Integrated nerve monitoring system with video laryngoscopy

Abstract

The technology relates to an integrated medical system with a nerve monitoring system that wirelessly pairs to a video laryngoscope. The nerve monitoring system generate nerve stimulation signals that stimulate nerve, and response signals are received from an electrode positioned at a target anatomy that responds to the stimulation of the nerve. The nerve monitoring system receives internal images from the wirelessly paired video laryngoscope, and the internal images include a view of the electrode and the target anatomy. The received internal images are then concurrently displayed with nerve monitoring data generated from the response signals from the electrode.

Description

Attorney Docket No. A0013467W001INTEGRATED NERVE MONITORING SYSTEM WITH VIDEO LARYNGOSCOPYCROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No. 63 / 761,541, filed February 21, 2025, the entire content of which is incorporated herein by reference.BACKGROUND

[0002] Video laryngoscopes are commonly used to perform intubations on patients who require breathing assistance. During an intubation, the video laryngoscope may be used to manipulate the anatomy of the larynx and associated structures of a patient’s airway, in order to obtain a view sufficient for insertion of a breathing tube (e.g., an endotracheal tube) into the trachea. Intubation procedures often happen in combination with other procedures and / or while a patient is sedated.

[0003] It is with respect to this general technical environment that aspects of the present technology disclosed herein have been contemplated. Furthermore, although a general environment is discussed, it should be understood that the examples described herein should not be limited to the general environment identified herein.SUMMARY

[0004] This summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. Additional aspects, features, and / or advantages of examples will be set forth in part in the description which follows and, in part, will be apparent from the description, or may be learned by practice of the disclosure.

[0005] The technology relates to systems and methods for integrated and wirelessly pairing a nerve monitoring system with an imaging device, such as a video laryngoscope. In an aspect, the technology relates to nerve monitoring system that includes a display; at least one processor; and memory storing instructions that, when executed by the at least oneAttorney Docket No. A0013467W001processor, cause the nerve monitoring system to perform operations. The operations include wirelessly pairing with a video laryngoscope; generating nerve stimulation signals to stimulate a nerve; receiving response signals from a sensing electrode positioned at a target anatomy that responds to the stimulation of the nerve; generating nerve monitoring data based on the received response signals; receiving internal images from the wirelessly paired video laryngoscope, wherein the internal images include a view of the electrode, target anatomy, and muscle movement; and concurrently displaying, on the display, the received internal images with the generated nerve monitoring data.

[0006] In another aspect, the technology relates to a computer-implemented method, performed by a nerve monitoring system. The method includes wirelessly pairing with an imaging device with a camera that captures internal images of a patient; receiving response signals from an electrode positioned at a target anatomy that responds to stimulation of a nerve; generating nerve monitoring data based on the received response signals; receiving internal images from the wirelessly paired imaging device, wherein the internal images include a view of the electrode and the target anatomy; and concurrently displaying, on the display, the received internal images with the generated nerve monitoring data.

[0007] In another aspect, the technology relates to a medical system that includes a video laryngoscope comprising a video laryngoscope camera; a flexible endoscope, removably couplable to the video laryngoscope, comprising an endoscope camera; an endotracheal tube including at least one electrode; and a nerve monitoring system. The nerve monitoring system includes a display; at least one processor; and memory storing instructions that, when executed by the at least one processor, cause the nerve monitoring system to perform operations. The operations include wirelessly pairing with the video laryngoscope; receiving response signals from the electrode positioned at vocal cords of a patient; generating nerve monitoring data based on the received response signals; during initial positioning of the endotracheal tube, receiving, from the wirelessly paired video laryngoscope, first internal images captured by the video laryngoscope camera, wherein the first internal images include a view of the electrode and the vocal cords; concurrently displaying, on the display, the received first internal images with the generated nerve monitoring data; subsequent to the initial positioning of the endotracheal tube, receiving, from the wirelessly paired video laryngoscope, second internal images captured by theAttorney Docket No. A0013467W001endoscope camera, wherein the second internal images include a view of the electrode and the vocal cords; and concurrently displaying, on the display, the received second internal images with the generated nerve monitoring data.BRIEF DESCRIPTION OF THE DRAWINGS

[0008] The following drawing figures, which form a part of this application, are illustrative of aspects of systems and methods described below and are not meant to limit the scope of the disclosure in any manner, which scope shall be based on the claims.

[0009] FIGS. 1 A-1C depict example views of a patient environment that includes a video laryngoscope in communication with a nerve monitoring system.

[0010] FIGs. 2A-2B depict an example video laryngoscope.

[0011] FIG. 2C depicts another example video laryngoscope with an attachable endoscope.

[0012] FIG. 3 depicts an example endotracheal tube with one or more electrodes.

[0013] FIG. 4A depicts an example user interface for the nerve monitoring system for dual display of camera data and a nerve monitoring data.

[0014] FIG. 4B depicts another example user interface for the nerve monitoring system for report generation.

[0015] FIG. 4C depicts another example user interface for setup of the nerve monitoring system.

[0016] FIG. 4D depicts another example user interface for the nerve monitoring system for capturing data during monitoring.

[0017] FIG. 5 depicts a schematic diagram of an example video laryngoscope.

[0018] FIG. 6 depicts a schematic diagram of an example nerve monitoring system.Attorney Docket No. A0013467W001

[0019] FIG. 7 depicts an example method for integrated functionality of a nerve monitoring system.

[0020] FIG. 8 depicts another example method for integrated functionality of a nerve monitoring system.

[0021] FIG. 9 depicts another example method for integrated functionality of a nerve monitoring system.DETAILED DESCRIPTION

[0022] Patients who require breathing assistance may be connected to a mechanical ventilator via a breathing tube (e.g., an endotracheal tube). In a medical procedure referred to as an intubation, a clinician inserts a breathing tube into the mouth of the patient, past the larynx, and into the trachea. The breathing tube may then be connected to a ventilation system that includes an anesthesia machine, mechanical ventilator, and / or other device for supplying breathing gases (e.g., anesthetic gases, oxygen, etc.) to the patient.

[0023] A laryngoscope may be used during intubation to help the clinician manipulate portions of the patient’s anatomy, such as the tongue and epiglottis, and obtain a view of the larynx sufficient for inserting the breathing tube into the trachea. To further help visualize the larynx, some laryngoscopes may be configured with a camera system that includes a video camera and light source. A laryngoscope that includes a camera system may be referred to as a video laryngoscope (VL). The video laryngoscope includes an integrated display on which the clinician may view images acquired by the camera.

[0024] A video laryngoscope may further include a feature that provides for wireless connection between the video laryngoscope and other medical devices or systems. For example, the video laryngoscope may establish connection with another medical device via an optical-based method (such as to pair with the device), and the video laryngoscope may then communicate with the other medical device using a more robust wireless communication method (e.g., WiFi or Bluetooth). One example pairing and transmission method is described in detail in U.S. Provisional Patent Application No. 63 / 505,275, titled Video Laryngoscope and Medical Device Wireless Video Transfer, which is incorporated herein by reference in its entirety.Attorney Docket No. A0013467W001

[0025] In some surgical procedures, there is a potential risk that one or more nerves may be damaged during the surgery. There is a risk of nerve damage in head-neck, thoracic, cervical spine, and vascular surgeries. For example, in thyroid surgery (e.g., thyroidectomy or parathyroidectomy) there is a risk of injury to the Recurrent Laryngeal Nerve (RLN), Vagus nerve (VN), and Superior Laryngeal nerve (SLN). The function of such nerves may be monitored by a nerve monitoring (NM) system that monitors the integrity of the nerve function. For example, and evoked potential nerve monitoring system operates by providing stimulation to the nerve and then monitoring the electrical responses, such as Electromyography (EMG), responses to the nerve stimulation. In the case of monitoring the RLN during thyroid surgery, the electrodes for monitoring the nerve stimulation may be provided directly on an endotracheal tube (ETT) that is positioned within the airway of the patient. For instance, the electrodes of the endotracheal tube contact the vocal cords of the patient and measure EMG responses to stimulation of the RLN.

[0026] The response measured by the electrodes is then displayed and / or analyzed by the nerve monitoring system. If the response signal indicates a drop in response to the stimulation, the nerve being stimulated may have been injured and the clinician should respond accordingly. However, the decay in response signal may also be due to either the stimulation leads becoming dislodged and / or the measurement electrodes being dislodged. Often times, the stimulation probe or leads may be externally visually inspected. The movement and positioning of the measurement electrodes located on an endotracheal tube, however, cannot be so easily seen.

