 , 308 . It is coupled to resume logic and frame timer 316 circuitry and hub repeater circuitry 318 . SIE 310 is coupled to command decoder 326 via interface logic 328 to control commands from the serial EEPROM via serial EEPROM interface 330 .

In various aspects, the USB network hub 300 can connect 127 functions organized in up to 6 logical layers (hierarchies) to a single computer. Additionally, the USB network hub 300 can connect to all peripherals using a standardized four wire cable that provides both communication and power distribution. The power configurations are bus power mode and self power mode. USB network hub 300 has four power management capabilities: a bus-powered hub with either individual port power management or ganged port power management, and a self-powered hub with either individual port power management or ganged port power management. It may be configured to support two modes. In one aspect, using a USB cable, USB network hub 300, the upstream USB transmit/receive port 302 plugs into a USB host controller and the downstream USB transmit/receive ports 304, 306, 308 connect USB compatible devices. and so on.

Additional details regarding the structure and function of surgical hubs and/or networks of surgical hubs are provided in U.S. patent entitled "METHOD OF HUB COMMUNICATION," filed April 19, 2018, which is incorporated herein by reference in its entirety. It can be found in Provisional Application No. 62/659,900.

Cloud System Hardware and Functional Modules FIG. 12 is a block diagram of a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure. In one aspect, the computer-implemented interactive surgical system is configured to monitor and analyze data regarding the operation of various surgical systems, including surgical hubs, surgical instruments, robotic devices, and operating rooms or medical facilities. be. Computer-implemented interactive surgical systems include cloud-based analysis systems. The cloud-based analysis system, although described as a surgical system, is not necessarily so limited and may generally be a cloud-based medical system. As shown in FIG. 12, the cloud-based analysis system includes a plurality of surgical instruments 7012 (which may be the same or similar to instrument 112) and a plurality of surgical instruments 7012 (which may be the same or similar to hub 106). surgical hub 7006 and surgical data network 7001 (which may be the same or similar to network 201) connect surgical hub 7006 to cloud 7004 (which may be the same or similar to cloud 204). Link. Each of the plurality of surgical hubs 7006 are communicatively coupled to one or more surgical instruments 7012 . Hub 7006 is also communicatively coupled via network 7001 to cloud 7004 of computer-implemented interactive surgical systems. Cloud 7004 is a remote, centralized source of hardware and software for storing, manipulating, and communicating data generated based on the operation of various surgical systems. As shown in FIG. 12, access to cloud 7004 is achieved via network 7001, which may be the Internet or some other suitable computer network. Surgical hub 7006 coupled to cloud 7004 can be considered the client side of the cloud computing system (ie, cloud-based analysis system). Surgical instrument 7012 is paired with surgical hub 7006 for control and implementation of various surgical procedures or actions described herein.

Additionally, surgical instruments 7012 may include transceivers for data transmission to and from their corresponding surgical hubs 7006 (which may also include transceivers). . The combination of surgical instrument 7012 and corresponding hub 7006 may point to a particular location, such as an operating room within a medical facility (eg, hospital) for providing medical surgery. For example, the memory of surgical hub 7006 may store position data. As shown in FIG. 12, cloud 7004 includes central server 7013 (which may be the same or similar to remote server 113 of FIG. 1 and/or remote server 213 of FIG. 9), hub application server 7002, data analysis module 7034, and an input/output (“I/O”) interface 7007 . A central server 7013 of cloud 7004 collectively manages the cloud computing system, including monitoring requests by client modules 7006 and managing the processing power of cloud 7004 to execute the requests. Each of the central servers 7013 comprises one or more processors 7008 coupled to suitable memory devices 7010, which can include volatile memory such as random access memory (RAM) and non-volatile memory such as magnetic storage. . Memory device 7010 contains machine-executable instructions that, when executed, cause processor 7008 to execute data analysis module 7034 for cloud-based data analysis, operations, recommendations, and other operations described below. It's okay. Further, processor 7008 can execute data analysis module 7034 independently of, or in conjunction with, hub applications independently executed by hub 7006 . Central server 7013 also includes an aggregated medical data database 2212 that may reside within memory 2210 .

Based on its connection to various surgical hubs 7006 via network 7001, cloud 7004 can aggregate data from specific data generated by various surgical instruments 7012 and their corresponding hubs 7006. can. Such aggregated data may be stored in aggregated medical database 7011 in cloud 7004 . Specifically, cloud 7004 may advantageously perform data analysis and operations on aggregated data to provide functionality that individual hubs 7006 cannot accomplish on their own. To this end, as shown in FIG. 12, cloud 7004 and surgical hub 7006 are communicatively coupled to send and receive information. I/O interface 7007 is connected to multiple surgical hubs 7006 via network 7001 . In this manner, I/O interface 7007 can be configured to transfer information between surgical hub 7006 and aggregated medical data database 7011 . Accordingly, the I/O interface 7007 can facilitate read/write operations of the cloud-based analysis system. Such read/write operations may be performed in response to requests from hub 7006 . These requests may be sent to hub 7006 via the hub application. I/O interfaces 7007 may include Universal Serial Bus (USB) ports, IEEE 1394 ports, and Wi-Fi and Bluetooth I/O interfaces for connecting cloud 7004 to hub 7006. One or more high speed data May include ports. Hub application server 7002 in cloud 7004 is configured to host and provide shared capabilities to software applications (eg, hub applications) executed by surgical hub 7006 . For example, hub application server 7002 may manage requests made by hub applications via hub 7006 to control access to centralized medical data database 7011 and perform load balancing. Data analysis module 7034 is described in more detail with reference to FIG.

The configuration of the particular cloud computing system described in this disclosure specifically raises various issues in the context of medical operations and procedures performed using medical devices such as surgical instruments 7012, 112. designed to deal with Specifically, surgical instrument 7012 may be a digital surgical device configured to interact with cloud 7004 to implement techniques for improving surgical performance. Various surgical instruments 7012 and/or surgical hubs 7006 include touch-controlled user interfaces so that the clinician may control aspects of the interaction between the surgical instruments 7012 and the cloud 7004. It's okay. Other suitable user interfaces for control may also be used, such as an audibly controlled user interface.

FIG. 13 is a block diagram illustrating the functional architecture of a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure; The cloud-based analysis system includes multiple data analysis modules 7034 that can be executed by the processor 7008 of the cloud 7004 to provide data analysis solutions to problems that arise specifically in the medical field. As shown in FIG. 13, the functionality of the cloud-based data analysis module 7034 can be supported via a hub application 7014 hosted by a hub application server 7002 that can be accessed on the surgical hub 7006. Cloud processor 7008 and hub application 7014 may work together to execute data analysis module 7034 . Application program interface (API) 7016 defines a set of protocols and routines corresponding to hub application 7014 . Additionally, the API 7016 manages the storage and retrieval of data within the aggregated medical data database 7011 for the operation of the application 7014 . Cache 7018 also stores data (eg, temporarily) and is coupled to API 7016 for more efficient retrieval of data for use by application 7014 . The data analysis module 7034 of FIG. Contains modules. Other suitable data analysis modules may also be implemented by cloud 7004, according to some aspects. In one aspect, the data analysis module is used to make specific recommendations based on analysis of trends, outcomes, and other data.

For example, the data collection and aggregation module 7022 can identify salient features or configurations (e.g., trends), manage redundant data sets, and group by surgery, but not necessarily on the actual surgical date and surgeon. It may be used to generate self-describing data (eg, metadata), including storing data in unmatched paired datasets. Specifically, the paired data set generated from the operation of surgical instrument 7012 may include applying a binary classification such as, for example, bleeding or non-bleeding events. More generally, a binary classification may be characterized as either a desirable event (eg, a successful surgical procedure) or an undesirable event (eg, misfiring or misused surgical instrument 7012). Aggregated self-describing data may correspond to individual data received from various groups or subgroups of surgical hub 7006 . Accordingly, data collection and aggregation module 7022 can generate aggregated metadata or other organized data based on raw data received from surgical hub 7006 . To this end, processor 7008 can be operatively coupled to hub application 7014 and aggregated medical data database 7011 to execute data analysis module 7034 . Data collection and aggregation module 7022 may store the aggregated organized data in aggregated medical data database 2212 .

A resource optimization module 7020 can be configured to analyze this aggregated data to determine the optimal use of resources for a particular medical facility or group of medical facilities. For example, resource optimization module 7020 may determine an optimal ordering point for surgical stapling instruments 7012 for a group of medical facilities based on the corresponding predicted demand for such instruments 7012 . The resource optimization module 7020 may also evaluate resource usage or other operating configurations of various medical facilities to determine if resource usage can be improved. Similarly, suggestion module 7030 can be configured to analyze organized data aggregated from data collection and aggregation module 7022 and provide suggestions. For example, the suggestion module 7030 may indicate that a particular surgical instrument 7012 should be upgraded to an improved version based, for example, on a higher than expected error rate. health care providers). Additionally, the suggestion module 7030 and/or the resource optimization module 7020 may suggest better supply chain parameters, such as product reorder points, for different surgical instruments 7012, their use, or actions to improve surgical outcomes. In some cases, process suggestions can be provided. Medical facilities can receive such suggestions via corresponding surgical hubs 7006 . More specific suggestions regarding various surgical instrument 7012 parameters or configurations may also be provided. Hub 7006 and/or surgical instrument 7012 may each have a display screen for displaying data or suggestions provided by cloud 7004 .

Patient outcome analysis module 7028 can analyze surgical results associated with currently used operating parameters of surgical instrument 7012 . Patient outcome analysis module 7028 may also analyze and evaluate other potential operating parameters. In this connection, the suggestion module 7030 may make suggestions using these other potential operating parameters based on yielding better surgical outcomes, such as better sealing or less bleeding. Sometimes you can. For example, suggestion module 7030 can send suggestions to surgical hub 7006 regarding when to use a particular cartridge in a corresponding stapling surgical instrument 7012 . Cloud-based analysis systems can therefore analyze large collections of raw data, across multiple medical facilities (advantageously, decisions based on aggregated data) while controlling for common variables. ) may be configured to provide focused suggestions. For example, cloud-based analytics systems analyze geographic similarities between types of practices, types of patients, numbers of patients, providers/facilities, and providers using similar types of equipment, etc. , evaluated, and/or aggregated, in which case a single healthcare facility alone cannot be analyzed independently.

Control program update module 7026 may also be configurable to implement various surgical instrument 7012 suggestions when the corresponding control program is updated. For example, the patient outcome analysis module 7028 may be able to identify correlations linking certain control parameters with successful (or unsuccessful) outcomes. Such correlations may be addressed when updated control programs are sent to surgical instrument 7012 via control program update module 7026 . Updates to fixtures 7012 sent via corresponding hubs 7006 may incorporate aggregated performance data collected and analyzed by data collection and aggregation module 7022 of cloud 7004 . Additionally, patient outcome analysis module 7028 and recommendation module 7030 may be able to identify improved methods of using instrument 7012 based on aggregated performance data.

A cloud-based analytics system may include security features implemented by the cloud 7004 . These security features may be managed by authorization and security module 7024 . Each surgical hub 7006 can have associated unique credentials such as a username, password, and other suitable security credentials. These credentials may be stored in memory 7010 and associated with permitted cloud access levels. For example, based on providing correct credentials, surgical hub 7006 may be granted access to communicate with the cloud to a predetermined extent (e.g., transmit or receive certain defined types of information). may engage). To this end, the aggregated medical data database 7011 of cloud 7004 may include a database of authorized credentials for verifying the accuracy of provided credentials. Different credentials may be associated with different levels of authorization for interaction with cloud 7004 , such as a predetermined access level for receiving data analytics generated by cloud 7004 .

Additionally, for security purposes, the cloud may be able to maintain a database of hubs 7006, appliances 7012, and other devices that may include a "blacklist" of prohibited devices. Specifically, a blacklisted surgical hub 7006 may not be allowed to interact with the cloud, while a blacklisted surgical instrument 7012 may not be allowed to interact with the corresponding hub. 7006 and/or may be prevented from being fully functional when paired with a corresponding hub 7006. Additionally or alternatively, cloud 7004 may flag instruments 7012 based on non-compliance or other specified criteria. In this manner, counterfeit medical devices and inappropriate reuse of such devices across cloud-based analysis systems can be identified and addressed.

Surgical instruments 7012 may use wireless transceivers to transmit wireless signals that may represent authorization credentials for access to corresponding hubs 7006 and cloud 7004, for example. Wired transceivers may also be used to transmit signals. Such authorization credentials can be stored in the respective memory device of surgical instrument 7012 . Authorization and security module 7024 can determine whether authorization credentials are correct or forged. Authorization and security module 7024 may also dynamically generate authorization credentials for enhanced security. Credentials may also be encrypted, such as by using hash-based encryption. Upon sending the appropriate authorization, the surgical instrument 7012 signals the corresponding hub 7006 and ultimately the cloud 7004 to indicate that the instrument 7012 is ready to acquire and transmit medical data. may In response, cloud 7004 may transition to a state capable of receiving medical data for storage in aggregated medical data database 7011 . This readiness for data transmission may be indicated by a light indicator on the instrument 7012, for example. Cloud 7004 can also send signals to surgical instruments 7012 to update their associated control programs. The cloud 7004 can send signals directed to specific classes of surgical instruments 7012 (e.g., electrosurgical instruments) such that software updates to control programs are sent only to appropriate surgical instruments 7012 . can. Additionally, cloud 7004 may also be used to implement system-wide solutions to address local or global issues based on selective data transmission and authorization credentials. For example, if a group of surgical instruments 7012 is identified as having a common manufacturing defect, cloud 7004 may modify the authorization credentials corresponding to this group to implement operational lockout for this group. good.

The cloud-based analytics system is adapted to monitor multiple healthcare facilities (e.g., healthcare facilities such as hospitals) to determine improved practices and suggested changes (e.g., via the recommendations module 2030). It may be possible. Accordingly, processor 7008 of cloud 7004 can analyze data associated with individual medical facilities to identify the facilities and aggregate that data with other data associated with other medical facilities. Groups may be defined based on similar operational behavior or geographic location, for example. In this manner, cloud 7004 may provide extensive analysis and recommendations for medical facility groups. Cloud-based analytics systems may also be used for enhanced situational awareness. For example, the processor 7008 may predictively model the effect of the cost and effectiveness recommendations for a particular facility (on overall operations and/or on various medical procedures). The costs and effectiveness associated with that particular facility can also be compared to corresponding local areas of other facilities or any other comparable facility.

Data classification and prioritization module 7032 may prioritize and classify data based on severity (eg, severity of medical events associated with the data, surprise, suspiciousness). This categorization and prioritization may be used in conjunction with other data analysis module 7034 functions described above to improve the cloud-based analysis and operations described herein. For example, data classification and prioritization module 7032 can assign priorities to data analysis performed by data collection and aggregation module 7022 and patient outcome analysis module 7028 . Different priority levels may be used from cloud 7004 (corresponding to levels of urgency), such as escalation for expedited response, special handling, exclusion from aggregated medical data database 7011, or other suitable response. can provide a specific response. Further, if desired, cloud 7004 can send requests (eg, push messages) through hub application servers for additional data from corresponding surgical instruments 7012 . A push message can result in a notification displayed on the corresponding hub 7006 to request support or additional data. This push message may be required in situations where the cloud detects significant irregularities or outliers and the cloud is unable to determine the cause of the irregularities. The central server 7013 is configured to trigger this push message in certain critical situations, such as when data is determined to differ from expected values by more than a predetermined threshold, or when security appears to have been involved. may be programmed to

Additional details regarding cloud analytics systems can be found in U.S. Provisional Patent Application No. 62/659,900, filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION", which is incorporated herein by reference in its entirety. can be issued.

