# US 10,368,854 B2 · Methods and devices to decrease tissue trauma during surgery

> Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt

- Number: US 10,368,854 B2
- Document ID: US10368854B2
- Status: Granted
- Kind: B2
- Application number: 15/495,248
- Filed: 2017-04-24
- Published: 2018-02-08
- Granted: 2019-08-06
- Earliest claimed: 2009-04-13
- Assignees: Physcient, Inc.
- Applicants: Physcient, Inc.
- Inventors: Charles Anthony Pell; Hugh Charles Crenshaw
- Web page: https://patentgrep.com/patent/US10368854B2

## CPC

- A61B 17/0218: {for minimally invasive surgery (A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence)}
- A61B 5/0051: {by applying vibrations}
- A61B 5/442: {Evaluating skin mechanical properties, e.g. elasticity, hardness, texture, wrinkle assessment}
- A61B 5/7239: {using differentiation including higher order derivatives}
- A61B 7/00: Instruments for auscultation
- A61B 17/02: for holding wounds open, e.g. retractors; Tractors
- A61B 17/0206: {with antagonistic arms as supports for retractor elements}
- A61B 17/025: {Joint distractors}
- A61B 17/0293: {with ring member to support retractor elements}
- A61B 17/12136: {Balloons}
- A61B 90/03: {Automatic limiting or abutting means, e.g. for safety}
- A61M 25/104: {used for angioplasty}
- A61B 2017/00022: {Sensing or detecting at the treatment site}
- A61B 2017/00172: {Pulse trains, bursts, intermittent continuous operation}
- A61B 2017/00181: {Means for setting or varying the pulse energy}
- A61B 2017/00314: {Separate linked members}
- A61B 2017/00323: {Cables or rods}
- A61B 2017/00398: {using powered actuators, e.g. stepper motors, solenoids}
- A61B 2017/00539: {hydraulically}
- A61B 2017/00544: {pneumatically}
- A61B 2017/00557: {inflatable (A61B2017/22051 takes precedence)}
- A61B 2017/00734: {battery operated}
- A61B 2017/0225: {flexible, e.g. fabrics, meshes, or membranes}
- A61B 2017/0256: {for the spine}
- A61B 2017/0262: {with a provision for protecting nerves}
- A61B 2090/064: {for measuring force, pressure or mechanical tension}
- A61B 2090/065: {for measuring contact or contact pressure}
- A61B 2090/0809: {Indication of cracks or breakages}
- A61B 2562/0219: Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- A61M: DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY (introducing media into or onto the bodies of animals A61D7/00; means for inserting tampons A61F13/26; devices for administering food or medicines orally A61J; containers for collecting, storing or administering blood or medical fluids A61J1/05); DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY (surgery A61B; chemical aspects of surgical articles A61L); DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR {(Electrotherapy, e.g. producing anaesthesia by the use of alternating or intermittent currents A61N1/36021)}

## Abstract

Methods and devices are disclosed to reduce tissue trauma when a physician retracts a patient's tissues for surgery. A device includes a tissue engager adapted to engage a patient's tissue, a control system adapted to control the tissue engager to deform the patient's tissue, and a sensor adapted to produce a first signal based on the deformation. The control system is further adapted to receive the first signal, perform a plurality of measurements based on the first signal over time; and compare a substantially instantaneous measurement of the first signal to a variance in the plurality of measurements over an interval of time preceding the instantaneous measurement, and detect a state of the patient's tissue based on the comparison.