[0027] The technology disclosed in this application, among other things, addresses the above problem by integrating a view of the measurement electrodes with a view of the monitored nerve response data. Thus, changes in the nerve monitoring data can be easily assessed with respect to the positioning of the electrodes. For example, continuing with the example of thyroid surgery, a view captured from a camera of the video laryngoscope may be displayed concurrently with the nerve monitoring data. The view captured by the video laryngoscope shows the electrodes of the endotracheal tube along with the vocal cords. When positioning the endotracheal tube within the airway of the patient, the electrodes need to be placed at the correct depth and the correct orientation to ensure that the electrodes are in contact with the vocal cords. With the view provided by the VL camera, this properAttorney Docket No. A0013467W001positioning can be confirmed. The view of both the nerve monitoring data and the VL camera are positioned in a prominent view such that the surgeon and / or other clinicians can easily view and assess the data without interruption. This view from the VL camera may also be provided to assist in initial positioning of the endotracheal tube as well as integrated into a report for the procedure and / or patient. In some examples, the view of the vocal cords and the electrodes of the endotracheal tube are captured by a flexible endoscope that may be coupled to the video laryngoscope.

[0028] FIG. 1 A depicts an example view of a patient environment that includes a video laryngoscope 200 in communication with a nerve monitoring system 100. The patient environment can be any room or theater where an intubation is being performed, such as a medical suite in a hospital or other care setting, an operating or other procedure room, patient recovery room, an emergency intubation setting (e.g., an ambulance), or other environments.

[0029] The nerve monitoring system 100 includes a display screen and a nerve stimulation and monitoring subsystem 103. The display screen 102 may display the various graphical user interfaces discussed herein. For instance, in the example depicted, the display screen 102 is displaying an image 104 captured by the video laryngoscope 200 concurrently with a nerve monitoring data panel 106 with data generated from the from the nerve stimulation and monitoring subsystem 103 of the nerve monitoring system 100.

[0030] During the intubation procedure, a laryngoscope operator 454 (e.g., clinician) holds a handle of the video laryngoscope 200. Acquired image data is displayed on the display of the video laryngoscope 200 so that the laryngoscope operator 454 is able to see the images. As part of an intubation procedure, an endotracheal tube 300 is advanced into the airway of a patient 452 to secure the airway for anesthesia. Accordingly, the operator 454 of the video laryngoscope 200 performs the intubation and directly manipulates the endotracheal tube 300 within the patient’s airway, and other clinicians in the patient environment assist the laryngoscope operator 454, monitor the condition of the patient 452, prepare or adjust medical equipment in the patient environment, and / or wait until the airway is secured to perform other procedures or interventions. As discussed further herein, the placement of the 300 within the airway also includes positioning electrodes of theAttorney Docket No. A0013467W001endotracheal tube 300 against the vocal cords of the patient 452. This includes ensuring that the depth of the endotracheal tube 300 is correct and the rotational alignment of the endotracheal tube 300 is also correct such that the electrodes of the endotracheal tube are in contact with the vocal cords of the patient 452. The laryngoscope operator 454 may view the positions of the electrodes and the vocal cords via the images captured by the video laryngoscope 200 and displayed on the screen of the video laryngoscope 200. As provided herein, the image data can be stored in a memory on the video laryngoscope 200. The image data may be in the form of video data (e.g., a video feed, video stream) and / or may be in the form of still images.

[0031] In the example depicted in FIG. 1A, the patient environment includes the nerve monitoring system 100, with which the video laryngoscope 200 may be in communication as described further herein. The nerve monitoring system 100 further includes one or more stimulation probes or electrodes that are connected to the patient 452 to provide the nerve stimulation discussed herein. The nerve stimulation probes or electrodes are positioned near the nerve that is to be stimulated and may be connected via a wire 107 to the nerve monitoring system 100. In other examples, a separate nerve stimulation unit (e.g., a patient interface in FIG. IB) may be provided that provides the nerve stimulation signals through the stimulation probe or stimulation electrode.

[0032] The nerve monitoring system 100 is also connected to the electrodes of the endotracheal tube 300. The connection between the nerve monitoring system 100 and the electrodes may be accomplished via a wired connection via an electrode cable or electrode wires 314 that extend from the endotracheal tube 300 to a port on the nerve monitoring system 100. The nerve monitoring system 100 then receives response measurements from the electrodes that measure a nerve response to the nerve stimulation delivered via the stimulation instrument and stimulation components that are connected to the nerve monitoring system 100 via stimulation wires or cables 107. In other examples, the wires 314 may extend to an intermediate component (e.g., a patient interface in FIG. IB) that then communicates the response signals to the nerve monitoring system 100 wirelessly.

[0033] The video laryngoscope 200 wirelessly connects to the nerve monitoring system 100. Once connected, the video laryngoscope 200 transmits video image data to theAttorney Docket No. A0013467W001nerve monitoring system 100, where the nerve monitoring system 100 displays and / or stores the received video data.

[0034] As described in further detail below, connection or pairing of the video laryngoscope 200 with the nerve monitoring system 100 may be performed through the use of optical and non-optical signals with little to no input required from the laryngoscope operator 454 or other clinical staff. In an example, when the video laryngoscope 200 is powered on (e.g., in response to a manual selection of a power button), the video laryngoscope 200 goes through an initial pairing process that includes the emission of an optical signal that is received nerve monitoring system 100. For instance, an optical transceiver of the video laryngoscope 200 emits an optical signal through an optically transparent window of the video laryngoscope 200 such that the optical signal is emitted throughout the example patient environment. The nerve monitoring system 100 then detects the optical signal from the video laryngoscope 200. For example, the nerve monitoring system 100 may also include an optical transceiver within the housing of the nerve monitoring system 100. The optical transceiver of the nerve monitoring system 100 processes the received optical signal from the video laryngoscope 200, and the nerve monitoring system 100 then emits an optical response signal of its own via its optical transceiver. The video laryngoscope 200 receives this optical response signal, and a non-optical connection between the video laryngoscope 200 and nerve monitoring system 100 may then be established.

[0035] Once the non-optical connection is established between the video laryngoscope 200 and nerve monitoring system 100, the video image data (and / or still image data) captured by the video laryngoscope 200, is transmitted by the video laryngoscope 200 to the nerve monitoring system 100 via the non-optical connection. Once received by the nerve monitoring system 100, the video image data may be displayed and / or stored by the nerve monitoring system 100. For example, the nerve monitoring system 100 may display the image data on display 102 concurrently with the nerve monitoring data panel 106. Additionally or alternatively, the nerve monitoring system 100 may store the image data in memory of the nerve monitoring system 100 such that the image data may be accessed at a later time after the intubation procedure has been completed and / or after or during the surgical procedure.Attorney Docket No. A0013467W001

[0036] In some examples, the video laryngoscope 200 may connect to the nerve monitoring system 100 using optical and / or electronic elements integrated within the nerve monitoring system 100. In other examples, the video laryngoscope 200 may connect to the nerve monitoring system 100 by way of an externally connected adapter, such as a pluggable adapter, module, dongle. For example, the optical and non-optical elements used for connecting the nerve monitoring system 100 to the video laryngoscope 200 may be integrated in a portable adapter that may be detachably connected to the nerve monitoring system 100.

[0037] FIG. IB depicts the patient environment of FIG. 1A. The medical system in FIG. IB is substantially similar to that of FIG. IB with the exception that the electrode wires 314 and the stimulation wires 107 connect directly to a nerve monitoring patient interface 160. The nerve monitoring patient interface 160 has its own housing and includes multiple physical ports for receiving the electrode wires 314 and the stimulation wires 107. The nerve monitoring patient interface 160 then provides the actual stimulation signal for the nerves. For instance, the stimulation wires 107 connect to a stimulation instrument 109 that is used to deliver the nerve stimulation to the nerve, as shown in FIG. 1C and discussed below. While the stimulation instrument 109 is depicted as being a stimulation probe, in other examples the stimulation instrument 109 may be a stimulation electrode. Such stimulation electrodes may be clipped or otherwise connected near the nerve to provide continuous or intermittent stimulation (e.g., once per second) without a clinician needed to manually hold or activate a probe. These stimulation electrodes may be referred to as continuous monitoring electrodes. The stimulus wires may also connect to a stimulus-return lead 111 and a stimulus-ground lead 113, which are often connected near the sternum of the patient. When the nerve is stimulated with the stimulation instrument 109, the response signals from the endotracheal -tube electrodes are received via the wires 314.