Situational Awareness An "intelligent" device that includes control algorithms responsive to sensed data can be an improvement over a "dumb" device that operates without considering sensed data. However, some sensed data may be incomplete or inconclusive when considered alone, i.e., without the context of the type of surgical procedure being performed or the type of tissue being operated on. be. Without knowing the procedure context (e.g., knowing the type of tissue being operated on or the type of procedure being performed), the control algorithm would be able to operate the modular device given sensory data that does not contain a specific context. It may control imprecisely or sub-optimally. For example, the optimal method of control algorithms for controlling a surgical instrument in response to particular sensed parameters may vary according to the particular tissue type being operated on. This is due to the fact that different tissue types have different properties (eg, resistance to tearing) and thereby respond differently to motion taken by a surgical instrument. Therefore, it may be desirable for the surgical instrument to behave differently even when the same measurement is sensed for a particular parameter. As one specific example, the optimal method of controlling surgical stapling and severing instruments in response to the instrument sensing an unexpectedly high force to close its end effector is to determine whether the tissue type is torn. depending on whether it is susceptible or resistant to For tissue susceptible to tearing, such as lung tissue, the instrument's control algorithm optimally ramps down the motor in response to the unexpectedly high closing force to avoid tearing the tissue. For tissue that is resistant to tearing, such as stomach tissue, the instrument's control algorithm responds to an unexpectedly high closing force to ensure that the end effector is properly clamped to the tissue. Allows the motor to ramp up optimally. Without knowing whether lung tissue is clamped or stomach tissue is clamped, the control algorithm may make sub-optimal decisions.

One solution includes a system configured to derive information regarding a surgical procedure to be performed based on data received from various data sources, and then control the paired modular devices accordingly. Utilize a surgical hub. In other words, the surgical hub infers information about the surgical procedure from the received data and then controls the modular devices paired with the surgical hub based on the inferred context of the surgical procedure. Configured. FIG. 14 shows a diagram of a situation-aware surgical system 5100, according to at least one aspect of the present disclosure. In some examples, data sources 5126 may include, for example, modular device 5102 (which may include sensors configured to detect parameters associated with the patient and/or the modular device itself), database 5122 ( EMR database containing patient records), and patient monitors 5124 (eg, blood pressure (BP) monitors and electrocardiogram (EKG) monitors).

Surgical hub 5104, which may be similar in many respects to hub 106, extracts contextual information about a surgical procedure from the data, for example, based on a particular combination of received data or a particular order in which data is received from data sources 5126. can be configured to derive Contextual information inferred from the received data may be, for example, the type of surgical procedure being performed, the particular steps of the surgical procedure being performed by the surgeon, the type of tissue being operated on, or the body cavity being treated. can contain. This ability by some aspects of the surgical hub 5104 to derive or infer surgical procedure-related information from the received data may be referred to as "situational awareness." In one illustration, surgical hub 5104 can incorporate a situational awareness system, which is hardware and/or programming associated with surgical hub 5104 that derives contextual information related to surgical procedures from received data.

The situational awareness system of surgical hub 5104 may be configured to derive contextual information from data received from data sources 5126 in a variety of different ways. In one example, the situational awareness system is trained to correlate various inputs (eg, data from database 5122, patient monitor 5124, and/or modular device 5102) with corresponding contextual information about surgical procedures. Including pattern recognition systems trained on data, or machine learning systems (eg, artificial neural networks). In other words, a machine learning system can be trained to accurately derive contextual information about a surgical procedure from the input provided. In another example, the situational awareness system stores pre-characterized contextual information about a surgical procedure in association with one or more inputs (or ranges of inputs) corresponding to the contextual information. Can include uptables. In response to interrogation by one or more inputs, the lookup table can return corresponding contextual information for the situational awareness system to control the modular device 5102 . In one example, the contextual information received by the situational awareness system of surgical hub 5104 is associated with a particular control adjustment or set of control adjustments for one or more modular devices 5102 . In another illustration, the situational awareness system is a further machine that generates or retrieves one or more control adjustments for one or more modular devices 5102 when contextual information is provided as input. Including learning systems, lookup tables, or other such systems.

Surgical hub 5104 incorporating a situational awareness system provides surgical system 5100 with many benefits. One benefit includes improved interpretation of sensed and collected data, which improves processing accuracy and/or use of data during the course of a surgical procedure. To return to the previous example, the context-aware surgical hub 5104 can determine what type of tissue is being operated on, and thus an unexpectedly high force is required to close the end effector of the surgical instrument. Once detected, the context-aware surgical hub 5104 can properly ramp up or ramp down the motor of the surgical instrument for the tissue type.

As another example, the type of tissue being operated on can affect adjustments made to the compression rate and load threshold of the surgical stapling and cutting instrument for a particular tissue gap measurement. The context-aware surgical hub 5104 can deduce whether the surgical procedure being performed is a thoracic procedure or an abdominal procedure, which allows the context-aware surgical hub 5104 to use surgical stapling and severing instruments. It can be determined whether the tissue being clamped by the end effector is the lung (for thoracic surgery) or the stomach (for abdominal surgery). Surgical hub 5104 can then adjust the compression rate and load threshold of the surgical stapling and severing instrument appropriately for the tissue type.

As yet another example, the type of body cavity being operated on during an insufflation procedure can affect smoke evacuator function. The context-aware surgical hub 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure utilizes insufflation) and determine the type of procedure. Because the type of procedure is typically performed in a specific body cavity, the surgical hub 5104 can control the motor speed of the smoke evacuator appropriately for the body cavity being operated on. Accordingly, the context-aware surgical hub 5104 can provide a consistent amount of smoke evacuation for both thoracic and abdominal surgery.

As yet another example, the type of procedure being performed can affect the optimal energy level at which an ultrasonic surgical instrument or radio frequency (RF) electrosurgical instrument operates. Arthroscopic procedures, for example, require higher energy levels because the end effectors of ultrasonic surgical instruments or RF electrosurgical instruments are immersed in fluid. The context-aware surgical hub 5104 can determine whether the surgical procedure is an arthroscopic procedure. The surgical hub 5104 can then adjust the generator's RF power level or ultrasound amplitude (ie, “energy level”) to compensate for the fluid-filled environment. Relatedly, the type of tissue being operated on can affect the optimal energy level at which an ultrasonic or RF electrosurgical instrument operates. The situational awareness surgical hub 5104 determines which type of surgical procedure is being performed according to the expected tissue profile of the surgical procedure and then adjusts the energy level of the ultrasonic surgical instrument or the RF electrosurgical instrument, respectively. Can be customized. Additionally, the context-aware surgical hub 5104 may be configured to adjust the energy levels of ultrasonic or RF electrosurgical instruments over the course of a surgical procedure, not just on a procedure basis. The context-aware surgical hub 5104 determines which step of the surgical procedure is being performed or is to be performed after which the generator and/or ultrasonic or RF electrosurgical instrument control algorithms can be updated to set the energy level to a value appropriate for the expected tissue type according to the surgical procedure.

As yet another example, data can be drawn from additional data sources 5126 to improve the conclusions surgical hub 5104 draws from one data source 5126 . Situational Awareness Surgical Hub 5104 can augment the data received from modular device 5102 with contextual information built about surgical procedures from other data sources 5126 . For example, the context-aware surgical hub 5104 is configured to determine whether hemostasis has occurred (i.e., whether bleeding has stopped at the surgical site) according to video or image data received from a medical imaging device. can be However, in some cases the video or image data may not be deterministic. Thus, in one illustration, the surgical hub 5104 can communicate physiological measurements (eg, blood pressure sensed by a BP monitor communicatively connected to the surgical hub 5104) to the surgical hub 5104 (eg, It may be further configured to make a determination as to the integrity of the staple line or tissue weld compared to visual or image data of hemostasis (from a medical imaging device 124 (FIG. 2) coupled to the hemostat). In other words, the situational awareness system of surgical hub 5104 can consider physiological measurement data to provide additional context in analyzing visualization data. Additional context may be useful when visualization data may be inconclusive or incomplete on their own.

Another benefit is to reduce the number of times medical personnel are required to interact with or control surgical system 5100 during the course of the surgical procedure. It involves actively and automatically controlling the paired modular devices 5102 according to a specific process. For example, the context-aware surgical hub 5104 can actively activate a generator to which an RF electrosurgical instrument is connected if it determines that a subsequent step in the procedure requires use of the instrument. By actively activating the energy source, the instrument can be ready for use as soon as the preceding steps of the procedure are completed.

As another example, the context-aware surgical hub 5104 anticipates that the surgeon will need to see if the current or subsequent steps in the surgical procedure require different views or degrees of magnification on the display. can be determined according to the characteristic(s) at the surgical site. Surgical hub 5104 can then actively change the displayed field of view (eg, provided by the medical imaging device for visualization system 108) accordingly, so that the display automatically changes over the surgical procedure. adjust accordingly.

As yet another example, the context-aware surgical hub 5104 can determine which steps of a surgical procedure are being performed or will be performed after that particular data or comparisons between data are required for that step of the surgical procedure. It can be determined whether Surgical hub 5104 may be configured to automatically invoke data screens based on the steps of the surgical procedure being performed without waiting for the surgeon to ask for specific information.

Another benefit includes checking for errors during surgical setup or during the course of a surgical procedure. For example, the context-aware surgical hub 5104 can determine whether the operating room is properly or optimally set up for the surgical procedure to be performed. Surgical hub 5104 determines the type of surgical procedure being performed, retrieves (eg, from memory) the corresponding checklists, product locations, or setup needs, and then maps the current operating room layout to the surgical The surgical hub 5104 may be configured to compare to a standard layout for the type of surgical procedure determined to be performed. In one example, surgical hub 5104 may, for example, store a list of items for a procedure scanned by a suitable scanner and/or a list of devices paired with surgical hub 5104 for a given surgical procedure. It may be configured to compare against a proposed or expected manifest of items and/or devices for the purpose. If there is any discontinuity between the listings, surgical hub 5104 provides an alert indicating that a particular modular device 5102, patient monitor 5124, and/or other surgical item is missing. can be configured to In one illustration, surgical hub 5104 can be configured to determine the relative distance or position of modular device 5102 and patient monitor 5124 by, for example, proximity sensors. Surgical hub 5104 can compare the relative positions of the devices to a proposed or anticipated layout for a particular surgical procedure. If a discontinuity exists between layouts, surgical hub 5104 may be configured to provide a warning indicating that the current layout of the surgical procedure deviates from the proposed layout.

As another example, the situational awareness surgical hub 5104 may indicate that the surgeon (or other medical personnel) has made a mistake or otherwise deviated from the expected course of action during the course of a surgical procedure. can determine whether there is For example, the surgical hub 5104 determines the type of surgical procedure to be performed, retrieves (eg, from memory) a corresponding list of steps or sequences of instrument use, and then performs the procedure during the course of the surgical procedure. The steps or instruments being used may be configured to be compared to expected steps or instruments for the type of surgical procedure that surgical hub 5104 determined was being performed. In one example, surgical hub 5104 is configured to provide a warning indicating that an unexpected motion has been performed or an unexpected device has been utilized at a particular step in a surgical procedure. obtain.

Overall, the situational awareness system for surgical hub 5104 tailors surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure (e.g., adapts to different tissue types). etc.), to improve surgical outcomes by validating actions during a surgical procedure. The Situational Awareness System also enables surgical intervention by automatically suggesting next steps, providing data, and coordinating displays and other modular devices 5102 within the surgical site according to the specific context of the procedure. Improves surgeon efficiency in performing procedures.

Referring now to FIG. 15, a timeline 5200 illustrating the situational awareness of a hub such as, for example, surgical hub 106 or 206 (FIGS. 1-11) is shown. Timeline 5200 is an exemplary surgical procedure and contextual information that surgical hubs 106, 206 can derive from data received from data sources at each step of the surgical procedure. Timeline 5200 is taken by nurses, surgeons, and other medical personnel during the course of a segmentectomy surgery, beginning with setting up the operating room and ending with transferring the patient to the post-operative recovery room. Illustrate a typical process that might occur.

The situational awareness surgical hub 106, 206 sources data throughout the course of a surgical procedure, including data generated each time a modular device paired with the surgical hub 106, 206 is utilized. receive from The surgical hubs 106, 206 receive this data from paired modular devices and other data sources to receive new data such as what steps of the procedure are being performed at any given time. Once done, inferences (ie, contextual information) about the ongoing procedure can be continuously derived. The situational awareness system of the surgical hub 106, 206 may, for example, record data regarding a procedure to generate a report, verify steps being taken by medical personnel, collect data that may be relevant to a particular procedure step, or Provide prompts (e.g., via a display screen), adjust modular devices based on context (e.g., activate a monitor, adjust the field of view (FOV) of a medical imaging device, or perform ultrasound surgical changing the energy level of the instrument or RF electrosurgical instrument), and any other such actions described above.

As a first step 5202 in this exemplary procedure, hospital personnel retrieve the patient's EMR from the hospital's EMR database. Based on selected patient data in the EMR, surgical hub 106, 206 determines that the procedure to be performed is a thoracic procedure.

In a second step 5204, personnel scan incoming medical supplies for treatment. The surgical hub 106, 206 cross-references the scanned supplies with lists of supplies utilized in various types of procedures to confirm that the mix of supplies corresponds to the thoracic procedure. In addition, the surgical hub 106, 206 can also determine that the procedure is not a wedge procedure (either the incoming product does not include the specific product required for a thoracic wedge procedure or the otherwise thoracic (because it is either not compatible with the wedge treatment).

In a third step 5206, medical personnel scan the patient's band via a scanner communicatively connected to the surgical hub 106,206. The surgical hub 106, 206 can then verify the patient's identity based on the scanned data.

In a fourth step 5208, the medical staff turns on the assistive device. The auxiliary devices utilized may vary according to the type of surgical procedure and the technique used by the surgeon, but in this exemplary case they include smoke evacuators, inhalers, and medical imaging equipment. Upon activation, an auxiliary instrument that is a modular device may automatically pair as part of its initialization process with a surgical hub 106, 206 that is placed within a particular proximity of the modular device. can. The surgical hub 106, 206 can then derive contextual information about the surgical procedure by detecting the type of modular device paired with it during this preoperative or initialization phase. In this particular example, surgical hubs 106, 206 determine that the surgical procedure is a VATS procedure based on this particular combination of paired modular devices. Based on a combination of data from the patient's EMR, the list of medical supplies used in the surgery, and the type of modular device that connects to the hub, the surgical hub 106, 206 can determine the specific procedure to be performed by the surgical team. can be roughly estimated. Once the surgical hub 106, 206 knows what particular procedure is being performed, then the surgical hub 106, 206 retrieves the procedures for that procedure from memory or from the cloud and then connects. Data subsequently received from other data sources (eg, modular devices and patient monitors) can be cross-referenced to deduce which steps of the surgical procedure the surgical team is performing.

In a fifth step 5210, personnel attach EKG electrodes and other patient monitoring devices to the patient. EKG electrodes and other patient monitoring devices can be paired with the surgical hub 106,206. Once the surgical hub 106, 206 begins receiving data from the patient monitor, the surgical hub 106, 206 confirms that the patient is in the operating room.

In a sixth step 5212, medical personnel induce anesthesia in the patient. The surgical hub 106, 206 determines that the patient is under anesthesia based on data from the modular device and/or patient monitor including, for example, EKG data, blood pressure data, ventilator data, or combinations thereof. can be estimated. Completion of the sixth step 5212 completes the preoperative portion of the segmentectomy surgery and begins the surgical portion.

In a seventh step 5214, the lung of the patient being manipulated is collapsed (while ventilation is switched to the contralateral lung). The surgical hub 106, 206 can, for example, deduce from the ventilator data that the patient's lung has collapsed. The surgical hub 106, 206 can compare the detection of the patient's lung collapse to the expected steps of the procedure (which can be accessed or read out in advance) so that the surgical portion of the procedure is Assuming it has started, it can be determined that collapsing the lung is the first surgical step in this particular procedure.

In an eighth step 5216, a medical imaging device (eg, scope) is inserted and video footage from the medical imaging device is initiated. Surgical hubs 106, 206 receive medical imaging device data (ie, video or image data) through connections to medical imaging devices. Upon receiving the medical imaging device data, the surgical hub 106, 206 can determine that the laparoscopic portion of the surgical procedure has begun. Additionally, the surgical hub 106, 206 can determine that the particular procedure being performed is a segmentectomy as opposed to a lobectomy (based on the data received in the second step 5204 of the procedure). Note that the wedge procedure is already discounted by the surgical hubs 106, 206). Data from the medical imaging device 124 (FIG. 2) is utilized (i.e., activated) by determining the angle of the medical imaging device oriented with respect to visualization of the patient's anatomy. , by monitoring the number or medical imaging devices paired with the surgical hub 106, 206), and by monitoring the type of visualization device being utilized. can be utilized to determine contextual information regarding the type of treatment being performed from. For example, one technique for performing a VATS lobectomy places the camera above the diaphragm in the anterior inferior corner of the patient's thoracic cavity, while one technique for performing a VATS segmentectomy is to place the camera above the diaphragm. is positioned in the anterior intercostal position relative to the segmental cleft. For example, using pattern recognition or machine learning techniques, a situational awareness system can be trained to recognize the location of medical imaging devices based on visualizations of patient anatomy. As another example, one technique for performing VATS lobectomy utilizes a single medical imaging device, while another technique for performing VATS segmentectomy utilizes multiple cameras. As yet another example, one technique for performing a VATS segmentectomy utilizes an infrared light source (which may be communicatively coupled to the surgical hub as part of the visualization system) to visualize the segmental cleft. , which is not utilized in VATS lobectomy. By tracking any or all of this data from the medical imaging device, the surgical hub 106, 206 can be used for the particular type of surgical procedure being performed and/or the type of surgical procedure being performed. technology can be determined.