## Claims

### Claim 1

An automated control device for assisting a surgeon performing a procedure in which a patient's tissue is being deformed, comprising:
at least one tissue engager adapted to engage a patient's tissue;
a sensor configured to produce a first signal based on the deformation of the patient's tissue; and
an automated control system configured to adjust input from all the surgeon during the procedure based on a state of the patient's tissue during the procedure and to control the at least one tissue engager to deform the patient's tissue based on the first signal received from the sensor,
wherein the automated control system comprises a processor containing software instructions that, when executed by the processor, cause the automated control system to:
receive the first signal from the sensor during the procedure:
perform a plurality of measurements during the procedure based on the first signal over time:
calculate a variance in the plurality of measurements over an interval of time preceding an instantaneous measurement of the first signal, wherein the variance is a statistical distribution of amplitude of the plurality of measurements during the interval of time preceding the instantaneous measurement of the first signal;
compare the instantaneous measurement of the first signal to the calculated variance in the plurality of measurements over the interval of time preceding the instantaneous measurement;
detect the state of the patient's tissue based on the comparison; and
adjust, at least in part, a motion of the at least one tissue engager based on the detected state of the patient's tissue based on the comparison.

### Claim 2 (depends on 1)

The automated control device of claim 1, wherein the processor containing software instructions that, when executed by the processor, cause the automated control system to predict a trauma to the patient's tissue based on the detected state.

### Claim 3 (depends on 1)

The automated control device of claim 1, wherein the first signal comprises a force of deformation of the patient's tissue.

### Claim 4 (depends on 1)

The automated control device of claim 1, wherein the plurality of measurements are comprised of a plurality of first time derivatives of the first signal.

### Claim 5 (depends on 1)

The automated control device of claim 1, wherein the plurality of measurements are comprised of second time derivatives of the first signal.

### Claim 6 (depends on 1)

The automated control device of claim 1, wherein the at least one tissue engager is configured to oscillate the patient's tissue.

### Claim 7 (depends on 1)

The automated control device of claim 1, wherein the variance is comprised of a root-mean-square of the plurality of measurements.

### Claim 8 (depends on 1)

The automated control device of claim 1, wherein the processor containing software instructions that, when executed by the processor, cause the automated control system to:
compare a ratio between the variance in the plurality of measurements and the instantaneous measurement; and
detect the state of the patient's tissue based on the comparison exceeding a threshold value, T_v.

### Claim 9 (depends on 1)

The automated control device of claim 1, wherein the automated control system has a sensitivity setting, T_s, for detecting an onset of tissue trauma.

### Claim 10 (depends on 8)

The automated control device of claim 8, wherein the processor containing software instructions that, when executed by the processor, cause the automated control system to alter deformation of the patient's tissue when the threshold value, T_V, is exceeded.

### Claim 11 (depends on 8)

The automated control device of claim 8, wherein the threshold value, T_v, is configured to be determined by the surgeon performing the procedure.

### Claim 12 (depends on 9)

The automated control device of claim 9, wherein the sensitivity setting, T_s, is configured to be determined by the surgeon performing the procedure.

### Claim 13 (depends on 10)

The automated control device of claim 10, wherein the processor containing software instructions that, when executed by the processor, cause the automated control system to alter the deformation of the patient's tissue by oscillating loading of the patient's tissue.

### Claim 14 (depends on 13)

The automated control device of claim 13, wherein the processor containing software instructions that, when executed by the processor, cause the automated control system to modify the oscillation of the at least one tissue engager loading the patient's tissue.

### Claim 15 (depends on 6)

The automated control device of claim 6, wherein the at least one tissue engager is configured to induce small scale failure of the patient's tissue, avoiding catastrophic failure of the patient's tissue.

### Claim 16 (depends on 6)

The automated control device of claim 6, wherein the at least one tissue engager is configured to measure properties of the patient's tissue.

### Claim 17 (depends on 16)

The automated control device of claim 16, wherein the measured properties of the patient's tissue comprise a tissue state signal.

### Claim 18 (depends on 17)

The automated control device of claim 17, wherein the tissue state signal is used to guide additional manipulations of the patient's tissue.

### Claim 19 (depends on 1)

The automated control device of claim 1, further comprising at least one motor configured to control the at least one tissue engager to deform the patient's tissue.

### Claim 20 (depends on 19)

The automated control device of claim 19, wherein the at least one motor is controlled at least in part by the automated control system.