[0038] The nerve monitoring patient interface 160 is in wireless communication with the nerve monitoring system 100 and can communicate the response signals to the monitoring subsystem 103 and receive instructions from the monitoring subsystem 103 regarding the stimulation levels to be delivered via the stimulation instrument 109. The nerve monitoring patient interface 160 may be considered to be part of the nerve monitoring system 100.Attorney Docket No. A0013467W001

[0039] FIG. 1C depicts another view of the patient environment while the stimulation instrument 109 is being inserted and activated to stimulate a nerve 460 of the patient 352. The example depicted, the example endotracheal tube 300 has been inserted into the airway of the patient such that the electrodes 312 of the example endotracheal tube 300 are positioned adjacent to or in contact with tissue 462 (e.g., vocal cords) of the patient 452. A flexible endoscope 250 is also positioned in the airway of the patient 452 such that a view of a camera of the flexible endoscope 250 has a view of the tissue 462 and the electrodes of the endotracheal tube 300.

[0040] To stimulate the nerve 460, the clinician 454 inserts the end of the stimulation instrument 109 to a position at or near the nerve 460 of interest. The stimulation instrument 109 may be inserted via an incision in the patient or through other access ports where available. The stimulation instrument 109 is then activated by the clinician 454 to generate and deliver a nerve stimulus signal and generate a response that can be detected by the electrodes 312 of the endotracheal tube 300. The detected response signal (e.g., EMG signal) from the electrodes 312 is communicated to the nerve monitoring system 100 via the wires 314.

[0041] As an example, the stimulation instrument 109 may be positioned at or near the nerve 460, which may be the Vagus nerve, the RLN, or the SLN (among other nerves). A stimulating voltage and / or current is delivered form the stimulation instrument 109 to attempt to evoke a response in the tissue 462 (e.g., vocal cords). For instance, the evoked response may be movement of the muscles and / or associated tissues, such as the vocal cords. The evoked response is detected by the sensing electrodes 312 of the endotracheal tube 300 and may be an EMG signal. That EMG signal is transmitted from the electrodes 312 to the nerve monitoring system 100 via the wires 314 for display and / or processing by the nerve monitoring system 100.

[0042] FIGs. 2A-2B depict an example video laryngoscope 200. FIG. 2A depicts a front view of the video laryngoscope 200 and FIG. 2B depicts a rear perspective view of the video laryngoscope 200.

[0043] In example depicted, the video laryngoscope 200 has a body 204 (e.g., reusable body). The body 204 includes a display portion 206 having a display 208 that isAttorney Docket No. A0013467W001configured to display images and / or other data, a handle portion 210 that is configured to be gripped by the medical professional during the laryngoscopy procedure, and an elongate portion or arm 214 that supports a camera 216 and light source (e.g., light-emitting diodes (LEDs)) that are configured to obtain images, which may be still-shot images and / or moving images (e.g., a video feed). The camera 216 and light source may be incorporated on the distal end of the arm 214. The light source may be provided as part of the camera 216 or separate from the camera 216 on the blade 218 or arm 214.

[0044] In examples, the display portion 206 and the handle portion 210 may not be distinct portions, such that the display 208 is integrated into the handle portion 210. In the illustrated embodiment, an activating cover, such as a removable laryngoscope blade 218 (e.g., activating blade, disposable cover, sleeve, or blade), is positioned about the arm 214 of the body 204 of the video laryngoscope 200. Together, the arm 214 of the body 204 and the blade 218 form an insertable assembly that is configured to be inserted into the patient’s oral cavity. The display portion 206, the handle portion 210, and / or the arm 214 that form the body 204 of the video laryngoscope 200 may be fixed to one another or integrally formed with one another (e.g., not intended to be separated by the medical professional during routine use) or may be removably coupled to one another (e.g., intended to be separated by the medical professional during routine use) to facilitate storage, use, inspection, maintenance, repair, cleaning, replacement, or interchangeable parts (e.g., use of different arms or extensions with one handle portion 210), for example.

[0045] The handle portion 210, arm 214, and / or display portion 206 may include one or more sensors capable of monitoring functions (e.g., different, additional, and / or advanced monitoring functions). The sensors may include a torque sensor, force sensor, strain gauge, accelerometer, gyroscope, magnet, magnetometer, proximity sensor, reed switch, Hall effect sensor, infrared sensor, wireless connectivity sensor, etc. disposed within or coupled to any suitable location of the video laryngoscope 200. The sensors may detect interaction of the video laryngoscope 200 with other objects, such as a blade 218, physiological structures of the patient (e.g., teeth, tissue, muscle, etc.), or proximity of an airway tool (e.g., an endoscope). For example, a sensor such as a magnet, pressure sensor, proximity sensor, etc. may enable the video laryngoscope 200 to determine when a blade isAttorney Docket No. A0013467W001securely coupled (e.g., as distinguished between a secure coupling and a partial decoupling) with the arm 214 of the video laryngoscope 200.

[0046] The video laryngoscope 200 may also include a power button 220 that enables a medical professional to power the video laryngoscope 200 off and on. In examples, the video laryngoscope 200 may be powered by a power source (e.g., battery) that is coupled to the video laryngoscope 200. The power source may be removably coupled to the video laryngoscope 200. In an instance where the power source is removably couplable to the video laryngoscope 200, the power button 220 may be positioned on the removable power source, instead of on the video laryngoscope 200 itself. The power button 220 may also be used as an input device to access settings of the video laryngoscope 200, including a mode of operation (e.g., routine operation, settings, etc.). Additionally, the video laryngoscope 200 may include an input button or digital input device, such as a touch sensor or proximity sensor (e.g., capacitive sensor, proximity sensor, or the like) that is configured to detect a touch or object (e.g., a finger or stylus). The touch sensor may be in the form of a touchscreen. The touch sensor may enable the medical professional operating the video laryngoscope 200 to efficiently provide inputs or commands associated with functions of the video laryngoscope and / or a communicatively coupled introducer or endoscope (discussed below), such as steering inputs for the endoscope (e.g., steering the introducer in a direction, causing straightening of a distal tip of the introducer, etc.), capturing an image acquired by a camera of the endoscope, capturing an image acquired by a camera of the video laryngoscope, accessing menus or options, or any other inputs relating to function of the video laryngoscope 200 and / or the endoscope.

[0047] The video laryngoscope 200 may also include a tool port 226 configured to electrically couple with an input / output port of the endoscope. The tool port 226 may be integrated anywhere on the body of the video laryngoscope 200 that is not intended to be inserted into a body of a patient (e.g., on the display portion 206, the handle portion 210, etc.). Images (video images and / or still-shot images) acquired by an endoscope camera of the endoscope may be received by the video laryngoscope 200 for display at an integrated display screen (e.g., display 208) of the video laryngoscope 200. The laryngoscope images and the introducer images may be displayed individually or concurrently at the display 208. The images acquired by the video laryngoscope 200, endoscope, or both may be analyzedAttorney Docket No. A0013467W001(e.g., via machine learning (ML) and / or artificial intelligent (Al) models) to detect elements within the images, such as the endotracheal tube and / or the vocal cords of the patient, to help the user determine proper placement. In embodiments the endotracheal tube may be an electromyography endotracheal tube.

[0048] An infrared (IR) optical window 222 may also be provided on the rear side of the video laryngoscope 200. The optical window 222 allows for optical pairing signals to be transmitted and received by the video laryngoscope 200.

[0049] FIG. 2C depicts another example video laryngoscope 200 with an attachable endoscope 250. Rather than having a dedicated tool port 226 for receiving the endoscope 250, a connector 270 may be removably attachable to the video laryngoscope 200 and configured to receive part of the endoscope 250.

[0050] The example endoscope 250 includes a proximal end 256 and a distal end 258. The distal end 258 is the end that is inserted into the patient. The endoscope 250 also includes a steerable distal tip 254 proximate the distal end 258. The steerable distal tip 254 may articulate or bend according to steering signals that are provided from the video laryngoscope 200. For instance, steering wires may extend through the example endoscope 250 that are connected to the steerable distal tip 254 such that pulling on one or more of the steering wires causes the steerable distal tip 254 to articulate.