At a ninth step 5218, the surgical team begins the incision step of the procedure. The surgical hub 106, 206 receives data from the RF or ultrasound generator indicating that the energy device is being fired, so presuming that the surgeon is in the process of cutting and separating the patient's lungs. can be done. The surgical hub 106, 206 cross-references the received data with the readout steps of the surgical procedure and is fired at this point in the process (i.e., after the previously-discussed steps of the procedure are completed). It can be determined that the energy device present is compatible with the lancing process. In certain examples, the energy instrument can be an energy tool attached to a robotic arm of a robotic surgical system.

At a tenth step 5220, the surgical team proceeds to the ligation step of the procedure. The surgical hub 106, 206 receives data from the surgical stapling and severing instrument indicating that the instrument has been fired, so it can be inferred that the surgeon is ligating the artery and vein. Similar to the previous step, the surgical hub 106, 206 can derive this estimate by cross-referencing the receipt of data from the surgical stapling and severing instrument with the read out steps in the process. . In certain examples, the surgical instrument may be a surgical tool attached to a robotic arm of a robotic surgical system.

In an eleventh step 5222, the segmental excision portion of the treatment is performed. The surgical hub 106, 206 can infer that the surgeon is transsecting parenchyma based on data from the surgical stapling and cutting instrument, including data from its cartridge. The cartridge data can correspond, for example, to the size or type of staples fired by the instrument. Since different types of staples are utilized on different types of tissue, the cartridge data can indicate the type of tissue being stapled and/or transected. In this case, the type of staple fired is applied to parenchymal tissue (or other similar tissue types) so that the surgical hub 106, 206 assumes that the segmental excision portion of the procedure is being performed. can be done.

Subsequently, in a twelfth step 5224, a knot dissection step is performed. The surgical hub 106, 206 infers that the surgical team is incising the nodule and performing a leak test based on data received from the generator indicating RF or ultrasonic instruments are being fired. can be done. For this particular procedure, the RF or ultrasonic instruments utilized after the parenchymal tissue is transected correspond to the knototomy process by which surgical hubs 106, 206 make this estimate. becomes possible. Surgeons routinely combine surgical stapling/cutting instruments and surgical energy (i.e., RF or ultrasonic) depending on the particular step in the procedure, as different instruments are better suited to specific tasks. ) instruments. Thus, the particular sequence in which stapling/cutting instruments and surgical energy instruments are used can indicate which step of the procedure the surgeon is performing. Further, in certain instances, robotic tools may be utilized for one or more steps during a surgical procedure and/or hand-held surgical instruments may be used for one or more steps during a surgical procedure. can be used. The surgeon(s) may, for example, alternate between robotic tools and handheld surgical instruments and/or may use the devices simultaneously, for example. Upon completion of the twelfth step 5224, the incision is closed and the post-operative portion of the procedure begins.

In a thirteenth step 5226, the patient's anesthesia is reversed. The surgical hub 106, 206 can deduce that the patient is emerging from anesthesia, for example, based on ventilator data (ie, the patient's breathing rate begins to increase).

Finally, a fourteenth step 5228 is for medical personnel to remove various patient monitors from the patient. Therefore, the surgical hub 106, 206 can assume that the patient is being transported to the recovery room when the hub loses EKG, BP, and other data from the patient monitor. As can be seen from this exemplary procedure description, surgical hubs 106, 206 may perform a given surgical procedure based on data received from various data sources communicatively coupled with surgical hubs 106, 206. can be determined or estimated when each step of is occurring.

Situational awareness is further described in U.S. Provisional Patent Application No. 62/659,900, filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," which is hereby incorporated by reference in its entirety. . In certain examples, operation of a robotic surgical system, including, for example, various robotic surgical systems disclosed herein, is based on its situational awareness and/or feedback from its components and/or from cloud 104. can be controlled by the hub 106, 206 based on the information in the

Data Manipulation, Analysis, and Storage In various aspects, a surgical hub system collects rich contextual data related to the use of surgical devices connected to the system that provides a hierarchy of awareness for the surgical hub system. can be configured as

Data Indexing and Storage Various techniques are described herein for data transformation, validation, organization, and fusion.

One issue that arises in the surgical hub system context is how to fuse data from diverse and disparate sources into a useful common data set. For example, what solutions are available for fusing two types of data recorded at different sampling rates? Can the system be sampled at a similar rate? Can timing signals be inserted into all data to help synchronize datasets? The solution chosen for various applications may depend on the particular type of surgical device collecting the dataset being fused and other such factors.

In one aspect, the surgical hub is configured to perform automated data scaling, alignment, and organization of collected data based on predetermined parameters within the surgical hub before the data is transmitted. can be In one aspect, the predetermined parameters may be established or changed by interaction between the surgical hub and the cloud system when configured for use. The cloud system may offer solutions from other hubs in the network that address similar problems, and use various learning mechanisms to determine how to align the data. Offline processing may also be provided. This allows the data collected by the Surgical Hub to be directly integrated into a larger cloud-based database for analysis. In another aspect, the surgical hub and/or cloud system can be configured to vary the sampling rate of the measured system. For example, data sets may be organized into functional databases and/or analyzed via functional data analysis. For example, the system may be configured to include aggregating multiple measurements from the same or different devices into a single measurement. For example, the system may be configured to include hash functions for encrypting or authenticating sources or sources of data.

Data Wrangling In one aspect, the surgical hub system can be configured to perform "data wrangling" or "manging," the reorganization of raw data into a usable form. For example, a surgical hub system may be configured to organize data from surgical hubs and other instruments into a unified data set.

Data Warehousing and Fusing One challenge with embedding and fusing datasets is that the data sources differ in data rates, data organization, file formats, and organizational methods. Furthermore, when moving data into a single storage framework, some examples include the context of the conditions under which the data was recorded, any changes in the data to expected forms, and direct comparisons. It is useful to include any calibration changes in the data for

FIG. 16 is a block diagram of a system for automated scaling, organization, fusion and alignment of heterogeneous datasets, according to at least one aspect of the present disclosure. Illustration 204000 provides an example of how data can be organized through several different stages. An automated system can be implemented within a medical hub that incorporates data from multiple sources, such as one or more medical devices, enterprise software, and management software. In one aspect of the automated system, data may be extracted from various data sources 204005 and positioned within staging module 204010 . Sources may be from typical vendors and other proprietary data types from medical devices and other inputs that may be received at the medical hub. Staging module 204010 may include one or more programs for storing various types of data in their various native formats, including staging databases or universal file transfer protocols and repositories. This data is then read into a data warehouse 204015 that can be configured to perform the analysis necessary to fuse or combine the data into common data types that are useful to those who analyze the data. Data warehouse module 204015 provides some examples of the types of programs that can be used to perform these functions. Once the data is properly aligned, additional analysis can be performed on the composite data, which is then followed by business metadata (via metadata layer 204020), reports, and analytics (reports and analytics layer 204025). via). Data sources from which data is extracted may include, for example, electronic medical record (EMR) databases and supply databases of products moving within the operating room (OR).

In one aspect, data may be loaded into data warehouse 204015 via a number of different techniques. Known techniques for transferring data can be used, preserving the format of the data. The rate at which data can be transferred may be further based on the means by which the data is transferred, such as via physical means or if the data is transferred wirelessly. Using hardware can be much faster than relying on software, as another example.

In one aspect, the organized data can be read into a functional database for analysis. The process of loading data may depend on the structure of the data warehouse 204015. For example, metadata tends to grow dramatically in size and be significantly more associated with the primary data itself. Thus, data can be pooled/stored in one location so that data can be referenced faster/on-the-fly and metadata can be stored in another location (e.g., off-site) and/or in long-term storage. The metadata may be stored on a storage medium more suitable for the purpose, whereby the metadata is referenced when needed or directly requested. Accordingly, the system can be configured to parse the data and send it to the appropriate repository. In such aspects, different datasets or data types can be manipulated in the absence of each other, or metadata can be used as a means to modify primary data, which is then returned in storage or stored in datasets. can be otherwise removed from the combined dataset to limit the size of .

In another aspect, all portions of the data (i.e., primary data and/or metadata) may be stored in place, and the reference database would not have all the data stored in one combined database. Instead, it can be configured to read each piece of data required by the current analysis.

In one aspect, the data warehousing system 204015 can be configured to fuse dissimilar data, such as high and low volume data. In one aspect, received data that is in a different format or structure than another dataset uses metadata linked to the data points to fuse the data into a format compatible with the other dataset. make it possible. For example, data recorded at very different data rates may be duplicated and positioned within empty cells of the data storage structure. This technique may be used, for example, when the data source is metadata for non-critical or supplemental data elements, or another critical data point. As another example, if the data rate is very high and it is merged into a lower, more significant data form, the data point average or dropped data point methods provide an average homogenous data flow. can be used to To illustrate, when kHz harmonic transducer data (i.e., transducer data sampled at a kHz rate) is combined with or within result-based 30 Hz data, each 1,000 data points of blade impedance Averaging can be used with the lower sampling jaw clamp force to create a uniform time-based data stream. As another example, 3D imaging data may be converted to a 2D planar version within the plane measured by the adjacent mechanical device. In some aspects, the cloud system helps facilitate the determination of which datasets are more important than others, thereby how to effectively combine and align the data. can be determined. Using situational awareness, the cloud system recreates what types of data are trusted and most commonly followed from other data sets or various medical procedures. These data sets used by surgeons, analysts or others provide probabilistic indications of what kinds of data are most useful and then how to fuse the data for these purposes. can decide whether to let

In various aspects, data coming from one or more sources connected to the medical hub is sent to the data warehouse and organized, scaled, and/or positioned using predetermined parameters within the medical hub. can be matched. That is, prior to incorporation or aggregation into cloud systems, data may already be processed to conform to a predetermined format, scale, or other alignment as collected at the medical hub. In some cases, these predetermined parameters may be adjusted after interaction with the cloud system. For example, a cloud system may determine that some data needs to be revised after including a new medical device in its system. As another example, cloud systems may utilize situational awareness or other machine learning to determine more efficient scales for certain types of data that are more useful to end users. This type of change is propagated to each of the medical hubs so that automated data scaling, alignment, and organization at the medical hubs can provide more relevant data before it is uploaded to the cloud system. sell.

Data Cleansing Data cleansing, also called data preprocessing, refers to removing duplicates, reorienting columns or rows, and linking interrelated data.

In one aspect, the data warehousing system 204015 can be configured to remove duplicate data. Data duplication may result from the fact that data can enter data warehouse system 204015 from multiple sources (see block 204005), some of which are used together during the course of a surgical procedure. may be For example, a robot hub, an energy/visualization hub, and a monitor tower hub can all be interfaced within the same procedure, and each of these hubs can generate at least some overlapping data, but are combined and aligned. Finally useful for Additionally, the hub may be moved in and out of the OR for a portion of the surgical procedure and may be moved within other procedures. Being able to look for duplicate data sets coming from different sources, and then remove duplicate data, indicates that a particular user, use, or domain is derived from the entire data set resulting solely from duplication of data. not unduly influence the conclusions reached. As another example, data may be duplicated due to interruption or loss of data in transition to initiate a second transmission of the same data. As yet another example, data may be intentionally uploaded multiple times. All of these overlaps will affect the weighting of certain conclusions drawn from the data set, which can interfere with trends and analyses.

In one aspect, data warehousing system 204015 may be configured to merge separate data streams. An alternative to multiple duplication of data may occur when each set of devices or hubs used in the same procedure all send their data separately to the Data Warehouse 204015 that builds them. This presents a problem unrelated to the fact that each device will need some scheme of synchronizing several successive measurements, allowing the devices to be related to each other. In aspects where patient data is anonymized, synchronization of data from different data sources may not be an acceptable synchronizer (storing the real time associated with the data). (because it can be used to verify sensitive patient data), it can be even more difficult. Additionally, if a randomized date and time is generated, the randomizer will need to communicate its starting point to all devices to enable them to use simultaneous measurements.

In one aspect, surgical devices are configured to use the time of their internal clocks, rather than real time, to communicate synchronizer signals between devices within the same procedure. Thus, each device records and timestamps data from their individualized view, and then when all of the data is sent to a data warehouse (e.g., data warehouse 204015), the data warehouse: Signals can be synchronized and used to correlate or merge different data feeds into a signal unified data set. This addresses patient privacy concerns while still successfully synchronizing data.

Computing Values from Independent Imported Data Elements In one aspect, a portion of the metadata may be utilized to transform primary data points into associated aspect data. For example, data warehousing system 204015 may be configured to use tissue type to calculate a constant, which is then multiplied by tissue impedance to balance collagen levels and conductivity with impedance, Comparable impedance values are generated to assess comparable seal strengths between tissue types. As another example, the data warehousing system 204015 may be configured to use the tissue thickness and cartridge color of the surgical stapling instrument to calculate a constant, which is then the firing force (FTF ) to create a tissue-independent value of device firing performance.

In one aspect, generation of a particular surgical instrument or its serial number can be utilized to convert instrument behavior into a cascade that allows all devices to be compared across multiple design variations. The cloud system can propagate changes from one medical hub connected to a particular surgical instrument to all other medical hubs to the relevant extent. New changes may also be incorporated into updating the medical device's situational awareness to note that new or updated versions of surgical instruments introduce changes that should be considered.

Chronological Correlation Data In one aspect, chronological correlation data may be stored as part of a patient's electronic health record (EHR) within HIPAA controls and protected privacy restrictions. Patients may then have access to a combined data set derived from multiple different data sources. For example, if multiple medical hubs and/or multiple medical devices were used in the surgery, the patient would be able to determine how all of the instruments would behave based on the data fused and registered according to the processes described herein. may have interacted in a time series fashion.

Randomized Data Pairs In one aspect, untraceable, seemingly unrelated data pairs or clusters can be merged into the results. In one such aspect, the data wrangling process may include randomized data pairs, ensuring that metadata resulting from the data remains correlated with the results present as part of the data pairs or bundles. enable.

Data Conformation and Form Transformation In various aspects, the conformation and form of data may be transformed so that the data is in the expected format (eg, the format expected by the data warehousing system 204015). In one aspect, raw data may be mapped to specific functional forms in data staging module 204010 . For example, numeric data elements can be substituted for alphabetic data elements. Alternatively, the data may be transformed into a predetermined configuration, such as a particular arrangement of rows, columns, fields, cells, or the like.

The illustration 204100 of FIG. 17 shows a first graph 204105 illustrating measured blood pressure versus time, a second graph 204110 illustrating fused blood pressure versus time, and different sample rates, according to at least one aspect of the present disclosure. 204115 is a set of graphs including a third graph 204115 illustrating blood pressure versus time of . Example 204100 graphs illustrate how data entering data warehouse 204015 can contain different measurements at different scales, sampling rates, and over time, and the system of FIG. 16 produces a usable format. An example of how the data can be properly fused and aligned to do so is shown. Here graphs 204105 and 204110 are shown on the same time scale, although they are different data sets. Graph 204105 represents a subset of blood pressures measured over time (over time period _t1 ). In this example, line graph 204125 represents the actual blood pressure, while there are sampled data points that are mostly shown along a smooth continuous line. The sampled data points actually contain a pair of erroneous data points 204120 . Data warehouse 204015, through processing by one or more medical hubs and/or cloud systems, may utilize error point accounting techniques to form accurate blood pressure curves.

This measured blood pressure curve of graph 204105 can then be fused with other sampled data to create fused blood pressure graph 204110 . The periods are aligned with additional data that may be collected from other data sets as shown. For example, line graph 204140 may be a data set recorded over the same time period from a slower sampling rate. Blood pressure plot 204135 may be partially generated by the sampled data points of plot 204105, but may be generated by additional data. In fused plot 204110, erroneous data points, such as point 204120, may be smoothed as data warehouse 204015 processes to incorporate the data. They may be removed and the revised plot 204135 may be located at the average of the last data points before and after in some cases. In other cases, simply the last data point may replace the error point if the rate of change of data over unit time exceeds a predetermined threshold.

Plot 204115 shows an example of low frequency data scaling. A downslope plot 204155 sampled at 100 Hz may be overlaid with data sampled at a lower frequency, but then upscaled to align with the higher sampling rate. Around the 100 Hz sampled plot 204155 are shown several data plots 204145 and 204150 sampled at 10 Hz but scaled to 100 Hz to match the higher sampled plots. Plot 204145 is an example of errors in the lower sampled plot, but with error points filled and/or replaced. As shown, the lower sampled points are simply scaled horizontally at higher frequency rates in this example. Otherwise, if enough data points are presented to establish a non-horizontal slope, data warehouse 204015 extrapolates a lower frequency sampling to produce a smoother slope following the lower slope of plot 204155, for example. can create a perfect match.

Illustration 204200 of FIG. 18 shows a graph 204205 illustrating blood pressure versus high and low thresholds, according to at least one aspect of the present disclosure. Graph 204205 may be an example of a data analysis report that may utilize metadata resulting from the fusion and alignment of data from data warehouse 204200 . Graph 204205 may be the final product, utilizing the data from FIG. Thus, in this example, a plot of blood pressure 204210, like one or more of the above processes, is a plot of one or more sampled datasets of a patient that may have been fused together. can be the result. For example, multiple data sets sampled at different data rates from 2 Hz to 10 Hz may be used to create plot 204210 . Systems according to the present disclosure may also add graphical overlays, such as upper line 204215 and lower line 204220, to indicate blood pressure ranges based on the data. Using the processes and systems described herein, patients or analysts can obtain more comprehensive data that have more beneficial uses than if multiple data sets were examined independently. is possible.

FIG. 19 is a graph illustrating ultrasound system frequency versus time, in accordance with at least one aspect of the present disclosure; Illustration 204300 may be another example of a final product report that is the result of data fusion and alignment by data warehouse 204015 and subsequent analysis using metadata layer 204020 and/or reporting and analysis layer 204025 . Here, graph 204305 shows a plot of ultrasound frequency over time for the medical device. Plot 204315 may be the combined result of multiple data sets monitoring the device, each data set having a sampling rate varying from 100 Hz to 2 kHz. The data sets may be combined to produce this final plot 204315. As shown, different sampling rates may account for varying frequency rates. Data sampled within the period of circle 204310 show that the frequency of the device was decreasing somewhat gradually, while data sampled within the period of circle 204320 shows that the frequency of the device decreased even more dramatically. indicates that it has decreased to

FIG. 20 is a graph illustrating expected blood pressure for different vessel types, according to at least one embodiment of the present disclosure; The illustration 204400 may be another example of a final product report that is the result of data fusion and alignment by the data warehouse 204015 and subsequent analysis using the metadata layer 204020 and/or the reports and analysis layer 204025. Here graph 204405 shows how different types of blood vessels are expected or reported to have different blood pressures. Each single data point in graph 204405 may be the result of aggregate data compilation from multiple data samples. The data warehouse 204015 may be organized to combine data into a common scale and then be viewed as the plot shown. Additional overlays such as labels and vertical lines may be included to help better visualize the data.

As described above and shown in FIGS. 17-20, in various aspects the computer system may be configured to smooth or fuse data based on, for example, expected variations in the source data. For example, blood pressure measured in the aorta may be measured in smaller vessels (eg, smaller arteries, arteries, etc.) in which energy surgical instruments (ie, electrosurgical instruments or ultrasonic surgical instruments) may be operating. ) is not necessarily equivalent to blood pressure measured by Accordingly, the computer system applies a scaling factor to the pressure measurements (i.e., the pressure measured in the larger artery) to convert the pressure measurements to the pressure being experienced by the end effector of the device (i.e., the surgical instrument end). actual pressure in smaller arteries that are incised, sealed, or otherwise manipulated by the effector). Additionally, there may also be a lag between the blood pulse (pressure) measured within the artery and correlated pressure to tissue properties measured locally to the end effector. Accordingly, the computer system may apply a time delay factor to shift the pressure measurements. Furthermore, different types of sampled data may have very different sampling rates and bit sizes. For example, ultrasound feedback/control data may be sampled at, eg, 100 Hz to 2 kHz (see FIG. 19), while blood pressure may be sampled, eg, at 2 Hz to 0.25 Hz. Accordingly, a computer system may be configured to pair or fuse data having different sample rates using the techniques described above in order to perform deep analysis on the data.

Dataset Validation In various aspects, the computer system may be configured to validate the dataset itself and/or the source of the dataset, including hubs, individual instruments, or sensing systems. Additionally, the computer system (eg, surgical hub and/or cloud system) can be configured to validate received data and provide a response to invalid data.

In one aspect, the hub, device, and/or cloud may be configured to provide a specific response based on verification of the received data set and authentication of its source and integrity. Additionally, the response(s) provided by the hub, device, and/or cloud may be selected from a response set corresponding to the data and/or metadata. In one aspect, the cloud may be configured in response to poor data integrity, lack of data authenticity (i.e., lack of ability to authenticate data, or ability to determine that data is not authenticated), or user behavior. , may be configured to isolate data from the primary data group. In another aspect, the computer system identifies users or facilities, isolates data from other data sets, compiles the effects of data to determine warehouse responses, and/or It can be configured to provide various responses, including providing warnings of missing instruments and their implications. In one aspect, the hub may flag data for later analysis, modify control algorithm changes in linked instruments, or verify or analyze data, instruments, user behavior, or linked data sources. Based on authentication, it can be configured to provide various responses, including preventing use of the hub or appliance. In one aspect, a local user may have the ability to override the local hub's reaction.

Data Trend Validation In one aspect, a computer system may be configured to check for trends in data to ensure that its behavior, and thus its data, has not changed. There can be several sources of error or invalid information that can migrate to large datasets. If all data are treated as valid, it means that other data points were significantly different events, either shifting the mean/correlation or increasing the error term of the analysis. can affect the statistical significance of other data points. Furthermore, data can be maliciously altered with the intent to impede the ability to improve or detect anything or to cause the computer system to change the behavior of the device (eg, the control algorithm of the device) in the wrong direction. Bad faith stems from hiding use when the device is used off-label, too many times (i.e., more times than suggested by the device manufacturer), or in a more abusive manner. can. Malice can also undermine the ability to effectively determine trends in data, or even mislead data analysis.

Continuous trends and repetitive data points that can be used throughout any normal surgical procedure that may not be deceiving when the device is used for the job and when the device is said to have been used exists. In one aspect, these comparison points can be used to verify the integrity of the data. This analysis of continuous trends and recurring data points should be an on-the-fly means to ensure that the data itself has not been affected in any way, as well as a check to confirm verification or encryption terms. can be

In one aspect, private key encrypted verification terms and/or checksums may be utilized to verify that the received data truly originates from the instrument it claims to originate from. For example, verification terms can be used as opposed to encrypting all data and metadata, which can be costly in terms of bandwidth, storage size, and processor speed. Using a verification term allows the cloud and surgical hub units to verify that the data is true and comes from the particular source for which it is intended, in a less cumbersome manner. can be scanned.

In one aspect, the cloud system may utilize data from other sources, such as one or more other medical hubs, to determine whether data sets from different medical hubs are valid. . The cloud system may be configured to pull patterns of known valid datasets in multiple other medical hubs and/or known invalid datasets from these multiple sources. In other cases, the cloud system may cross-check the data to determine whether the dataset is unique and whether the dataset should actually be unique. For example, a data set may be flagged if data from a medical device with a particular serial number occurs to match the serial number from another known medical device.

In one aspect, when new malicious actors are discovered, the cloud system may utilize situational awareness to propagate known instances of fraud or malicious activity to other hubs in the network. In general, situational awareness can be used to determine patterns of valid or invalid data, and when determining the validity of any data set, put them into new situations or new nodes (e.g., hubs) in the network. pattern can be applied.

In one aspect, if the data is found to have been altered, the computer system can be configured to determine whether the data is entirely man-made or has been altered.

If the data is determined to be wholly man-made or man-made, the computer system will notify the security agent of the intrusion and initiate an investigation into the data source and behavior, affected hub, region, or Isolating all data and data requests from system users and/or erroneous data being added to any of the databases (e.g. data warehousing databases) or affected as part of any analysis or by preventing it from being considered.

If it is determined that the data has been modified (e.g., to affect data correlation analysis), but is from a valid source, the computer system flags the data and identifies it as tainted. and identifying the data source as the source of the data. An example of this is the generation of slightly offset data with the intention of hiding the fact that a knock-off device that it knows is being monitored is not as effective as the original device. Another example is that recalled devices contain mathematical constants that are used to offset the aging calibration of original devices that have been affected by their use (i.e., overuse) or resterilization. . These data sets can be validated by instruments that are instructed to operate in a given manner during controlled situations. For example, the instrument may be programmed to close the jaws on initial activation, activate the transducer at a known power level, and then examine blade harmonics. As another example, a motorized stapler may be programmed to retract the firing member when the knife is in a fully retracted state and monitor the force measured by the system. By being programmed to operate in certain known manners in controlled situations, the instrument can therefore determine if its operation has been altered or otherwise affected.

If the data is determined to be invalid and the data has characteristics of invalid data previously identified by the system, the data can be used to determine the source and purpose of the invalidation. The data is then relayed to the hub from which the data came in to inform the user that he or she is being affected by a product or individual interfering with the proper operation and best results of their device. can be returned.

Layered Contextual Information In some aspects, contextual information may be layered over data to enable contextual transformation rather than just aggregation of data sets. In other words, contextual metadata can be linked to results and device data to enable contextual transformation of datasets.

In one aspect, the system (eg, surgical hub system, cloud analysis system, etc.) can be programmed to adjust the control program of the device based on stratified contextual data in addition to the data. Contextual data represents the circumstances surrounding the collection of data or related patient, procedure, surgeon, or facility information. A stratified analysis to determine interrelationships of influencing factors can be utilized to develop improved causal responses for surgical hub and instrument control program updates. In one aspect, contextual stratification involves a hierarchy of influencing factors, where some may be functionally interrelated with greater importance or higher priority than others. In one aspect, the data pairs include results of instrument operation and its functional parameters. In one aspect, contextual parameters are derived from patient complications, other treatments, comorbidities, procedure complications, previous instrument function parameters, and the like. In one aspect, adjustments based on these contextual restrictions or influence factors may affect adjustments proportionally.

Identifying Relevant Contextual Cues FIG. 21 is a block diagram 204500 illustrating layered contextual information, according to at least one aspect of the present disclosure. In this illustration, there are four examples of the types of layered context information that can be considered by the system of this disclosure. Generally, the cloud system may be configured to adjust connected devices based on one or more contextual data sets in association with one or more medical hubs. FIG. 21 provides some examples of how to determine which adjustments to make when there are multiple context data sets, the data sets becoming conflict with each other or otherwise conflicting with each other. need to be adjusted. In Example A204505, the present disclosure enables a hierarchical conflict resolution system for layered context information when at least some of the context information conflicts. For example, a first set of primary contextual information related to a medical device may include maintaining a velocity of the medical device that results in an order not to exceed an initial activation velocity of 10 mm/sec. However, a second primary set of contextual information may be entered that relates to the diseased tissue to be operated on and leads to an instruction that does not exceed the initial activation speed of 8 mm/s. Hierarchical conflict resolution scheme 24505 may include logic to create combined instruction sets that satisfy all combined constraints. In this case, the resolved primary context information set therefore yields instructions with an initial activation speed of the medical instrument not exceeding 8 mm/sec. Contextual information at higher levels in the hierarchy may take precedence if the instructions directly conflict with each other. If conflicting instructions exist within the same hierarchy, a flag may be presented highlighting an unresolvable conflict. In other cases, situational awareness may be utilized to help determine how to resolve by looking at past instances of such conflicts.

In Example B 204510, adjustments to device control parameters may be made after resolving conflicts between different tiers in a non-standard manner. For example, a primary data set of contextual information may contain a maximum firing force of 400 lbs, while a secondary data set of contextual information regarding what type of medication the patient is taking shows a maximum force of only 150 lbs. obtain. A tertiary data set of contextual information may have additional instructions for maximum firing power based on patient parameters. In this case, the secondary context information may override the parameters of the primary context information because the patient has a high BMI or because some other overriding constraint exists. In some cases, the primary context dataset may include one or more exceptions to obey different parameters when the different parameters are present in other lower hierarchy datasets. In this case, the primary dataset may provide an exception to use a different maximum projectile force if the patient's medication requires a different maximum projectile force, and the secondary context dataset may then provide this condition. will be overridden.

In Example C 204515, control parameter adjustments may be determined by combining multiple pieces of context information rather than simply overriding each other. As an example, a primary contextual information set may provide instructions to set the instrument's initial activation speed to 8 mm/sec, while a tertiary contextual information set regarding patient parameters may result in additional A command that slows down by 20% may result. In this case, the effects are not directly contradictory, but rather the effects may be combined to create revised instructions. Here the speed set at 8 mm/s is reduced from the default of 10 mm/s with an initial reduction of 2 mm/s. A tertiary order provides an additional reduction of 20%, or 2.0 x 0.2 = 0.4 mm/sec. Therefore the final reduced velocity is 8-0.4=7.6 mm/sec. The cloud system may be configured to interpret the logic of the instructions and generate adjusted device parameters based on a combination of contextual information.

In Example D 204520, secondary or tertiary effects can still be used to override any predetermined control parameter that the primary context data set does not mention. In general, secondary and tertiary contextual data sets are based on patient-specific parameters and can therefore result in changes that occur at the time of surgery or "on the fly." In some cases, new contextual information may be provided in real-time, which in turn may cause the device to make additional adjustments.

FIG. 22 is a block diagram 204600 illustrating instrument feature settings, according to at least one aspect of the present disclosure. Illustration 204600 of FIG. 22 provides an example of how multiple sets of context information can be applied to the same device at the same time, but conditionally at different times or at different functions. For example, different settings may be applied to the instrument's firing system separately from the instrument's clamping system. How the control settings are applied according to any of the examples of FIG. 21 can be applied to different instrument contexts, as shown in FIG. Therefore, multiple sets of contextual information can be applied simultaneously to a single appliance. In some cases, this may result in some lower-level effects being applied to the instrument during a particular function, while those lower-level effects are applied during a different function. It will not apply to instruments.

FIG. 23 is a graph 204700 illustrating firing force (FTF) and firing rate for patients with different complication risks. Example 204700 shows four plots, two plots 204705 and 204720 corresponding to the left vertical axis related to rate of fire and two plots 204710 and 204715 corresponding to the right vertical axis related to firing force. corresponds to The two plots corresponding to one type of axis correspond to two different patients and how the instrument settings may vary between the two patients with different health conditions. In various aspects, contextual information adjustments for a single appliance may be queued for the same appliance to account for different patients to whom the appliance may be applied over the course of a day. In various aspects, the instrument may be configured to load disease context information, instrument context information, treatment context information, patient context information, etc. into a specific file, and the combined context information from multiple different data sets may be For a particular procedure on a particular patient, a particular combination is created that provides optimal adjustment of the instruments. For example, for a first patient, contextual information regarding emphysema stage 3 may be loaded into the instrument for disease status. Fire force information for a particular instrument can be loaded into the instrument state. Radiation therapy contextual information may be loaded for treatment status and steroid dose contextual information may be loaded for patient status. Any conflicts or combinations can be resolved using the exemplary process illustrated in Figures 21 and 22, which then provides the instrument with a specific set of adjustments to correctly handle this first patient. .

A second set of contextual information dealing with a second patient may then also be loaded into the instrument, but may remain queued before being implemented. For example, for a second patient, contextual information regarding hypertension (eg, 165/110) may be loaded into the instrument for disease states. Closure force information for a particular instrument may be read for instrument status. Chemotherapy contextual information may be loaded for treatment status and blood diluent dose contextual information may be loaded for patient status. Any conflicts or combinations can be resolved using the exemplary process illustrated in Figures 21 and 22, and then providing the instrument with a specific set of adjustments to correctly handle this second patient. .