[0051] An endoscope camera 260 is also positioned at or near the distal end 258. The endoscope camera 260 captures images from the distal end of the example endoscope 250. Additional sensors may also be provided at or near the distal end 258 of the example endoscope 250. For example, one or more accelerometers, gyroscopes, magnetometers, and / or inertial measurement units (IMUs) may be positioned near the distal end 258 of the example endoscope 250. Such sensors may provide positional data regarding the position and / or the articulation angle of the steerable distal tip 254.

[0052] The proximal segment 252 includes a motor housing 262, an electronics segment 264, and an electrical interface 266. The motor housing 262 houses one or more motors within the proximal segment 252. The motors within the motor housing 262 may be coupled to the steering wires that connect to the steerable distal tip 254. Thus, activation ofAttorney Docket No. A0013467W001the motors causes the steerable distal tip 254 to articulate. The electronics segment 264 may house electronics for receiving the image signals from the endoscope camera 260 and / or the sensor(s) located near the distal end 258. The electronics segment 264 may also receive and pass steering signals received from the video laryngoscope 200. The electronics segment 264 may also house one or more of the motors.

[0053] An electrical interface 266 is positioned on the electronics segment 264. The electrical interface 266 connects to a connector-based electrical interface 272 to allow for communication of the image data and / or sensor data captured by the example endoscope 250 to be communicated to the video laryngoscope 200.

[0054] The connector 270 is removably attachable to the video laryngoscope 200. For instance, the connector 270 may connect to a backside of the video laryngoscope 200. When the connector 270 is attached to the video laryngoscope 200, the connector-based electrical interface 272 connects to an electrical interface on the rear side of the video laryngoscope 200. When the proximal segment 252 is inserted into the connector 270, the electrical interface 266 of the example endoscope 250 is also in contact with the connectorbased electrical interface 272. Thus, when the proximal segment 252 is inserted into the connector 270 and the connector 270 is attached to the video laryngoscope 200, electrical signals may be passed between the example endoscope 250 and the video laryngoscope 200.

[0055] The signals that are passed may include image data and / or sensor data captured by the endoscope camera 260 and / or sensors of the example endoscope 250. For instance, the endoscope camera 260 may capture images, and those images are transmitted to the video laryngoscope 200 via the connector-based electrical interface 272 of the connector 270. Similarly, steering signals for controlling the motors of the example endoscope 250 may be transmitted to the example endoscope 250 via the connector-based electrical interface 272.

[0056] Additional elements and features detachable connect or cartridge for coupling an introducer or endoscope to a video laryngoscope are described in U.S. Provisional Patent Application No. 63 / 675,873, filed July 26, 2024, and U.S. Patent Application 18 / 421,476, filed November 25, 2024, which are hereby incorporated by reference in their entireties.Attorney Docket No. A0013467W001

[0057] FIG. 3 depicts an example endotracheal tube 300 with one or more electrodes 312. The endotracheal tube 300 includes a proximal end 302 and a distal end 304. A tube body 306 extends from the proximal end 302 to the distal end 304 of the endotracheal tube 300. The distal end 304 is inserted into the airway of the patient.

[0058] A cuff 308 is positioned near the distal end of the endotracheal tube 300. The cuff 308 may be inflated via a cuff-inflation port 310, which may be referred to as a pilot balloon. The cuff-inflation port 310 is in pneumatic communication with the cuff 308 such that air pressure received via the cuff-inflation port 310 causes inflation of the cuff 308. The cuff 308 is used to provide a seal against the tracheal wall.

[0059] The sensing electrodes 312 are positioned on an outer surface of the tube body 306. In the example depicted, a first electrode 312A is positioned on one side of the tube body 306 and a second electrode 312B is positioned on an opposite side of the tube body. The electrodes 312 are intended to contact the vocal cords of the patient when the endotracheal tube 300 is properly inserted and positioned within the patient. When the electrodes 312 are in contact with the vocal cords, the electrodes 312 are able to measure the response of the nerve to the external nerve stimulation delivered via the stimulation instrument 109, as discussed above. The signal that is measured or detected by the electrodes 312 may be considered an EMG signal. While the first electrode 312A and the electrodes 312B are shown in particular positions on the example endotracheal tube 300, the electrodes 312 may be positioned in different locations, such as on the left and right sides of the tube body 306.

[0060] The electrodes 312 are electrically connected to electrode wires 314. As discussed above, the electrode wires 314 are then connectable to the nerve monitoring system 100 to allow for communication of signals measured by the electrodes to be measured and displayed by the nerve monitoring system 100.

[0061] FIG. 4A depicts the display 102 with an example monitoring GUI 103 A for the nerve monitoring system 100 for dual display of camera data and a nerve monitoring data. The example monitoring GUI 103 A includes an internal image 104 captured by the VL camera 216 and / or the endoscope camera 260. The monitoring GUI 103 A further includes a nerve monitoring data panel 106 that displays nerve monitoring data concurrentlyAttorney Docket No. A0013467W001with the internal image 104. The nerve monitoring data in the nerve monitoring data panel 106 is based on the electrical signals received from the sensing electrodes 312 of the endotracheal tube 300.

[0062] The example monitoring GUI 103 A further includes a quick actions section 108, a tab selection section 110, a settings section 112, a procedure time section 115, and a collapse / expand UI element 114. The quick actions section 108 provides selectable UI elements for different actions that can be taken by the nerve monitoring system 100. For instance, the quick actions may include options for baseline nerve data or checking of the electrodes. The quick actions may also include options relating to the internal image 104. For instance, an adjust-view action may allow for adjusting the size of the internal image 104 within the monitoring GUI 103 A. The snapshot quick action may allow for a snapshot of the current internal image 104 to be taken and stored in memory of the nerve monitoring system 100. For example, the internal image 104 may be a video stream of the camera data received from the video laryngoscope 200. A still image (e.g., a snapshot) may be desired to be stored. The stream quick action may also control whether data is being streamed and / or displayed from the video laryngoscope 200 that is paired to the nerve monitoring system 100. For instance, receiving a selection of the stream quick action may toggle the streaming of the video data from the video laryngoscope 200.

[0063] The collapse / expand UI element 114 may control whether the internal image 104 is displayed in the monitoring GUI 103A. For example, if the collapse / expand UI element 114 was to be selected, the internal image 104 would be collapsed (e.g., removed from display). Upon the collapse / expand UI element 114 being selected to collapse the internal image 104, the image (e.g., icon) associated with the collapse / expand UI element 114 may change to an image (e.g., icon) that represents an expand function (e.g., an arrow pointing the other direction). Upon a subsequent selection of the collapse / expand UI element 114, the internal image 104 may expand back out to be displayed concurrently with the nerve monitoring data panel 106.

[0064] When the internal image 104 is collapsed, the nerve monitoring data panel 106 expands to fill the remainder of the space in the monitoring GUI 103 A that was previously occupied by the internal image 104. Similarly, when the internal image 104 isAttorney Docket No. A0013467W001expanded, the nerve monitoring data panel 106 shrinks, but still displays the respective nerve monitoring data concurrently with the internal image 104.

[0065] The tab selection section 110 allows for switching between different interfaces, such as the monitoring GUI 103 A, a report-generation GUI 103B (FIG. 4B), or a setup GUI 103C (FIG. 4C). For instance, the tab selection section 110 displays selectable tabs that correspond to each of the respective GUIs. In the monitoring GUI 103 A depicted in FIG. 4A, the monitoring tab is selected.

[0066] The settings section 112 provides for changing of settings for the nerve monitoring system 100. For example, the stimulation levels for the stimulation signals delivered via the stimulation instrument 109 may be adjusted. Different thresholds may also be adjusted. The volume emitted from the nerve monitoring system 100 (e.g., for audible feedback based on the nerve monitoring data) may also be adjusted from within the settings section 112. Additional or different settings may be displayed within the settings section 112.

[0067] The nerve monitoring data that is displayed in the nerve monitoring data panel 106 may be configurable or changeable by the user. The nerve monitoring data includes data based on measurements from the electrodes 312. In the example depicted, the nerve monitoring data panel 106 includes nerve monitoring data for automatic periodic stimulation provided by the stimulation instrument 109. This nerve monitoring data may be trended over time and a trendline or other trend indicators may be displayed on the plots within the nerve monitoring data panel 106 and / or in other manners to indicate the trend of the response signal over time. In situations where the trend is showing a decay in the response signal that may be indicative of nerve damage, the internal image 104 may then be concurrently viewed to determine if the decay in signal may instead be due to a shifted position of the example endotracheal tube 300. Other types of nerve monitoring data may be displayed within the nerve monitoring data panel 106.