The resulting combination of first patient contextual information may result in two graphs 204705 and 204710, for example, for firing rate and firing power settings over time, respectively. Similarly, the resulting combination of the second patient contextual information may result in two graphs 204720 and 204715, for example, for firing rate and firing force settings over time, respectively.

In one aspect, instrument adjustments for a single setting may be weighted by a hierarchical hierarchy from which suggested adjustments are derived. For example, if adjustments to FTF are found in all first, second, and third tiers of hierarchy, adjustments to FTF may be made according to the following exemplary weighting structure:
FTF = FTF (default) + 1.5 x FTF (primary) + 1.0 x FTF (secondary) + 0.75 x FTF (tertiary)
, where FTF is the force required to fire the surgical stapler.

Other weighting mechanisms may be used as well and are non-limiting.

Some non-limiting examples of contextual information that can be included to trigger adjustments to instruments are discussed below. The types and number of factors described can be used in the processes illustrated in Figures 21, 22 and 23 to provide combined or global instrument adjustments. Contextual cues may include non-device-specific cues, device-specific cues, medical cues, patient-specific cues, procedure-specific cues, and surgeon-specific cues.

Non-Device-Specific Contextual Cues Non-device-specific cues are contextual cues that relate to device behavior, but are not specific to any particular type of device. Contextual cues that are not device-specific may include, for example, device tissue clamps, tissue information, and instrument usage history.

Tissue clamping contextual cues may include, for example, the implications of clamping force or pressure on tissue (ie, primary effects of tissue clamping), which in turn may include desired and adverse effects on tissue. Clamping tissue can have a number of different desired effects on the clamped tissue. For example, clamping tissue can force fluid out of the tissue, disrupt tissue layers, and disrupt any internal openings. This allows the tissue layers to approximate and prevent leakage from any hollow structures in the region (eg, capillaries, bronchi, gastrointestinal tract). Another desired effect of tissue clamps is that tissue compressibility depends on the tissue type, its fluid content, pressure level, and compression rate, since body tissue is viscoelastic. Therefore, for the same amount of compression, the faster the compression, the higher the applied force. At constant pressure, the tissue will continue to move thinner and thinner until a steady state of full compression is achieved. This continuous thinning is defined as tissue creep and is a function of tissue viscoelasticity. This is important in discussion or pre-compression cycles, latency, and overall instant compression. Overall lower levels of compression over longer periods of time have less negative impact on pressure differentials (shear) on the treated tissue and adjacent tissue.

Clamping tissue can also adversely affect tissue due to compression. For example, when tissue is clamped and the tissue structure collapses, there may be structures within the tissue that are unwilling to collapse. This can create micro-tissue tension or pressure differentials between adjacent unclamped and compressed tissue. Some tissues (e.g., parenchymal tissue, parenchymal organ parenchyma) do not cause rupture of tissue layers adjacent to the clamped tissue and are not particularly resistant to such tension or pressure, resulting in , causing accidental collateral tissue damage and potentially additional leakage. The amount of pressure, the geometry of the clamp body, and the speed of the clamp all have a first-order effect on the likelihood of collateral damage. In addition, tissue composition, strength, and internal parameters also have implications for potential damage. Many of these internal parameters of tissue are affected by other medical procedures, disease states, or the physiological state of the tissue. All of these can complicate the possibility of secondary injury to secondary or primary sites. As another example, the maximum compression levels for different tissues and organs are different levels. Most tissues in the body are a series of layers or structures enclosed within other structures. When maximum compression occurs when the pressure or pressure differential applied to the outer encapsulation layer is excessive, the outer encapsulation layer tears, allowing the trapped tissue inside to exit. The lung is a good example of this. The lung parenchyma consists of alveoli, veins, arteries, and bronchi and is lined by external viscera and parietal pleura. When stapling lung parenchyma, it is desirable to staple the pleura to itself to promote good healing. However, tears in the pleura can expose the more fragile alveoli, which without an external restraining element can easily rupture and leak air. Another form of maximum tissue compression occurs when the tissue's own fiber bundles are ruptured or separated. It occurs at much higher levels and this tissue destruction is typically accompanied by extensive cell death and necrosis.

Several different device control parameters affect clamping, such as clamping force, clamping speed, and number of repeat clamps. The clamping force characteristics can represent the rate of change of force over time, the peak clamping force, the clamping force stabilization time, the steady state clamping force, and the difference between the peak clamping force and the stabilized clamping force, a clamping force vs. time curve. can be exemplified by

Clamping force can be measured either directly or indirectly via a scale. Several different scales can be utilized to measure clamping force. For power closing, measures may include the current through the motor and the difference between the target motor speed and the actual motor speed. Strain gauges on components that are loaded during clamp action, such as the anvil, closure member, and/or support frame, may also be utilized to measure clamp force.

The clamp speed may be determined by comparing the actual clamp speed to the target clamp speed for power closing. The clamping speed can also be determined according to the duration from start to finish of the clamping process.

The number of repeat clamps can be important because heavy tissue manipulations prior to tissue treatment transection can have a cumulative effect on tissue due to repeated application of pressure to the tissue. Some devices have a maximum pressure that can be applied and also a minimum closure level for the next mechanism to initiate its operation. In these examples, the jaws are repeatedly opened and closed to compress the tissue to a minimally closed condition until that condition is achieved. In one aspect, the robotic surgical system may signal when clamping parameters do not fall within thresholds to ensure that the jaws are properly clamped.

Tissue information contextual clues include, for example, intra-jaw placement (e.g., which may be considered secondary effects from surgical procedures), tissue quality knowledge from other sources (e.g., previous interventions, current/previous disease, etc.). imaging or EMR), type, thickness or density, and impedance (which may be considered, for example, primary effects from surgical procedures). The placement of the tissue within the jaws may include the percentage of the jaws covered by tissue, the area or location of the jaws covered by tissue (e.g., blood vessels, etc.), and the degree or uniformity of tissue concentration along the length of the jaws. can correspond to Any device that compresses tissue applies a known and measurable force to tissue within the jaws. The amount of tissue in the jaws, the placement of the tissue (ie, relative distal-to-proximal position), and variability in its thickness affect the pressure on the tissue. Knowing how much the jaws are covered by the tissue or the force applied to the tissue without knowing the tissue placement makes it difficult to determine the pressure on the tissue. Many devices are also technically sensitive. For example, often only the distal tip of the ultrasound system is used for dissecting, welding, and cutting, leaving a large portion of the jaw empty for many firings. As another example, surgical stapling and severing instruments often have tissue pushed into the proximal crotch of the jaws, leaving a tissue gap from the proximal end to the distal end of the end effector. there is Unless the only meaningful information sought is the trend of the parameter (which may be the case in certain circumstances), adjustments to machine control parameters will determine how much the jaws are loaded, where the jaws are loaded, and where the jaws are loaded. are functionally dependent on knowing what is being measured, since these factors have implications for the force being measured.

Instrument usage history contextual cues may include, for example, the number of uses and number of resterilizations of the device.

Device-Specific Context Cues There are a wide variety of device-specific contexts for staplers, ultrasonic instruments, laparoscopic or endoscopic suturing instruments, bibipolar instruments, monopolar instruments, and clip appliers.

Contextual cues for stalking devices may include device and reload identification cues and fire rate cues (eg, which may be considered primary effects from surgical procedures).

Device and reload identification clues may include, for example, stapler type and reload (ie, cartridge) information. Stapler type clues include brand, electric vs. manual, shaft length, general purpose vs. dedicated, handheld vs. robotic, single vs. multiple use, history of use, device reprocessed (e.g., standard reprocessed or resterilized, unlabeled use). ), and the stapler configuration (eg, straight, curved, or circular). Reload cues include color, length, uniform vs. variable staple height, authentication (i.e., whether reloads are compatible and the same brand, reloads are compatible but different or unknown brand). Whether illegal knock-off reloading used with the device or manufacturer's stapler, incompatible or current technology generation such as a), proprietary (e.g. curved tip, stiffening, radial, absorbing staples, drug-coated staples, or tissue thickness compensation), the use and type of buttress or other staple line assist, or providing drug delivery via the staple line assist.

Rate of fire cues include, for example, actual velocity over time over the firing cycle, the difference between target and actual velocity, or adaptive firing control of rate of fire (e.g., starting velocity, number of changes in target velocity, and recorded maximum and minimum actual velocities). Rate of fire has multiple direct and/or indirect implications for device function. For example, firing rate can have implications for staple formation for a number of reasons.

One reason is the speed at which the I-beam or bladed actuator is cycled to move the tissue while the staples are being deployed. In circular staplers, knife advancement is often coupled to staple driver advancement. If the knife begins to cut tissue before the staples are fully formed (in some cases), the tissue begins to move radially outward. This tissue flow can have implications for staple formation. In a continuous linear deployment stapler, the knife/actuator advances through the cartridge (typically proximal to distal, but may be in the opposite direction) to progressively deploy the staples. The tissue is cut as it forms, which causes the tissue to flow in the direction of travel. Precompression and tissue stabilization features can reduce this effect, while lower tissue compression and local flow compression of the I-beam typically increase this effect. The tissue movement effect can cause a wave to be created in front of the cutting member, which occurs within the associated region where unformed staples are advancing toward the anvil. This tissue flow therefore has an effect on staple formation and cut line length.

Another reason is that the speed at which the staple drivers are advanced has an effect on their advancement and the possibility of their rotation or bending, which causes the crowns of the staples to move out of plane. For surgical stapling and severing instruments where the diameter of the device is constrained by the trocar diameter, size or type, the staple driver is often short and, in addition to linear advancement perpendicular to the tissue contacting surface of the cartridge, It has an aspect ratio that allows the driver to roll. This rolling of the driver can result when advancement of the driver is difficult, such that as the sled continues to advance, the driver rotates rather than advances outward, causing the cartridge and staple line to roll. resulting in the destruction of This rolling of the staple driver is a function of sliding friction, lubrication, and cartridge geometry. The binding and hence rolling of the driver is amplified by the speed at which the sled is advanced and hence the speed of the device's firing actuator. Additionally, many staplers overdrive the driver over the tissue contacting surface of the cartridge. This accelerated drive exposes the driver to the tissue flow that occurs between the anvil and the cartridge. The driver has a moment of inertia and is driven into contact with tissue and receives the load from the staples being formed. The speed at which these drivers are advanced into tissue and the extent of the acceleration drive both affect the likelihood of a driver remaining directly under the anvil forming pocket.

As another example, firing rate can have implications for local tissue compression. In the case of an I-beam articulated surgical stapling and severing instrument, advancement of the firing member cuts tissue and deploys staples against the anvil pocket, as well as localized force around the location of the I-beam. cause tissue compression. This locally flowing compression wave travels from proximal to distal at the location of the I-beam. The viscoelastic aspect of the tissue directly relates this advancing speed to the applied local compressive force and the size of the rolling compression wave. This localized rolling compression can cause localized tissue tension damage and collateral damage within the treatment area as the compression rate can exceed the pre-compression rate.

As yet another example, rate of fire can have implications for forces within the device. The load experienced within the device itself is a cumulative effect from pre-compression and local rolling compression. The faster the firing member advances, the higher the force required to advance the firing member. This is due to the dynamics of moving structures and I-beam forces within the device. The higher these forces, the greater the extensibility present in all components within the elongated tube and frame, which in turn affects some forces (e.g. pre-compression as the system elongates). descend). These losses, in turn, apply greater forces to the balance of the firing member, resulting in a greater impact on the relationship of firing velocity to load.

These various examples of stapler context cues may be further illustrated with respect to particular embodiments. In this example, several things are known through the treatment plan, EMR, and other hospital records: (i) this is a right upper lobectomy procedure, (ii) the patient has a tumor in this area. (iii) the patient has interstitial lung disease, who has previously received radiation to treat it; These pieces of information suggest that the lungs are stiffer than normal healthy tissue. Based on this estimate, a conservative approach is to slow down the maximum closing speed and adjust the threshold. However, stratified contextual information can be further utilized in determining how the instrument should be controlled. For this same patient, during closure, the closure force is higher than expected and exceeds the new threshold (ie, the threshold set according to the procedure and patient information above). As a result, the waiting time before starting the firing sequence increases and the initial rate of fire slows down. The firing algorithm will run once firing begins. Note that context cues can affect thresholds within the firing algorithm.

Contextual cues for ultrasound devices include activation time, coherence tomography assessment of tissue collagen content, current mix of energy modalities (e.g., if the instrument is mixed ultrasound/bipolar, ultrasound/mixed monopolar, or ultrasonic waves only), blade temperature, and pad condition. The blade temperature increases with the duration of contact with either tissue or the clamp arm pad and power to the transducer. This temperature has the ability to change the natural frequency of the blade and add heat to the weld of unintended tissue. Also, even during actuation of the instrument, it can cause accidental damage to tissue that the instrument contacts. Hot blades also cause localized tissue charring, which can then adhere to the blade. Blade temperature has a long-term effect on cutting/coagulation performance, but also causes the tissue weld to create shear or tearing forces when the jaws are unclamped and removed (charred tissue adheres to the blade). . Pad condition may depend on the duration of activation without temperature history of the tissue and/or jaws in the jaws. As the pad deteriorates, the underlying metal strength of the clamp arm is exposed to the blade, ultimately impacting its performance.

These various examples of ultrasound contextual cues may be further illustrated with respect to particular embodiments. In this example, several things are known through the treatment plan, EMR, and other hospital records: (i) this is a longitudinal sleeve gastrectomy procedure, (ii) the patient's BMI is 40, and ( iii) the patient's body composition suggests having high levels of visceral fat; These pieces of information suggest that greater curvature will have a fatty mesentery that is larger than normal volume. Based on this assumption, the mixed algorithm learns to emphasize cutting over sealing given the expected high fat content. Algorithm parameters can be adjusted simultaneously to ensure a robust seal.

Contextual cues for laparoscopic or endoscopic suturing devices include stitch tension (e.g., tension monitoring can be utilized to inform suturing technique), stitch type (e.g., mattress vs. flow), or suture type. (eg, braid versus monofilament, absorbable versus non-absorbable, suture diameter/size, or needle size/type). For the pattern recognition model to recognize the pattern of tension applied in applying placed stitches versus stitches (e.g., stitch/tension/stitch/tension versus stitch/stitch/tension/stitch/stitch/tension). can be utilized. The pattern recognition system may find, for example, that three stitches without a tensioning step with a braided suture may be difficult to cut without tissue damage, whereas two stitches may be preferable. can be configured to provide technical advice.

For contextual clues about dual-jaw bipolar RF instruments, the coatings (disclosed in US Pat. design (which may include the design disclosed in U.S. Pat. No. D399,561, which is incorporated herein by reference in its entirety), bipolar coagulation, algorithms and load curves, generated Smoke, conductive contact of the electrode (e.g., amount of charring present on the electrode or whether there is a detected short circuit), jaw compression (e.g., compressive force, pressure, or bipolar shear, the entirety of which is incorporated herein by reference). localized electrode cross-section/raised geometry or higher peak force for the special case of bipolar shear, as disclosed in U.S. Pat. No. 9,084,606, incorporated herein by reference), tissue gap (i.e., whether the jaws are open/feathered or closed/spaced between jaws), electrode configuration (e.g., each of which is incorporated herein by reference in its entirety, US Patent No. 5,100,402, US Patent No. 5,496,315, US Patent No. 5,531,743, US Patent No. 5,846,237, and/or US Patent No. 6,090, counter electrodes, offset electrodes, or electrodes/insulators, as disclosed in '107.

Contextual cues for monopolar instruments include power (e.g., constant voltage or current and other variable control of a given tissue impedance), tissue impedance (e.g., rate of change of impedance, global measured impedance, or local time of given impedance), algorithms and load curves, return path capacitance, blade technology (e.g., U.S. Pat. No. 5,197,962, U.S. Pat. 697,926, U.S. Patent No. 5,893,849, U.S. Patent No. 6,685,704, U.S. Patent No. 6,783,525, U.S. Patent No. 6,951,559. the coating of the blade, the geometry of the exposed conductive surface, the electrical conductivity of the underlying structural material, or each of which is incorporated herein by reference in its entirety, such as dielectric breakdown or various coatings; 6,039,735, U.S. Pat. No. 6,066,137, U.S. Pat. No. 8,439,910), heat dissipation, smoke generated, applied Compression (eg, the compressive force between a monopolar blade and a support arm, or the driving force of a monopolar probe pressed against tissue), or the magnitude of leakage current may be mentioned.

Contextual cues about clip applier devices include clip size, first versus last clip from the applier, timing of force detected (e.g., when clipped over another clip or closed jaws on another instrument). (e.g., overload protection mechanisms in the event that an unexpectedly rigid structure is accidentally present in the jaws), clip feed monitoring (e.g., detection of feed load, or presence of a clip at a given location or time), lateral Directional end effector and bending loads, or jaw actuation loads (eg, clip closure, maximum load during displacement control actuation, maximum displacement during load control actuation, or tissue manipulation load by jaws) may be included.

Medical Contextual Cues Medical contextual cues may include contextual cues associated with medical complications, disease states, medications, and treatment complexities.

Contextual cues for medical complications include functional constipation, functional diarrhea, sphincter control or strength deficiency disorders, functional dyspepsia, and effects on tissue plane and tissue composition organization, among others. complications that affect

Functional constipation can result from colorectal surgery involving circular anastomosis, suggesting a longer period before allowing more extensive bowel motility after surgery. The use of expandable staple configurations or counters discourages the use of buttress or compression ring techniques that do not allow for larger and firmer stools (which may be a secondary effect from the surgical procedure, for example, as a complex effect of tissue fragility). It may also suggest showing

Functional diarrhea may exhibit higher acid levels and more fluid movement, which may lead to tighter staple morphology, higher pre-compression, and abdominal pain to minimize the possibility of fecal introduction into the abdominal cavity. May indicate potential need for laterally applied secondary support (may be defined as a tertiary effect from surgery).

Poor sphincter control or other intensity of the incomplete disorder can result in heartburn or acid reflux. These contextual cues may be associated with stronger staples, tighter morphology, and/or longer lengths of tissue, for example, to enable tighter staple morphology and lower tissue tension thresholds (both micro- and macro-tension). An esophageal anastomosis may be indicated that would benefit from pre-compression. Macro-tissue tension is related to greater mobilization of tissue from adjacent structures and can be measured by lateral forces on the stapling apparatus. Micro-tissue tension is due to the compression rate, maximum compression, and gradient of tissue compression between the area immediately adjacent to the treatment area and the type of staple configuration within the treatment area. 3D staples reduce micro tension as well as lower maximum precompression levels. Heartburn and/or acid reflux, for example, may be considered secondary effects of surgical procedures. The device or treatment suggestion may include sphincter strengthening therapy or adjunctive therapy applied to the staple line to improve robustness.

Functional dyspepsia may be due to peristaltic sensation or inhibition, suggesting stiffness of the anastomotic line (further amplifying the effect). Lower microtissue tension will mitigate the effect (3D staples) or expandable staple lines. Compression of the anastomotic line or auxiliary material used in the staple line creates more problems. Functional dyspepsia can be considered a secondary effect, for example as a complicating effect of adjunctive therapy use.

In the case of complications that affect tissue plane and tissue composition, healing by primary surgery and adhesions results in increased tissue thickness and uncontrolled remodeling of the tissue, resulting in increased tissue toughness. results in To adjust for these effects during stapling, it would be suggested to implement increased gaps, elevated tissue load thresholds, slower actuation, and proposed larger or heavier staples. These complications can be considered secondary effects of the surgical procedure, eg, tissue thickness/toughness complication effects. Other such complications may include revision surgery, adhesions, and altered tissue conditions from medical procedures (eg, irradiated tissue or steroid-induced alterations).

Contextual cues for disease states can vary for colorectal, thoracic, metabolic, and cardiovascular disease.

In colorectal disease, inflammatory bowel disease can be a contextual clue. All recurrent inflammatory colorectal diseases cause increased tissue thickness and uncontrolled remodeling of tissue, resulting in increased tissue toughness. Stapling adjustments may include increased gap, increased tissue load threshold, slower actuation, and larger or heavier staples. These complications can be considered secondary effects of the surgical procedure, such as stapling-assisted complication effects. Such colorectal diseases can include Crohn's disease and diverticulitis.

Chest disease, bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease can all be context cues. For example, emphysema results in thicker, stiffer lungs, and to prevent adjacent collateral damage around the perimeter of the anvil and cartridge due to excessive pressure differentials during treatment, load This would suggest clamping speeds, lower precompression levels, and slower firing actuation of the knife/I-beam. These are first order effects. As another example, COPD results in arterial walls that can be stiffer and less elastic, requiring more flexible handling of the artery prior to applying therapy. This may require the mechanical clamping element to clamp at a slower speed and potentially lower clamping force to minimize damage outside the treatment area and premature damage to the treatment area. These adjustments can be to either energy or stapling. These are secondary effects. In stapling, adjunctive suggestions may be contraindicated to prevent additional uncontrolled remodeling and hardening. At high energies, RF treatment modalities are preferred and the balance of RF to ultrasound balances welding over cutting.

Metabolic disease, metabolic syndrome, obesity, and type 2 diabetes can all be contextual cues.

Cardiovascular disease, arteriosclerosis, high cholesterol, and vascular disease can all be context cues.

Contextual cues for drugs may include hemodilution, blood clotting, steroids, radiotherapy, and chemotherapy.

For example, hemodilution may indicate that high energy devices will benefit from improved coagulation prior to cutting. This is the dominant and primary effect as a blood pressure complication effect. In hybrid energy devices, RF power may be increased or ultrasound application delayed to increase coagulation prior to cutting. For ultrasound-only devices, the algorithm can be adjusted to apply lower power levels for longer periods of time in order to denature the collagen for a longer period of time prior to cutting. Furthermore, in an ultrasonic-only device, the harmonic power can be adjusted lower as the temperature approaches a predetermined optimum temperature, which is maintained for an extended period of time before increasing the power of the transducer to initiate cutting. can be Additionally, for stapling instruments, the color of the proposed cartridge can be adjusted to suggest shorter formed staples, increased clamping time to close, or increased pressure prior to firing. This is a secondary effect.

For example, blood clotting may require that precompression or compression levels, either high energy or stapling, be lowered prior to treatment to minimize accidental injury and thus the formation of clots outside the treatment area. It can be shown that This is a secondary effect as a complication effect of increased pressure.

For example, steroids cause physiological effects that slow healing and increase blood pressure, which increases existing complications. This is a tertiary effect as an amplification of the disease complication effect and a longer term healing complication. Steroids raise blood pressure in many people who take them. One reason is that steroids and other corticosteroids cause the body to retain fluid. Excess fluid in circulation can cause an increase in blood pressure. Furthermore, anti-inflammatory corticosteroids significantly inhibit wound healing. Corticosteroids reduce transforming growth factor-β (TGF-β) and insulin-like growth factor-I (IGF-I) levels and tissue deposition within the wound. , whose retinoids stimulate corticosteroid-inhibiting TGF-β and IGF-I release and collagen production.

For example, radiation therapy can result in organ inflammation and tissue wall thickening. This effect can increase the stiffness, thickness, and toughness of the treated tissue. This increases the need for longer compression times and potentially higher compression thresholds unless complications prevent it. Radiation therapy may also have complicating effects on blood oxygenation by affecting the respiratory system, and may have a multiplicative effect on collagen vascular disease, which in turn may affect any high-energy welding energy. It may require a change in the algorithm that ramps towards more time to mix or weld at a slower speed before cutting. This is a secondary effect as a tissue compositional complication effect.

For example, chemotherapy treatment can result in tissue that becomes thin and fragile. These effects greatly increase the potential for collateral damage to tissue and make treatment more difficult. The implications for any mechanical device are lower velocity thresholds, and generally more gentle handling and required tissue tension, along with lower operating forces and precompression levels. This is a primary effect as a complication effect due to higher tissue compaction.

Contextual cues associated with the complexity of the procedure include tumor location, residual vascularization, challenges in accessing the surgical site, total time under anesthesia, amount of work required to complete the procedure, and whether there are any pre-treatments.

For example, residual angiogenesis can be a contextual clue, as angiogenesis is directly related to healing speed and tissue viability. Furthermore, it has long-term implications for tissue strength and recovery. This is the primary physiological effect on healing. While this does not have any short-term instrument movement impairment, it has implications for recovery strength and strengthening, requiring additional time of primary surgical treatment duration. This may affect post-surgical recovery, additional adjuvant therapy applied, and instrument recommendations for needed monitoring. This is a secondary effect as the amplification of disease states, blood glucose levels, and oxygenation affects tissue remodeling.

For example, total time under anesthesia can be a contextual clue as time under anesthesia has a complex effect on oxygenation levels and recovery to pre-operative levels on metabolic response. During surgery, anesthesiology time has an amplifying effect on lower blood oxygenation levels. This is a non-linear, time-dependent effect, the longer the time, the higher the impact of the effect. This is a tertiary effect as a complicating effect on lower blood oxygenation levels.

For example, the amount of work required to complete a procedure can be a contextual clue as it relates to the number of cycles of energy, the number of dissector or scissor movements, and/or the number of times a surgical stapling instrument is fired. .

For example, pretreatment can be a contextual cue because pretreatment increases the likelihood of tissue adhesion and secondary remodeling. This typically results in a more disordered tissue plane and toughens the tissue with more covering tissue. This is a tertiary effect as an amplification of the disease complication effect and the collagen level complication effect.

Patient-Specific Contextual Cues Patient-specific contextual cues may include, for example, patient parameters and physiological cues.

Patient parameters may include age, gender, whether the patient is a smoker, BMI, and body composition information.

For example, age results in weaker tissue that will require lower compression and lower compression rates of the treatment device, especially pre-treatment compression. This is a secondary effect as a complication effect of higher tissue compaction.

For example, gender has a threshold implication deviation from the ideal range for many physiologically relevant measures (eg, BMI, body fat composition, and the effect of age on physiology). This is a cubic effect on other parameters.

For example, whether the patient is a smoker can result in thicker, stiffer lungs and adjacent collateral damage around the perimeter of the anvil and cartridge due to excessive pressure differentials during treatment. would suggest load clamp speeds, lower precompression levels, and slower firing actuation of the knife/I-beam to prevent . These are secondary effects as emphysema and oxygen saturation complication effects. Tissue oxygenation may be a metric available to quantify the effects of smoking, as described below.

For example, BMI is a contextual clue as obesity tends to increase the comorbidity of many other medical complications. This is a tertiary effect as an amplified complication effect with blood sugar levels, congestive heart problems, oxygenation levels, and several other disease states.

For example, body composition information can be contextual cues because body fat percentage influences tissue collagen content, tissue type compression properties, and metabolic implications for healing and tissue remodeling. This has an effect at both too high and too low rates, with different effects at each extreme. Percentage body fat above a given level inhibits metabolic manipulation and adds complications around organ function. These complications tend to amplify disease state complications on mechanical device function. Furthermore, body fat percentages below a given level tend to affect tissue architecture itself. These tissue architecture changes can affect both healing and the ability of high energy devices to weld consistently due to fluctuations in collagen levels requiring more compression and longer welding times. . These are the amplification of the disease complication effect and the tertiary effect as the collagen level complication effect.

Physiological cues may include time since the patient's last meal, fasting blood glucose levels, blood pressure, macrotissue tension, tissue fluid levels, and tissue oxygenation.

For example, fasting blood glucose level can be a contextual clue as blood glucose level is a major physiological factor during healing. When blood sugar levels are higher than normal, it prevents nutrients and oxygen from supplying energy to cells and prevents the immune system from functioning efficiently. This is a secondary effect. Furthermore, knowing the steady-state fasting state, as well as postprandial changes and responses, influences the implications of the measured values. For most humans, this varies from about 82 mg/dl to 110 mg/dl (4.4-6.1 mmol/l). Blood sugar levels rise to approximately 140 mg/dl (7.8 mmol/l) or slightly more in normal humans after a complete meal. A normal human blood glucose level is about 90 mg/dl, which corresponds to 5 mM (mmol/l).

This measurement is also time dependent. Consuming a carbohydrate-heavy food causes a dramatic increase in blood sugar, which typically begins to decline after about 30 minutes.

For example, blood pressure can be utilized as a contextual cue for high energy devices to benefit from improved coagulation prior to ablation. This is a priority and first order effect. In hybrid energy devices, RF power may be increased or ultrasound application delayed to increase coagulation prior to cutting. For ultrasound-only devices, the algorithm can be adjusted to apply lower power levels for longer periods of time in order to denature the collagen for a longer period of time prior to cutting. Furthermore, in an ultrasonic-only device, the harmonic power can be adjusted lower as the temperature approaches a predetermined optimum temperature, which is maintained for an extended period of time before increasing the power of the transducer to initiate cutting. can be Blood pressure can be measured at different locations using different methods. For example, ten minutes of resting pressure, or resting blood pressure, can be very different from any blood pressure resulting from physical exertion. Knowing whether this is considered a blood pressure measurement based on an abrupt measurement or a whole body resting pressure has implications for the measurement and how it responds to excess of the upper or lower pressure. will have. Additionally, there is a difference in blood pressure with respect to vascular levels. A typical blood pressure is taken from a larger artery in the arm or other extremity. An arterial pressure of 129/80 in the arm may be related to a micropressure of 70/40 in capillaries and an even lower 20/10 in veins where the actual tissue treatment is preformed. Obstructions and fluctuations in physiology can amplify or constrain pressure differentials from one part of the system to another. Knowing where the pressure is taken, and any long-term measures, can help adjust the effect needed due to changes in pressure.

For example, tissue fluid levels are low because dehydration reduces blood flow throughout the body, which in turn reduces blood pressure, which depletes the wound bed for white blood cells that protect against infection and reaches the wound site by blood flow. Limiting oxygen, as well as vitamins and nutrients, can be contextual clues. Lower fluid levels generally inhibit all aspects of wound healing. This is a tertiary effect as an amplification of the healing complication effect. With respect to superficial tissue remodeling and potentially colorectal site healing, dehydration can delay healing in several ways. A hot, humid environment is ideal for new tissue growth, and lack of moisture to the affected area can halt cell development and migration. Without adequate hydration, epithelial cells that migrate across the wound bed in the process of repairing tissue cannot adequately pass through and cover the wound site. This interrupts the formation of new tissue and leaves the wound open and susceptible to harmful bacteria that can cause infection. Potential measures related to dehydration can include, for example, electrolytes, blood urea nitrogen, creatine, urinalysis, complete blood count, and urine and/or blood osmolality.

For example, tissue oxygenation can be a contextual clue as it is widely recognized that tissue oxygenation plays a role in nearly all stages of wound healing. During healing, the surgical site expresses an increased need for bacterial defense, cell proliferation, collagen synthesis, and angiogenesis, among other repair functions. Collagen accumulation is a linear function of oxygen partial pressure, and levels below 20 mmHg have been shown to inhibit accumulation. Collagen synthesis is dependent on enzymatic function and, consequently, is a function of local oxygen levels. In contrast, hyperbaric oxygen therapy has been shown to improve healing speed by increasing oxygen levels above normal. Tumor tissue is metabolically engineered to grow under conditions of hypoxia, but wound hypoxia, caused primarily by vascular restriction, is associated with synchronous conditions such as infection, pain, anxiety and hyperthermia. ) leading to poor healing results. This is a tertiary effect as an amplification of the healing complication effect. Tissue oxygenation is measured according to oxygen delivery (DO2), oxygen uptake/consumption (VO2), oxygen tension (PO2), or hemoglobin oxygen saturation (SO2). can be In addition, several other techniques are available for measuring tissue oxygenation, such as near infrared spectroscopy (NIR).

Procedure-Specific Contextual Cues Procedure-specific contextual cues include the date and time of the procedure performed, whether it was an emergency vs. planned surgery, the length of the procedure, the type of procedure (e.g., laparoscopic, robotic, or open), and It may include whether it is a revision surgery or a first treatment.

Surgeon-Specific Contextual Cues Surgeon-specific contextual cues include whether the surgeon was a specialist or general practitioner (this comparison is made to the procedure to be performed) and the skill level of the surgeon (e.g., the procedure performed). the total number of surgeries performed, the total number of times the current surgery was performed, and/or training level), and the concentration or physical strength of the surgeon (e.g., the number of other procedures performed that day and the duration of the current procedure). may be shown) may be mentioned.