[0068] The internal image 104 may be an image that is captured by the VL camera 216 or the endoscope camera 260 and communicated to the nerve monitoring system 100. The internal image 104 may be a live view such that the internal image 104 is a video stream of the video captured by the respective camera. The live view allows for a clinician to viewAttorney Docket No. A0013467W001the current state and positioning of the endotracheal tube 300 within the airway. An additional benefit of the live view is that the clinician can also see active muscle movement, such as movement of the vocal cords 402 during stimulation. For example, when a properly functioning nerve is stimulated, the vocal cords 402 move in an expected manner. By viewing a live view of the vocal cords 402, the clinician can visually determine if the vocal cords 402 are responding as expected to the external stimulation provided through the stimulation instrument 109.

[0069] In some examples, the nerve monitoring system 100 also records the video (e.g., images) that is received from the rigid VL camera 216 and / or the endoscope camera 260. In such examples, the video playback may be controlled by an operator and one or more video-playback controls (e.g., play, pause, rewind) may be provided on nerve monitoring system 100. This allows for the operator to navigate to a prior time in the video to potentially see vocal cord movement in response to the nerve stimulation. In some examples, the simulation markers may be displayed on a video playback bar that indicate when the nerve stimulation was delivered. For example, when the nerve stimulation is delivered, the nerve monitoring system 100 receives a signal or tracks the timing of such stimulation. These timings may be used to generate the stimulation markers on the video playback bar to allow for a clinician to navigate the video playback to times where the nerve stimulation was delivered. Thus, the clinician is able to see how the vocal cords respond to the different nerve stimulation signals. In some examples, the video recording of the internal images 104 is performed in response to the stimulation signal being activated or delivered. For instance, a short video segment (e.g., a few seconds, 5-20 seconds, 10-60 seconds) after the stimulation signal is delivered may be recorded each time the stimulation signal is delivered.

[0070] The live view and the internal image 104 may change from imagery captured by the VL camera 216 to imagery captured by the endoscope camera 260. For example, during the initial tube positioning procedure, the video laryngoscope 200 is inserted into the oral cavity of the patient and the view of the endotracheal tube 300 in the vocal cords 402 is easily captured from the rigid VL camera 216. The video laryngoscope 200, however, is then often removed from the patient after the tube positioning is complete. Re-inserting the video laryngoscope 200 with the endotracheal tube 300 already in place is possible, but suchAttorney Docket No. A0013467W001re-insertion presents some difficulties and challenges, particularly if the surgeon is currently operating in the neck area of the patient and stimulation is being provided to the nerve. As such, the endoscope 250 may be better suited for views of the endotracheal tube 300 after the initial positioning is completed. In such examples, the flexible endoscope 250 may be navigated through either the mouth or the nose of the patient to a position where the field of the view of the endoscope camera 260 includes the endotracheal tube 300, the electrodes 312, and the vocal cords 402. The endoscope camera 260 may then be left in this position for a longer duration, which may include the entire surgical procedure. The images captured by the endoscope camera 260 are provided to the video laryngoscope 200, as discussed herein, and then the video laryngoscope 200 wireless communicates those images to the nerve monitoring system 100 for display as the internal image 104.

[0071] In some examples, the internal image 104 is previously captured and / or a stored image or video clip showing a prior position of the endotracheal tube 300 within the airway. For example, during the initial positioning of the endotracheal tube 300 within the airway, the surgeon may not be present in the surgical theater or operating environment. However, when the surgeon arrives, the surgeon may wish to ensure that the endotracheal tube 300 was positioned correctly prior to beginning the surgical operations. Thus, the internal image 104 may provide that confirmation to the surgeon via a stored video clip or a representative image of the endotracheal tube 300 within the airway during the initial placement of the tube.

[0072] With respect to the internal image 104 itself, the internal image 104 includes a view of the vocal cords 402 of the patient with the endotracheal tube 300 extending through the vocal cords 402. The electrodes 312 of the endotracheal tube 300 may also be seen within the internal image 104. Thus, a visual confirmation that the electrodes 312 are properly in contact with the vocal cords 402 can be made.

[0073] In some examples, computer vision and / or object detection can be performed on the image(s) from the VL camera 216 and / or the endoscope camera 260. In such examples, the endotracheal tube 300 and / or the electrodes 312 may be automatically detected within the image(s). The patient anatomy of interest, such as the vocal cords, may also be automatically detected within the image(s). Based on the detected objects, anAttorney Docket No. A0013467W001automated determination of proper tube positioning may be generated that indicates whether the electrodes 312 are properly positioned against the vocal cords 402 (or other anatomy of interest).

[0074] In addition, once the object is detected, a visual object indicator 410 may be overlaid or displayed on the internal image 104 indicating the location of the detected object. In the example depicted, the electrode 312 is detected in the internal image 104 and the visual object indicator is the word “electrode” and an arrow pointing to the detected electrode 312 in the internal image 104. The display of the visual object indicator 410 may be configurable and / or toggled on or off depending on clinician preference.

[0075] The object detection and tracking features of the present technology may be accomplished through the use computer vision and / or AI / ML models that process the frames of the video feeds. In one example, a trained convolutional neural network (CNN) may be used to process the image frames of the video feed. A CNN is a class of deep neural networks that are effective at analyzing visual imagery. CNNs are composed of layers that include convolutional layers, pooling layers, and fully connected layers. The convolutional layers apply various filters to the input to create feature maps, which highlight specific features in the image. In the initial layers, simple features like edges and colors may be detected. As the data progresses through the network, more complex features like textures and patterns are identified. Some methods generate potential bounding boxes in the image where objects might be located. For each bounding box, the CNN predicts the probability of each object class (e.g., endoscope and / or vocal cords). The final output includes the class labels (e.g., vocal cords, endoscope) and bounding box coordinates for each detected object in the image or video frame.

[0076] The procedure time section 115 may indicate a duration of the procedure that is currently being performed. For example, a timer may begin upon a manual start of the timer (e.g., a selection of a start button on the nerve monitoring system 100). In other examples, the timer may begin automatically upon the pairing of the video laryngoscope 200 to the nerve monitoring system 100. In other examples, the procedure time section 115 may indicate the duration of a particular portion of the procedure being performed. For instance, the procedure time section 115 may indicate the duration of the intubationAttorney Docket No. A0013467W001procedure. One example of determining the duration of an intubation procedure is described in U.S. Patent Application No. 18 / 943,482, filed on November 11, 2024, which is incorporated herein by reference in its entirety.

[0077] The procedure time section 115 may also include identifying information for the video laryngoscope 200 that is paired with the nerve monitoring system 100, such as the name and / or serial number of the video laryngoscope 200. In the example depicted, the name of the video laryngoscope 200 is “McGrath” and the serial number of the video laryngoscope 200 is 10008999.

[0078] FIG. 4B depicts the display 102 with another example user interface for the nerve monitoring system 100 for report generation. In particular, FIG. 4B depicts an example report-generation GUI 103B that is displayed upon the selection of the “Reports” tab from the tab selection section 110.

[0079] The report-generation GUI 103B is a report section 116 and an interaction section 118. The report section 116 includes a preview of the procedure report 120 for the procedure (e.g., the thyroid surgery) that was performed for which the nerve monitoring functions were provided. The preview of the procedure report 120 includes header data 122, tube placement data 124, and nerve stimulation data 126. Each of the sections or included data of the procedure report 120 may be initially automatically generated based on the images received and stored (e.g., the internal images 104) and / or the nerve monitoring data.

[0080] The header data 122 may include basic data about the procedure, such as the surgeon’s name, patient name, patient ID, patient date of birth, date, and / or the procedure type that was performed (e.g., thyroid surgery), among other data. The tube placement data 124 may include the internal image 104, which may be one representative image of the positioning of the example endotracheal tube 300 within the airway of the patient. For instance, the representative internal image 104 may be an image showing the electrodes 312 properly positioned against the vocal cords 402. In other examples, multiple internal images 104 may be provided in the internal image 104. For instance, internal images 104 captured at different points in time during the procedure may be included. A video clip may also be provided in the tube placement data 124 that shows the tube position over time. In some examples, a link to the video clip stored on a server may be provided to access the videoAttorney Docket No. A0013467W001data. Additional comments may also be provided within the internal image 104 regarding the tube placement and / or any shifts in electrode or tube position during the procedure. The nerve stimulation data 126 includes nerve monitoring data that was collected or measured during the procedure. The nerve monitoring data may be displayed in the form of plots, charts, tables, graphs, etc. The report section 116 may also include a navigation element 117 that can be selected to navigate to different pages of the procedure report 120.

[0081] The interaction section 118 includes a modify-report section 130 and an export-report section 134. The modify-report section 130 includes selectable modification actions 132. The selectable modification actions 132 may include a quick tags action, a snapshots action, a nerve monitoring action, and a case monitoring action. The quick tags action and the snapshots action provide for access to previously stored quick tags (e.g., prior captures of data at points in time during the procedure) and stored snapshots (e.g., still images from the video feed of the rigid VL camera 216 and / or the endoscope camera 260 displayed as internal image 104). These elements can then be added to the procedure report 120. The nerve monitoring action and case information actions similarly allow for modifying the corresponding sections of the report.

[0082] The export-report section 136 includes export actions 136. For example, the export actions 136 may include a save-to-file option for saving the procedure report 120 and / or a print option to print the procedure report 120.

[0083] FIG. 4C depicts the display 102 with another example user interface for setup of the nerve monitoring system 100. In particular, FIG. 4C depicts an example setup GUI 103C that is displayed upon the selection of the “Setup” tab in the tab selection section 110. The setup GUI 103C provides instructions and guidance for properly setting up the stimulation leads 111, 113 and the respective electrodes of the system, such as the example endotracheal tube 300 with the electrodes 312.

[0084] The setup GUI 103C includes a model patient image 150 that may be an illustration of an example or model patient with certain anatomy exposed depending on where the stimulation leads and / or the electrodes 312 are to be positioned. In this example, an electrode indicator 152 is displayed that shows where the electrodes 312 of the example endotracheal tube 300 are to be positioned. Electrode wire indicators 154 are also shown toAttorney Docket No. A0013467W001indicate where and how to connect the electrode wires 314 to the patient terminal, as shown by patient terminal indicator 160. Stimulation lead indicators 156 are also similarly displayed to show how to connect the stimulation leads (e.g., stimulus-return lead 111 and stimulus-ground lead 113).

[0085] Concurrently with the display of these instructive indicators, the internal image 104 is also displayed. In this case, the internal image 104 is a live view (e.g., live video stream), likely from the VL camera 216 (but the endoscope camera 260 is also possible). The live view provides an internal view to the clinician that is placing the endotracheal tube 300. Thus, the clinician is able to view the instructive graphics and indicators while seeing exactly where the endotracheal tube 300 and the electrodes 312 are currently positioned.

[0086] FIG. 4D depicts another depicts the display 102 with another example user interface during nerve monitoring. In particular, FIG. 4D depicts an example monitoring GUI 103D that further displays a quick-tags pane 140. The monitoring GUI 103D is substantially the same as the monitoring GUI 103 A for FIG. 4A with the exception that the quick-tags pane 140 is displayed in monitoring GUI 103D.

[0087] The quick-tags pane 140 may be exposed upon the selection of a UI element from the GUI, such as a UI element from the quick actions section 108 or other section. The quick-tags pane 140 includes a plurality of quick-tags UI elements 142, in the example depicted, the quick-tags Ul-elements include a left-right indicator that indicates whether the nerve being stimulated is on left or right side of the patient. The quick-tags UI elements further include multiple event elements, such as L-Vl, L-R1-, L-R2, and L-Vl. These elements correspond to defined stimulation events of nerves. These may be pre-labeled events or, in some examples, configured by the user.

[0088] During EMG monitoring during thyroid surgery, the progression of the surgery is documented into the patient record. The quick-tags event elements may be configured based on the stimulation events that occur during such surgical procedures, such as Vagus nerve pre-dissection (VI), recurrent nerve pre-dissection (Rl), and recurrent nerve post-dissection (V2). The quick-tags feature is able to record and associate the EMG data with each of these quick-tags for the corresponding events. Thus, the neurological state andAttorney Docket No. A0013467W001protection is documented throughout the progression of the surgical procedure with the associated nerve stimulation events. Assessing a patient’s condition both before (preoperative) and after (post-operative) surgery can provide valuable prognostic information for follow-up treatment.

[0089] With the technology discussed herein, the images and / or video that is received from the VL camera and / or the endoscope camera may also be recorded and stored with the associated events of the quick tags. As discussed above with reference to FIG. 4B, when the quick tags are selected, both the video or images along with the nerve monitoring data may be accessed via the quick tags and similarly integrated into the patient report. Different quick tag elements 142 may be selected such that the following nerve stimulation data and received images are associated with that particular quick tag.

[0090] FIG. 5 depicts a schematic diagram of an example video laryngoscope 500, which may be the same as, or similar to, example video laryngoscope 200. The video laryngoscope 500 includes an optical transceiver 504 for transmitting and receiving the optical signals discussed herein. For example, the optical transceiver 504 may be a type of infrared (IR) transceiver or may be capable of transmitting and receiving optical signals in the visible wavelength. The video laryngoscope 500 includes an optical window 544 formed in the housing of the video laryngoscope 500 to allow for the optical signals to reach the optical transceiver 504 and exit the video laryngoscope 500.

[0091] The video laryngoscope 500 further includes a wireless communication device 506. The wireless communication device 506 may be a wireless transceiver that is configured to establish wireless communication in a non-optical frequency. By way of example, the wireless communication device 506 may be configured to communicate using the IEEE 802.15.4 standard, and may communicate, for example, using ZigBee, WirelessHART, or MiWi protocols. Additionally or alternatively, the wireless communication device 506 may be configured to communicate using the Bluetooth standard or one or more of the IEEE 802.11 standards or similar communication techniques. In some examples, the video laryngoscope 500 also include one or more connection ports 508. In examples, the connection ports 508 may include one or more external ports for establishing a wired connection.Attorney Docket No. A0013467W001

[0092] In some examples, the video laryngoscope 500 may also receive images captured by an external endoscope camera (e.g., endoscope camera 260) that is connected to the video laryngoscope 500 via an endoscope port 509. Image data acquired by the external endoscope camera may be transmitted to the other devices discussed herein, such as the nerve monitoring system 100, along with image data acquired by the video laryngoscope camera system 518.

[0093] The video laryngoscope 500 also includes a display 516, camera system 518, and power source (e.g., battery) 520. The camera system 518 includes a camera for imaging the patient’s airway and a light source that illuminates the field-of-view (FOV) of the camera. The light source may be a type of LED, lamp, or other type of light-emitting element. The camera includes an imaging sensor, such as a charge-coupled device (CCD), complementary metal-oxide-semiconductor (CMOS), or other type of sensor.

[0094] The display 516 may be any of a variety of display technologies, such as liquid crystal display (LCD), light emitting diode (LED), organic light emitting diode (OLED), or other display technology. In examples, the display 516 may be a touch-sensitive display (e.g., a capacitive touch-sensitive display) capable of receiving input from a user. Aspects of the operation of the video laryngoscope 500 may also be configured via the display 516, such as video image display preferences and other configurable settings of the video laryngoscope 500. In one example, a clinician may tag or mark a video image by providing input via the display 516. For instance, a clinician may provide input through the display 516 to indicate a video segment of interest.

[0095] Video images acquired by the video laryngoscope camera system 518 may be displayed on the display 516 or may be combined with images acquired by an attached endoscope and displayed simultaneously. For example, the display 516 may be capable of providing split screen, picture-in-picture, or other method for simultaneously displaying video images.

[0096] The video laryngoscope 500 includes a controller 510 that includes one or more processors 512 and memory elements 514. The processor 512 may include one or more general purpose processors, microprocessors, microcontrollers, graphics processing units (GPUs), digital signal processors (DSPs), and / or other programmable circuits. InAttorney Docket No. A0013467W001examples, the processor 512 may include any combination of commercially available components, and / or custom or semi-custom integrated circuits, such as application specific integrated circuits (ASICs). The processor 512 may include elements needed for control or communication with the display 516, camera system 518, wireless communication device 506, optical transceiver 504, and / or other elements of the video laryngoscope 500.

[0097] The processor 512 may perform control, interface, communication, or other processing functions by executing instructions that are stored in the memory 514. For instance, the memory 514 may store instructions that, when executed by the processor 512, cause the elements of the video laryngoscope 500 to perform operations described herein. In one example, the memory 514 may store portions of one or more algorithms associated with intubation mode as described below. In another example, the processor 512 and memory 514 may control the pairing process between the video laryngoscope 500 and the nerve monitoring system 100. The memory 514 may include random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory or other memory technology. The processor and memory may also perform the Al functions (e.g., object detection in images) discussed herein. For instance, the trained Al model(s) may be stored in the memory 514 of the video laryngoscope 500 and executed locally by the processor 512 of the video laryngoscope 500.