Metadata and Data Management In various aspects, metadata (eg, the contextual cues described above) may be included with general data generation.

In one aspect, metadata may be stored by appending metadata to primary data with the ability to filter data from the metadata. In another aspect, metadata may be stored elsewhere than the primary data, but may be linked to allow reaching metadata for important metadata.

Metadata accessibility can be controlled in a variety of different ways. In one aspect, the linked metadata may be transferred along with the original collected data. In another aspect, data may be extracted from metadata by filtering the data and associated context.

Knowledge Hierarchy In various aspects, contextual cues may be organized to provide data based on the required context. Accordingly, the computer system can be configured to identify or determine the relevance of particular metadata to provide context. Additionally, the computer system can be programmed to provide navigation through metadata.

Utilization Methodology In one aspect, metadata may be utilized for (i) identifying and linking isolated but interrelated data points or records, (ii) identifying linked occurrences, and/or (iii) ) algorithms automatically compare outcomes (and illnesses) to any/all recorded data, and automatically compare regression trends and predictive model performance to determine which factors may affect success. can be programmed to determine This data may be limited to a single device (e.g., rate of fire or energy vs. leakage), or firing time versus trocar placement or initiation of anesthesia (start of surgery), or number of scissor/dissector/energy device activations. (e.g. degree of fat incision/removal).

Various aspects of the subject matter described herein are illustrated in the following numbered examples.
Example 1 - A system for adjusting parameters of a medical device in the specific context of a patient on which the medical device is to be used, the system being communicatively coupled to a medical hub and to the medical hub. A system comprising: a medical device; The medical hub accesses a first context data set representing a first situation associated with a particular context in which the medical device is to be used on the patient and the medical device is to be used on the patient. accessing a second context data set representing a second situation associated with a particular context; Ordering the second context data set in a priority hierarchy and determining that at least a first portion of the first context data set is associated with adjusting a parameter of the medical device. , determining that at least a second portion of the second context data set is related to adjusting a parameter of the medical device; , resolving with respect to adjusting the parameters, and programming the medical device by adjusting the parameters of the medical device according to the resolved discrepancies. The medical device utilizes the adjusted parameters such that the performance of the medical device to the patient in a particular context is more effective with the adjusted parameters than without the adjusted parameters. configured for use on a patient;

Example 2 - Resolving discrepancies between the first part and the second part is determining that the first part conflicts with the second part with respect to adjusting parameters and adjusting the parameter according to the first portion only.

Example 3 - Resolving Discrepancies Between First Part and Second Part Determining that First Part Conflicts with Second Part Regarding Adjusting Parameters and determining that an exception in the first context data set indicates that the parameter follows the second context data set; and adjusting the parameter according to the second portion only. 1. The system according to 1.

Example 4 - Resolving the difference between the first part and the second part includes determining that the first part can be altered by the second part in terms of adjusting parameters , adjusting the parameters according to the first portion and the second portion.

Example 5 - Any of Examples 1-4, wherein the first or second context data set is derived from the patient's medical data, updated settings of the medical device, or information regarding the patient's condition requiring treatment. or the system according to one.

Example 6 - One of the first and second context data sets is derived from non-instrument-specific contextual cues relating to the operation of any instrument, but not specific to any particular type of instrument; 5. The system of any one of Examples 1-4, wherein the other of the first and second context data sets is derived from instrument-specific contextual cues regarding a particular operation of the medical instrument.

Example 7 - The first or second contextual data set is derived from medical contextual cues associated with medical complications known to occur in the specific context in which the medical device is used on the patient, The system of any one of Examples 1-4.

Example 8 - Patient physiology, wherein the first or second contextual data sets include time since the patient's most recent meal, fasting blood glucose levels, blood pressure, macro-tissue tension, tissue fluid levels, and tissue oxygenation The system of any one of Examples 1-4, wherein the system is derived from a physical cue.

Example 9 - The specific context includes a medical device-assisted medical procedure, and the first or second context data set includes the time when the medical procedure is expected to occur, whether the medical procedure is urgent or planned. procedure-specific contextual cues, including an indication of whether it was a surgical procedure, duration of the medical procedure, type of medical procedure, and an indication of whether the medical procedure is a re-operation or a first procedure; The system of any one of Examples 1-8.

Example 10 - The first or second context data set indicates whether the surgeon using the medical device on the patient is a specialist or a general practitioner, the skill level of the surgeon, what has already been performed by the surgeon on that day 9. The system of any one of Examples 1-4 or 8, wherein the system is derived from surgeon-specific contextual cues, including number of procedures and expected duration of medical procedures.

Example 11 - A method of a system for adjusting parameters of a medical device in a particular context of a patient on which the medical device is to be used, the system enabling communication with the medical device and the medical device and a medical hub coupled thereto. The method includes accessing, by the medical hub, a first context data set representing a first context associated with a particular context in which the medical device is to be used on a patient; and accessing a second context data set representing a second context associated with a particular context to be used in the medical hub to ensure that the first context data set is more relevant than the second context data set. Arranging the first and second context data sets in a priority hierarchy to have higher priority; and determining, by the medical hub, that at least a second portion of the second context data set is associated with adjusting a parameter of the medical device resolving, by the medical hub, the discrepancy between the first portion and the second portion in relation to adjusting the parameters; and programming the medical device by adjusting the parameters. The medical device utilizes the adjusted parameters such that the performance of the medical device to the patient in a particular context is more effective with the adjusted parameters than without the adjusted parameters. configured for use on a patient;

Example 12 - Resolving Discrepancies Between First Part and Second Part Determining that First Part Conflicts with Second Part Regarding Adjusting Parameters and adjusting the parameter according to the first portion only.

Example 13 - Resolving Discrepancies Between First Part and Second Part Determining that First Part Conflicts with Second Part Regarding Adjusting Parameters and determining that an exception in the first context data set indicates that the parameter follows the second context data set; and adjusting the parameter according to the second portion only. 11. The method according to 11.

Example 14 - Resolving the difference between the first part and the second part includes determining that the first part can be altered by the second part with respect to adjusting parameters , adjusting the parameters according to the first portion and the second portion.

Example 15 - Any of Examples 11-14, wherein the first or second context data set is derived from the patient's medical data, updated settings of the medical device, or information regarding the patient's condition requiring treatment or the method of claim 1.

Example 16 - One of the first and second context data sets is derived from non-instrument specific contextual cues relating to the operation of any instrument but not specific to any particular type of instrument; 15. The method of any one of Examples 11-14, wherein the other of the first and second context data sets is derived from instrument-specific contextual cues regarding a particular operation of the medical instrument.

Example 17 - The first or second contextual data set is derived from medical contextual cues associated with medical complications known to occur in the specific context in which the medical device is used on the patient, The method of any one of Examples 11-14.

Example 18 - Patient physiology, wherein the first or second contextual data sets include time since the patient's last meal, fasting blood glucose levels, blood pressure, macro-tissue tension, tissue fluid levels, and tissue oxygenation 15. The method of any one of Examples 11-14, wherein the method is derived from a physical cue.

Example 19 - The particular context includes a medical device-assisted medical procedure, and the first or second context data set includes the time when the medical procedure is expected to occur, the medical procedure is urgent, or is planned. procedure-specific contextual cues, including an indication of whether it was a surgical procedure, the duration of the medical procedure, the type of medical procedure, and an indication of whether the medical procedure is a re-operation or a first procedure; The method of any one of Examples 11-18.

Example 20 - A computer readable medium having no transient signals and containing instructions, the instructions, when executed by a processor, causing the processor to perform actions. The actions include accessing a first context data set representing a first situation associated with a particular context in which the medical device is to be used on the patient; accessing a second context data set representing a second context associated with the context of the first and first context data sets, such that the first context data set has a higher priority than the second context data set; ordering the two context data sets in a priority hierarchy; determining that at least a first portion of the first context data set is associated with adjusting a parameter of the medical device; determining that at least a second portion of the second context data set is related to adjusting a parameter of the medical device; determining the difference between the first portion and the second portion; resolving in relation to adjusting the parameters; and programming the medical device by adjusting the parameters of the medical device according to the resolved differences. The medical device utilizes the adjusted parameters such that the performance of the medical device to the patient in a particular context is more effective with the adjusted parameters than without the adjusted parameters. configured for use with a patient;

While several forms have been illustrated and described, it is not the intention of the applicant to limit or limit the scope of the appended claims to such recitations. Numerous modifications, variations, changes, permutations, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of this disclosure. Further, the structure of each element associated with the described form can be alternatively described as a means for providing the function performed by that element. Also, although materials are disclosed for particular components, other materials may be used. Accordingly, the above description and appended claims are intended to cover all such modifications, combinations, and variations as included within the scope of the disclosed forms. Please understand. The appended claims are intended to cover all such modifications, variations, variations, substitutions, modifications and equivalents.

The foregoing detailed description has set forth various aspects of apparatus and/or processes through block diagrams, flowcharts, and/or examples. To the extent such block diagrams, flowcharts, and/or embodiments include one or more functions and/or operations, it should be understood by those skilled in the art that such block diagrams, flowcharts, and/or examples Each function and/or operation included in the embodiments may be implemented individually and/or collectively by various hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will appreciate that all or part of some aspects of the forms disclosed herein can be implemented as one or more computer programs running on one or more computers ( as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or substantially any combination thereof, and can be equivalently implemented on an integrated circuit; , designing circuits, and/or writing software and/or firmware code are within the skill of one of ordinary skill in the art in view of the present disclosure. Additionally, the mechanisms of the subject matter described herein may be distributed in a variety of forms as one or more program products, an illustrative form of the subject matter described herein being apply regardless of the particular type of signal-bearing medium used to actually effect the distribution.

Instructions used to program logic to implement various disclosed aspects may be stored in system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage devices. . Further, the instructions may be distributed over a network or by other computer-readable media. Thus, a machine-readable medium can include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), including floppy diskettes, optical discs, compact discs, read-only memories (CDs), -ROM), as well as magneto-optical disks, read-only memory (ROM), random-access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, Any tangible, machine-readable material used to transmit information over the Internet via flash memory or electrical, optical, acoustic, or other form of propagated signal (e.g., carrier wave, infrared signal, digital signal, etc.) It is not limited to storage devices. Accordingly, non-transitory computer-readable media include any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (eg, a computer).

As used in any aspect herein, the term "control circuitry" includes, for example, hardwired circuits, programmable circuits (e.g., computer processors including one or more individual instruction processing cores, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic array (PLA), or field programmable gate array (FPGA)), state It can refer to a machine circuit, firmware storing instructions to be executed by a programmable circuit, and any combination thereof. Control circuits, collectively or individually, may be, for example, integrated circuits (ICs), application-specific integrated circuits (ASICs), system-on-chips (SoCs), desktop computers, laptop computers. , tablet computers, servers, smart phones, etc., as circuits forming part of a larger system. Thus, as used herein, the term “control circuit” includes an electrical circuit having at least one discrete electrical circuit, an electrical circuit having at least one integrated circuit, an electrical circuit having at least one application specific integrated circuit, A circuit, a general-purpose computing device configured with a computer program (e.g., a general-purpose computer configured with a computer program that executes, at least in part, a process and/or apparatus described herein, or a process described herein) and/or a microprocessor configured by a computer program that at least partially executes the device), an electrical circuit forming a memory device (e.g., in the form of a random access memory), and/or a communication device ( Examples include, but are not limited to, electrical circuits forming modems, communications switches, or opto-electrical devices). Those skilled in the art will recognize that the subject matter described herein may be implemented in analog or digital form, or some combination thereof.

As used in any aspect herein, the term "logic" may refer to applications, software, firmware, and/or circuitry configured to perform any of the operations described above. Software may be embodied as software packages, code, instructions, instruction sets, and/or data recorded on a non-transitory computer-readable storage medium. Firmware may be embodied as code, instructions, or sets of instructions in a memory device and/or hard-coded (eg, non-volatile) data.

As used in any aspect of this specification, the terms “component,” “system,” “module,” etc. refer to either hardware, a combination of hardware and software, software, or software in execution. can refer to a computer-related entity that is

As used in any aspect herein, "algorithm" refers to a self-consistent sequence of steps leading to a desired result; Refers to the comparison and manipulation of physical quantities and/or logical states, which may take the form of electrical or magnetic signals capable of being otherwise manipulated. It is common practice to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.

A network may include a packet-switched network. The communication devices can communicate with each other using a selected packet-switched network communication protocol. One exemplary communication protocol may include the Ethernet communication protocol, which may enable communication using Transmission Control Protocol/Internet Protocol (TCP/IP). The Ethernet protocol conforms to or is compatible with the Ethernet standard entitled "IEEE 802.3 Standard" published December 2008 by the Institute of Electrical and Electronics Engineers (IEEE) and/or later versions of this standard. possible. Alternatively or additionally, the communication device may V.25 communication protocol can be used to communicate with each other. X. The V.25 communication protocol may conform to or be compatible with standards promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices can communicate with each other using a frame relay communication protocol. The frame relay communication protocol may conform to or be compatible with standards promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be able to communicate with each other using the Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard published in August 2001 by the ATM Forum under the title "ATM-MPLS Network Interworking 2.0" and/or later versions of this standard. . Of course, different and/or later developed connection-oriented network communication protocols are equally contemplated herein.

Unless expressly specified otherwise, terms such as "process", "calculate", "compute", "determine", "display", etc. are used throughout the foregoing disclosure as is apparent from the foregoing disclosure. Discussion using the term may refer to data represented as physical (electronic) quantities in computer system registers and memory as physical quantities in computer system memory or registers or in any such information storage, transmission, or display device. It will be understood to refer to the operations and processes of a computer system or similar electronic computing device that manipulates and transforms data into other data that may similarly be represented as .

As used herein, one or more components are “configured to,” “configurable to,” “operable/to operable/operative to, adapted/adaptable, capable to, conformable/conformed to)”, etc. Those skilled in the art will understand that "configured to" generally refers to active components and/or inactive components and/or standby configurations, unless the context requires otherwise. It will be understood that it may contain elements.

The terms "proximal" and "distal" are used herein with reference to the clinician manipulating the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion located farther from the clinician. It will further be appreciated that for convenience and clarity, spatial terms such as "vertical," "horizontal," "above," and "below" may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Those skilled in the art will appreciate that the terms used herein generally, and particularly in the appended claims (e.g., the appended claim text), are generally intended as "open" terms. (e.g., the term "including" is to be interpreted as "including but not limited to"; the term "having" is to be interpreted as "including but not limited to"); should be interpreted as "having at least" and the term "includes" "includes but is not limited to" etc.). Moreover, where a particular number is intended in an introduced claim recitation, such intent is clearly set forth in the claim; will be understood by those skilled in the art. For example, as an aid to understanding, the appended claims that follow use the introductory phrases "at least one" and "one or more" to refer to May be included to introduce description. However, use of such phrases may be used to refer to "one or more" or "at least one" even within the same claim when introducing claim recitations by the indefinite article "a" or "an". and the indefinite article "a" or "an", any particular claim containing such an introduced claim recitation shall be subject to claims containing only one such recitation. should not be construed as to imply a limitation in scope (e.g., "a" and/or "an" generally mean "at least one" or "one or more should be construed as ). the same holds true where the definite article is used to introduce claim recitations.

In addition, even if a specific number is specified in an introduced claim statement, such statement should typically be construed to mean at least the stated number. but will be recognized by those skilled in the art (e.g., where there is a statement simply "two statements" without other modifiers, generally there are at least two statements, or two or three (meaning one or more entries). Further, where notations like "at least one of A, B, and C, etc." are used, such syntax is generally intended in the sense that a person skilled in the art would understand the notation ( For example, "a system having at least one of A, B, and C" includes, but is not limited to, A only, B only, C only, both A and B, both A and C, B and C, and/or all of A and B and C, etc.). Where notations like "at least one of A, B, or C, etc." are used, such syntax is generally intended in the sense that one skilled in the art would understand the notation (e.g., A "system having at least one of A, B, or C" includes, but is not limited to, A only, B only, C only, both A and B, both A and C, B and C and/or all of A and B and C, etc.). Moreover, typically any disjunctive word and/or phrase expressing two or more alternative terms is used in the specification unless the context requires otherwise. It is understood to be intended to include one of the terms, either of the terms, or both terms, whether in the claims, or in the drawings. Those skilled in the art will understand that should be done. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B."

With regard to the appended claims, those skilled in the art will understand that the operations recited herein can generally be performed in any order. Additionally, while the flow diagrams of various acts are depicted in sequence(s), it is understood that the various acts may be performed in an order other than that illustrated, or may be performed simultaneously. It should be. Examples of such alternative orderings include overlapping, interleaving, interrupting, reordering, incremental, preliminary, additional, simultaneous, reverse, or other different orderings, unless the context requires otherwise. may include Further, terms such as "response to", "related to", or other past tense adjectives generally exclude such variations unless the context dictates otherwise. not intended.

Any reference to "an aspect", "an aspect", "exemplary", "an example", etc., includes in at least one aspect the particular function, structure, or property described in connection with that aspect. It is worth noting that it means Thus, the phrases "in one aspect," "in an aspect," "in an example," and "in an example" appearing in various places throughout this specification do not necessarily all refer to the same aspect. . Moreover, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.

Any patent applications, patents, non-patent publications, or other disclosure material referenced herein and/or listed in any application data sheet is, to the extent the material incorporated herein, is not inconsistent with this specification. , incorporated herein by reference. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting statements incorporated herein by reference. Any content, or portion thereof, that is inconsistent with the current definitions, opinions, or other disclosures set forth herein, is hereby incorporated by reference, but the reference content and the current disclosure are hereby incorporated by reference. References shall be made only to the extent that there is no inconsistency between

In summary, a number of benefits have been described that result from using the concepts described herein. The foregoing description of one or more aspects has been presented for the purposes of illustration and description. It is not intended to be exhaustive or to be limited to the precise forms disclosed. Modifications or variations are possible in light of the above teachings. One or more embodiments illustrate principles and practical applications, thereby making the various forms, with various modifications, available to those skilled in the art as suitable for the particular use envisioned. It is selected and described for the purpose. It is intended that the claims presented herewith define the overall scope.

[Mode of implementation]
(1) A system for adjusting parameters of a medical device in the specific context of the patient in which the medical device is to be used, the system comprising:
a medical hub,
the medical device communicatively coupled to the medical hub;
the medical hub,
accessing a first context data set representing a first situation associated with the particular context in which the medical device is to be used on the patient;
accessing a second context data set representing a second situation associated with the particular context in which the medical device is to be used on the patient;
ordering the first and second context data sets in a priority hierarchy such that the first context data set has a higher priority than the second context data set;
determining that at least a first portion of the first context data set is associated with adjusting the parameter of the medical device;
determining that at least a second portion of the second context data set is associated with adjusting the parameter of the medical device;
Resolving discrepancies between the first portion and the second portion in relation to adjusting the parameter;
programming the medical device by adjusting the parameters of the medical device according to the resolved difference;
The medical device performs the adjustments such that performance of the medical device for the patient in the particular context is more effective with the adjusted parameters than without the adjusted parameters. A system configured to be used with said patient using the parameters determined.
(2) resolving said discrepancy between said first portion and said second portion comprises:
determining that the first portion conflicts with the second portion for adjusting the parameter;
3. The system of embodiment 1, comprising adjusting the parameter according to the first portion only.
(3) resolving said discrepancy between said first portion and said second portion comprises:
determining that the first portion conflicts with the second portion for adjusting the parameter;
determining that exceptions in the first context data set indicate compliance with the second context data set with respect to the parameter;
3. The system of embodiment 1, comprising adjusting the parameter according to the second portion only.
(4) resolving said discrepancy between said first portion and said second portion comprises:
determining that the first portion can be modified by the second portion for adjusting the parameter;
3. The system of embodiment 1, comprising adjusting the parameter according to the first portion and the second portion.
Embodiment 1, wherein said first or said second context data set is derived from said patient's medical data, updated settings of said medical device, or information regarding a condition of said patient requiring treatment. The system described in .

(6) one of said first and said second context data sets is derived from non-instrument specific contextual cues relating to the operation of any instrument but not specific to any particular type of instrument; 2. The system of embodiment 1, wherein the other of the first and second context data sets is derived from instrument-specific contextual cues regarding a particular operation of the medical instrument.
(7) medical contextual cues in which the first or second contextual data set is associated with a medical complication known to occur in the specific context in which the medical device is used on the patient; 2. The system of embodiment 1, wherein the system is derived from
(8) said first or said second context data set comprises time since last meal of said patient, fasting blood glucose level, blood pressure, macro-tissue tension, tissue fluid level, and tissue oxygenation; 2. The system of embodiment 1, wherein the system is derived from the patient's physiological cues.
(9) the specific context includes a medical procedure assisted by the medical device, and the first or second context data set includes a time when the medical procedure is expected to occur, a time when the medical procedure is urgent; procedure-specific, including an indication of whether it is a surgical or planned surgery, the duration of the medical procedure, the type of medical procedure, and an indication of whether the medical procedure is a reoperation or a first procedure; Embodiment 1. The system of embodiment 1, derived from contextual cues.
(10) the first or second context data set includes an indication of whether the surgeon using the medical device on the patient is a specialist or a general practitioner; the skill level of the surgeon; 2. The system of embodiment 1, derived from surgeon-specific contextual cues including the number of procedures already performed by and the expected duration of medical procedures.

(11) A method of a system for adjusting parameters of said medical device in the specific context of said patient in which said medical device is to be used on said patient, said system comprising: said medical device; a medical hub communicatively coupled to the method, the method comprising:
accessing, by the medical hub, a first context data set representing a first context associated with the particular context in which the medical device is to be used on the patient;
accessing, by the medical hub, a second context data set representing a second context associated with the particular context in which the medical device is to be used on the patient;
ordering, by the medical hub, the first and second context data sets in a priority hierarchy such that the first context data set has a higher priority than the second context data set; ,
determining, by the medical hub, that at least a first portion of the first context data set is related to adjusting the parameter of the medical device;
determining, by the medical hub, that at least a second portion of the second context data set is related to adjusting the parameter of the medical device;
resolving, by the medical hub, differences between the first portion and the second portion in relation to adjusting the parameter;
programming the medical device by adjusting the parameters of the medical device according to the resolved discrepancies by the medical hub;
The medical device performs the adjustments such that performance of the medical device for the patient in the particular context is more effective with the adjusted parameters than without the adjusted parameters. A method configured to be used on said patient using the parameters obtained.
(12) resolving the difference between the first portion and the second portion comprises:
determining that the first portion conflicts with the second portion for adjusting the parameter;
12. The method of embodiment 11, comprising adjusting the parameter according to the first portion only.
(13) resolving said discrepancy between said first portion and said second portion comprises:
determining that the first portion conflicts with the second portion for adjusting the parameter;
determining that exceptions in the first context data set indicate compliance with the second context data set with respect to the parameter;
12. The method of embodiment 11, comprising adjusting the parameter according to the second portion only.
(14) resolving said discrepancy between said first portion and said second portion comprises:
determining that the first portion can be modified by the second portion for adjusting the parameter;
12. The method of embodiment 11, comprising adjusting the parameter according to the first portion and the second portion.
15. Embodiment 11, wherein said first or said second context data set is derived from said patient's medical data, updated settings of said medical device, or information regarding a condition of said patient requiring treatment. The method described in .

(16) one of the first and second context data sets is derived from non-instrument specific contextual cues relating to the operation of any instrument but not specific to any particular type of instrument; 12. The method of embodiment 11, wherein the other of the first and second context data sets is derived from instrument-specific contextual cues regarding a particular operation of the medical instrument.
(17) medical contextual cues in which the first or second contextual data set is associated with a medical complication known to occur in the specific context in which the medical device is used on the patient; 12. The method of embodiment 11, wherein the method is derived from
(18) said first or said second context data set comprises time since last meal of said patient, fasting blood glucose level, blood pressure, macro-tissue tension, tissue fluid level, and tissue oxygenation; 12. The method of embodiment 11, wherein the method is derived from the patient's physiological cues.
(19) the specific context includes a medical procedure assisted by the medical device, and the first or second context data set includes a time at which the medical procedure is expected to occur, a time at which the medical procedure is urgent; procedure-specific, including an indication of whether it is a surgical or planned surgery, the duration of the medical procedure, the type of medical procedure, and an indication of whether the medical procedure is a reoperation or a first procedure; 12. The method of embodiment 11, derived from contextual cues.
(20) A computer-readable medium having no transient signals and containing instructions which, when executed by a processor, cause the processor to:
accessing a first context data set representing a first situation associated with a particular context in which the medical device is to be used on a patient;
accessing a second context data set representing a second situation associated with the particular context in which the medical device is to be used on the patient;
ordering the first and second context data sets in a priority hierarchy such that the first context data set has a higher priority than the second context data set;
determining that at least a first portion of the first context data set is associated with adjusting a parameter of the medical device;
determining that at least a second portion of the second context data set is associated with adjusting the parameter of the medical device;
resolving discrepancies between the first portion and the second portion in relation to adjusting the parameter;
programming the medical device by adjusting the parameters of the medical device according to the resolved differences;
The medical device performs the adjustments such that performance of the medical device for the patient in the particular context is more effective with the adjusted parameters than without the adjusted parameters. A computer readable medium configured for use with the patient using the parameters determined.

Claims (12)

A system for adjusting instrument control parameters of a medical instrument in the specific context of the patient in which the medical instrument is to be used, the system comprising:
a medical hub,
the medical device communicatively coupled to the medical hub;
the medical hub,
accessing a first context data set representing a first situation associated with the particular context in which the medical device is to be used on the patient;
accessing a second context data set representing a second situation associated with the particular context in which the medical device is to be used on the patient;
ordering the first and second context data sets in a priority hierarchy such that the first context data set has a higher priority than the second context data set;
determining that at least a first portion of the first context data set is associated with adjusting the instrument control parameter of the medical instrument;
determining that at least a second portion of the second context data set is associated with adjusting the device control parameter of the medical device;
resolving discrepancies between the first portion and the second portion in relation to adjusting the instrument control parameters;
programming the medical device by adjusting the device control parameters of the medical device according to the resolved difference;
wherein the medical device is configured for use with the patient utilizing the adjusted device control parameters ;
wherein the first or second context data set is derived from the patient's medical data, updated settings of the medical device, or information about the patient's condition requiring treatment;
The system, wherein resolving the discrepancy between the first portion and the second portion includes one of 1) to 3) below.
1) determining that the first portion conflicts with the second portion for adjusting the instrument control parameter;
Adjusting the instrument control parameter according to the first portion only.
2) determining that the first portion conflicts with the second portion for adjusting the instrument control parameter;
determining that exceptions in the first context data set indicate compliance with the second context data set with respect to the appliance control parameters;
Adjusting the instrument control parameter according to the second portion only.
3) determining that the contributions of the first portion and the second portion can be combined to provide a combined adjustment, the combination weighting in favor of the first portion; being done . one of the first and second context data sets is derived from non-instrument-specific contextual cues relating to operation of any instrument but not specific to any particular type of instrument; 2. The system of claim 1, wherein the other of the second set of context data and the second set of context data is derived from instrument-specific contextual cues regarding a particular operation of the medical instrument. The first or second context data set is derived from medical contextual cues associated with medical complications known to occur in the particular context in which the medical device is used on the patient. , the system of claim 1. Physiology of the patient, wherein the first or second contextual datasets include time since the patient's last meal, fasting blood glucose levels, blood pressure, macrotissue tension, tissue fluid levels, and tissue oxygenation. 2. The system of claim 1, wherein the system is derived from a physical cue. The specific context includes a medical procedure assisted by the medical device, and the first or second context data set includes a time when the medical procedure is expected to occur, whether the medical procedure is urgent, or procedure-specific contextual cues, including an indication of whether it is a planned surgery, the duration of said medical procedure, the type of medical procedure, and an indication of whether said medical procedure is a re-operation or a first procedure; 2. The system of claim 1, derived from. The first or the second context data set includes an indication to the patient whether the surgeon using the medical device is a specialist or a general practitioner, the skill level of the surgeon, already performed by the surgeon on that day. 2. The system of claim 1, derived from surgeon-specific contextual cues including number of procedures performed and expected duration of medical procedures. A method of a system for adjusting device control parameters of said medical device in a particular context of said patient in which said medical device is to be used with said patient, said system comprising: a medical hub communicatively coupled, the method comprising:
accessing, by the medical hub, a first context data set representing a first context associated with the particular context in which the medical device is to be used on the patient;
accessing, by the medical hub, a second context data set representing a second context associated with the particular context in which the medical device is to be used on the patient;
ordering, by the medical hub, the first and second context data sets in a priority hierarchy such that the first context data set has a higher priority than the second context data set; ,
determining, by the medical hub, that at least a first portion of the first context data set is associated with adjusting the device control parameter of the medical device;
determining, by the medical hub, that at least a second portion of the second context data set is associated with adjusting the device control parameter of the medical device;
resolving, by the medical hub, differences between the first portion and the second portion in connection with adjusting the instrument control parameters;
programming the medical device by adjusting the device control parameters of the medical device according to the resolved discrepancies by the medical hub;
wherein the medical device is configured for use with the patient utilizing the adjusted device control parameters ;
wherein the first or second context data set is derived from the patient's medical data, updated settings of the medical device, or information about the patient's condition requiring treatment;
A method, wherein resolving the discrepancy between the first portion and the second portion includes one of 1) to 3) below.
1) determining that the first portion conflicts with the second portion for adjusting the instrument control parameter;
Adjusting the instrument control parameter according to the first portion only.
2) determining that the first portion conflicts with the second portion for adjusting the instrument control parameter;
determining that exceptions in the first context data set indicate compliance with the second context data set with respect to the appliance control parameters;
Adjusting said instrument control parameter according to said second portion only.
3) determining that the contributions of the first portion and the second portion can be combined to provide a combined adjustment, the combination weighting in favor of the first portion; being done . one of the first and second context data sets is derived from non-instrument-specific contextual cues relating to operation of any instrument but not specific to any particular type of instrument; 8. The method of claim 7 , wherein the other of the and the second context data set is derived from instrument-specific contextual cues regarding a particular operation of the medical instrument. The first or second context data set is derived from medical contextual cues associated with medical complications known to occur in the particular context in which the medical device is used on the patient. 8. The method of claim 7 . Physiology of the patient, wherein the first or second contextual datasets include time since the patient's last meal, fasting blood glucose levels, blood pressure, macrotissue tension, tissue fluid levels, and tissue oxygenation. 8. The method of claim 7 , wherein the method is derived from a psychological cue. wherein the particular context includes a medical procedure assisted by the medical device, and the first or second context data set includes a time when the medical procedure is expected to occur, whether the medical procedure is urgent, or procedure-specific contextual cues, including an indication of whether it is a planned surgery, the duration of said medical procedure, the type of medical procedure, and an indication of whether said medical procedure is a re-operation or a first procedure; 8. The method of claim 7 , wherein the method is derived from A computer readable medium having no transient signals and containing instructions which, when executed by a processor, cause the processor to:
accessing a first context data set representing a first situation associated with a particular context in which the medical device is to be used on a patient;
accessing a second context data set representing a second situation associated with the particular context in which the medical device is to be used on the patient;
ordering the first and second context data sets in a priority hierarchy such that the first context data set has a higher priority than the second context data set;
determining that at least a first portion of the first context data set is associated with adjusting an instrument control parameter of the medical instrument;
determining that at least a second portion of the second context data set is associated with adjusting the device control parameter of the medical device;
resolving discrepancies between the first portion and the second portion in relation to adjusting the instrument control parameters;
programming the medical device by adjusting the device control parameters of the medical device according to the resolved difference;
wherein the medical device is configured for use with the patient utilizing the adjusted device control parameters ;
wherein the first or second context data set is derived from the patient's medical data, updated settings of the medical device, or information about the patient's condition requiring treatment;
A computer readable medium wherein resolving the discrepancy between the first portion and the second portion includes one of 1) to 3) below.
1) determining that the first portion conflicts with the second portion for adjusting the instrument control parameter;
Adjusting the instrument control parameter according to the first portion only.
2) determining that the first portion conflicts with the second portion for adjusting the instrument control parameter;
determining that exceptions in the first context data set indicate compliance with the second context data set with respect to the appliance control parameters;
Adjusting the instrument control parameter according to the second portion only.
3) determining that the contributions of the first portion and the second portion can be combined to provide a combined adjustment, the combination weighting in favor of the first portion; being done .

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