[0098] FIG. 6 depicts a schematic diagram of an example nerve monitoring system 600, which may be the same as, or similar to, nerve monitoring system 100. The nerve monitoring system 600 includes a video laryngoscope pairing section 602 and nerve monitoring operations section 620.

[0099] The components of the pairing section 602 may be positioned on, or connected to, a first circuit board or a first set of circuit boards (e.g., printed circuit board assembly (PCB A)), and the components of the nerve monitoring operations section 620 may be positioned on, or connected to, a second circuit board or second set of circuit boards. In examples, the hardware and / or circuitry of the pairing section 602 is integrated and / or nonremovable from the nerve monitoring system 600. For instance, the components and / or circuit boards may be physically attached inside the housing of the nerve monitoring system 600 via screws, adhesives, solder, or other attachment means. The components are nonAttorney Docket No. A0013467W001removable in that they are not intended to be removed or detached by a user (with the limited exception of for repair or replacement during maintenance of the nerve monitoring system 600). In the example depicted, the hardware and / or circuitry of the pairing section 602 are not included in any type of removable dongle, plug, or other type or removable or detachable component. The hardware and / or circuitry of the nerve monitoring operations section 620 are similarly integrated and non-removable from the medical device. In other examples, however, the components of the video laryngoscope pairing section 602 may be included in a removable module, relay, plug, or other similar component that may be removable connected to the nerve monitoring system 600.

[0100] The pairing section 602 includes an optical transceiver 604, a wireless communications device 606 for non-optical communication, and one or more connection ports 608 to interface with the components of the nerve monitoring operations section 620. The nerve monitoring system 600 may also include an optical window 644 formed in the housing of the nerve monitoring system 600 to allow for the optical signals to reach the optical transceiver 604 and exit the nerve monitoring system 600. The optical transceiver 604 may be a type of infrared (IR) detector and / or transmitter as described above. The wireless communications device 606 may be the same or similar as wireless communications device 506 described above.

[0101] The pairing section 602 also includes a pairing controller 610 that includes one or more processors 612 and hardware memory 614. The processor 612 and memory 614 control the pairing process with the video laryngoscope but may not control the nerve monitoring operations of the nerve monitoring system 600.

[0102] The nerve monitoring operations section 620 includes a display 622, a power source 624, stimulation controls 626, and an EMG analyzer 628. The stimulation controls 626 may control the stimulation signal(s) that are delivered to the patient via the stimulation instrument 109. For instance, the stimulation controls 626 respond to settings changes and generate a corresponding voltage and / or current for delivery as a stimulation signal. The EMG analyzer 628 analyzes the signals that are received from the sensing electrodes (e.g., sensing electrodes 312) and provides the corresponding analysis and / or data for display on the display 622. The nerve monitoring operations section 620 also includes a nerveAttorney Docket No. A0013467W001monitoring controller 632 that includes one or more processors 634 and hardware memory 636. The nerve monitoring controller 632 controls the nerve monitoring operations but may not control or perform operations relating to the pairing of the nerve monitoring system 600 with a video laryngoscope. The nerve monitoring operations section 620 also includes communication device(s) 630 for communicating with devices other than the video laryngoscope. For instance, the communication device(s) 630 may provide for Internet or other networked communications, such as to a medical database or monitoring station.

[0103] By having some duplicate components (e.g., processors, memory, communication devices), the primary functions of the nerve monitoring system 600 may be segregated from the pairing functions. As such, any operations relating to pairing are less likely to potentially interfere with the nerve monitoring operations of the nerve monitoring system 600. However, in other examples, only a single set of processors, memory, and / or communication devices may be present in the nerve monitoring system 600 that control both the pairing operations and the nerve monitoring operations. Such examples reduce the need for duplicate hardware, which ultimately conserves resources and provides for more efficient medical devices.

[0104] One or more of the memories, such as memory 636, may store data associated with the nerve monitoring operations as well as the video or image data received from the video laryngoscope. This data may then be incorporated into the patient or procedure report as discussed above.

[0105] In some examples, the AI / ML models that are applied to the video feed to detect objects, events, and / or patterns may be stored on one or more of the memories, such as memory 636, of the nerve monitoring system 600. In such examples, the analysis of the video feed from the video laryngoscope may be performed by the nerve monitoring system 600 to extract data and / or detect objects within the video stream.

[0106] FIG. 7 depicts an example method 700 for integrated functionality of a nerve monitoring system with a video laryngoscope. The operations of method 700 may be performed by a nerve monitoring system, such as nerve monitoring system 100, 600. For instance, one or more memories of the nerve monitoring system may store instructions that,Attorney Docket No. A0013467W001when executed by one or more processors of the nerve monitoring system, cause the nerve monitoring system to perform the operations of method 700.

[0107] At operation 702, the nerve monitoring system is initialized. The initialization of the nerve monitoring system may include powering on the nerve monitoring system and making some of the initial connections of the stimulation leads, stimulation instrument, and / or other wiring.

[0108] At operation 704, the nerve monitoring system wirelessly pairs with a video laryngoscope. As discussed further herein, the wireless pairing may be performed via a combination of optical and non-optical signals. For instance, the nerve monitoring system may first exchange optical signals with the video laryngoscope. The optical signals include pairing data for establishing a non-optical connection between the nerve monitoring system and the video laryngoscope. The non-optical communication or pairing is then established based on the pairing data that was received in the optical signal. The pairing functions of the nerve monitoring system may be performed by components that are permanently installed in nerve monitoring system housing and / or via components housed in pluggable dongle or module.

[0109] At operation 706, the nerve monitoring system generates nerve stimulation signals based on the settings of the nerve monitoring system. These nerve stimulation signals are transmitted via the stimulation instrument to the patient to stimulate a nerve of the patient. At operation 708, response signals are received from one or more sensing electrodes that indicate the patient’s response to the nerve stimulation. For example, the stimulation may be of the Vagus nerve, RLN, SLN, or other similar nerve and the sensing electrode may be an electrode on an endotracheal tube where the electrode is in contact with the vocal cords of a patient. At operation 710, nerve monitoring data (e.g., EMG data) is generated based on the response signals that were received in operation 708.

[0110] At operation 712, internal images are received from the wirelessly paired video laryngoscope. The internal images may have been captured by one or more of the VL camera of the video laryngoscope or the endoscope camera of the endoscope that is coupled to the video laryngoscope. The internal images may be received as a video stream from the video laryngoscope. The images that are received may have the vocal cords and theAttorney Docket No. A0013467W001endotracheal tube with the electrodes in the field of view. Thus, the position of the electrode(s) relative to the vocal cords can be determined from inspection of the images.

[0111] At operation 714, the nerve monitoring system concurrently displays one or more of the received internal images within the nerve monitoring data generated in operation 710. The concurrent display may be in the form of monitoring GUI 103 A shown in FIG.4A. The display of the internal image may be a live stream of the internal images that are received from the video laryngoscope. For instance, the live view shows a video feed of the sensing electrode, the target anatomy (e.g., the vocal cords), and muscle movement of the target anatomy (e.g., movement of the vocal cords). In other examples, the internal image may be a single image that is representative of the positioning of the electrode relative to the vocal cords. In other examples, the internal image may be short video clip that can be selectively played to show the positioning of the endotracheal tube and the electrode relative to the vocal cords.

[0112] At operation 716, one or more objects may be detected within the internal images received from the video laryngoscope. For instance, the electrode(s) may be detected. As an example, the electrodes of attached to an outer surface of the body of an endotracheal tube may be detected. The anatomy of interest may also be detected from the image, such as the vocal cords. Such detection may be performed through the use of object recognition and / or computer vision algorithms, such as through the use of trained CNNs as discussed herein.

[0113] At operation 718, one or more indicia may be generated based on the objects detected in operation 716. For instance, one or more indicators may be generated and overlaid on the internal image to indicate the location of the detected object. As an example, the visual object indicator 410 in FIG. 4A may be generated and displayed that identifies the location of the electrode.

[0114] Other indicia may be generated based on the detected location of multiple objects from within the images. For example, based on the detected location of the target anatomy (e.g., vocal cords) and the detected location of the electrode(s), a determination or prediction can be made as to whether the electrode is in contact with the anatomy. Based on that determination or prediction, an indicator may be generated to indicate whether theAttorney Docket No. A0013467W001electrode is in contact with the target anatomy (and / or a range or likelihood that the electrode is in contact with the target anatomy).

[0115] At operation 719, the movement of the target anatomy may be detected. For instance, where the target anatomy is detected in multiple frames of the video feed, the movement of that target anatomy can be assessed on a frame-by-frame basis or across multiple frames of the video feed. For example, a size and / or position of the target anatomy in one frame may be determined and the size and / or position of the target anatomy for a subsequent frame may also be determined. Changes in size and / or position may then be attributed to movement of the target anatomy (e.g., muscle movement). Movement of the camera (e.g., the endoscope camera 260 or the VL camera 216) may also be accounted for in the determination of the movement or the tissue. For example, the flexible endoscope 250 may include an accelerometer, or other similar sensor, near the endoscope camera 260, and that accelerometer may be used to determine movement of the endoscope camera 260. Such physical movement of the camera may be used to calculate or offset detected movement of the target anatomy to account for a changing reference frame of the captured view due to the camera movement.

[0116] This detected movement may be further quantified and / or classified based on the amount of movement detected and / or the speed and / or acceleration of the movement. For instance, a movement amount value may be generated and / or a movement-acceleration / speed value may be generated. These values may also be combined or otherwise represented by a movement score that is based on the movement amount and / or movement acceleration / speed. These values may be normalized in some examples, and or the values may be based on an initial or baseline value. For instance, baseline values may be calculated for an initial stimulation. Then, subsequent values may be represented as a proportion or percentage of the baseline values. These movement values and / or scores may also be compared to corresponding thresholds, and alarms and / or indicators may be generated based on the comparison, such as if the movement of the target tissue is below a threshold. For instance, if the movement values drop 10% or more from the baseline values, an indicator or an alarm may be generated.Attorney Docket No. A0013467W001

[0117] The relative timing of the detected movement may also be detected relative to when the stimulation signal was delivered to the nerve. For instance, the nerve monitoring system receives an indication when the stimulation signal was delivered via the stimulation instrument. The beginning of the detected movement of the target anatomy may then be recorded and compared to the time when the stimulation signal was delivered. A delay value may then be generated. These different values (e.g., movement amount, movement speed, delay) may be used as secondary, or confirmatory, values when changes in the nerve monitoring data (e.g., EMG data) are detected. In other examples, the movement values may be used as a primary monitoring modality.

[0118] At operation 720, an interaction is received with the displayed internal images. The interaction may be the selection of a selectable UI elements within the displayed GUI. For instance, the interaction may be an interaction to collapse the displayed internal image and / or to capture a screenshot of the displayed internal image.

[0119] At operation 722, the GUI is adjusted based on the interaction received in operation 720. For example, if the interaction was to collapse the display of the internal images, then the adjustment to the GUI is to collapse the display of the internal images and expand the display of the nerve monitoring data.

[0120] While the example of thyroid surgery has been the primary example discussed herein, the technology is not limited such surgical procedures. For instance, the view of an electrode position can be captured and displayed on the nerve monitoring system for other types of procedures and electrodes as well. For instance, the nerve monitoring system may wirelessly pair to an imaging device, which may be an endoscope, video laryngoscope, or another imaging device, that is capable of capturing internal images of the patient to show electrode position relative to the anatomy of interest that displays the response to the nerve stimulation. Then, the nerve data generated from the electrode response signals may still be displayed concurrently with an internal image received from the wirelessly paired imaging device. Thus, the clinician is able to concurrently view the nerve monitoring data as well as an image of the electrode position relative to the anatomy of interest. Such indicia may then be displayed or otherwise surfaced (e.g., audible tone) to the clinician.Attorney Docket No. A0013467W001

[0121] FIG. 8 depicts an example method 800 for integrated functionality of a nerve monitoring system with a video laryngoscope. The operations of method 800 may be performed by a nerve monitoring system, such as nerve monitoring system 100, 600. For instance, one or more memories of the nerve monitoring system may store instructions that, when executed by one or more processors of the nerve monitoring system, cause the nerve monitoring system to perform the operations of method 800.

[0122] At operation 802, the nerve monitoring system wirelessly pairs with a video laryngoscope. Operation 802 may be substantially the same as operation 704 in method 700. At operation 804, internal images are received from the wirelessly paired video laryngoscope. Operation 804 may be substantially the same as operation 712 in method 700.

[0123] The method 800 then proceeds to operation 806 where the setup GUI is displayed with the received internal images. The setup GUI may be similar to the setup GUI shown in FIG. 4C.

[0124] After the electrodes and stimulation leads and / or instrument have been positioned and / or connected, a selection of a different GUI may be received at operation 812 to change to a different GUI from the setup GUI. For instance, a different tab may be selected. In an example, the monitoring GUI may be selected. In response, the monitoring GUI is displayed at operation 808. At a later time, another selection of a different GUI may be received at operation 812. This subsequent selection may be to return to the setup GUI or move to the report-generation GUI. If the report-generation GUI is selected, the method 800 proceeds to operation 810 where the report-generation GUI is displayed with one or more of the internal images displayed a preview of a procedure or patient report. This can continue to repeat as different GUIs are selected by the clinician. In some examples, the setup GUI may be bypassed and the method 800 may flow directly from operation 804 to operation 808 or operation 810.

[0125] FIG. 9 depicts an example method 900 for integrated functionality of a nerve monitoring system with a video laryngoscope. The operations of method 900 may be performed by a nerve monitoring system, such as nerve monitoring system 100, 600. For instance, one or more memories of the nerve monitoring system may store instructions that,Attorney Docket No. A0013467W001when executed by one or more processors of the nerve monitoring system, cause the nerve monitoring system to perform the operations of method 900.

[0126] At operation 902, the nerve monitoring system wirelessly pairs with a video laryngoscope. Operation 802 may be substantially the same as operation 704 in method 700.

[0127] At operation 904, first internal images are received from the wirelessly paired video laryngoscope. The first internal images are captured by the VL camera, and the first internal images are received during initial positioning of the endotracheal tube with the electrode. The first internal images include a view of the electrode of the endotracheal tube and the vocal cords.

[0128] At operation 906, the first internal images are displayed in at least one of the setup GUI or the monitoring GUI. When displayed in the setup GUI, the first internal images are displayed concurrently with the guidance indicators of the setup GUI. When displayed in the monitoring GUI, the first internal images are displayed concurrently with nerve monitoring data o the monitoring GUI.

[0129] At operation 908, second internal images are received from the wirelessly paired video laryngoscope. The second internal images are captured by the endoscope camera of an endoscope removable coupled to the video laryngoscope. The second internal images also include a view of the electrode of the endotracheal tube and the vocal cords.

[0130] The second internal images are received at a time subsequent to the initial positioning of the endotracheal tube, such as during the surgical procedure (e.g., after an incision has been made). As discussed above, the video laryngoscope is often removed from the patient after the initial tube positing is complete. Re-inserting the video laryngoscope with the endotracheal tube already in place is possible, but such re-insertion presents some difficulties and challenges, particularly if the surgeon is currently operating in the neck area of the patient and stimulation is being provided to the nerve. As such, the endoscope may be better suited for views of the endotracheal tube after the initial positioning is completed. In such examples, the flexible endoscope may be navigated through either the mouth or the nose of the patient to a position where the field of the view of the endoscope camera includes the endotracheal tube, the electrodes, and the vocal cords. The endoscope camera may thenAttorney Docket No. A0013467W001be left in this position for a longer duration, which may include the entire surgical procedure. The images captured by the endoscope camera are provided to the video laryngoscope, as discussed herein, and then the nerve monitoring system receives the images from the video laryngoscope.

[0131] At operation 912, a patient report is generated that includes at least one of the first internal images of the second internal images. For example, when the reportgeneration GUI is selected, the report preview may include one or more of the first internal images or the second internal images.

[0132] The systems and methods discussed herein may be used throughout the surgical procedure. For example, at the beginning of the surgical procedure or prior to the surgical procedure, an initial assessment of nerve integrity may be performed by assessing the vocal cord movement and / or the EMG signal in response to the stimulation of the nerve. For example, for a thyroidectomy, the Vagus nerve may be initially stimulated, and a response is detected via the sensing electrode contacting the vocal cords and movement of the vocal cords can be seen in the images captured by the VL camera and / or the endoscope camera. The surgery may then continue to proceed. During the surgery, the RLN may be located. The RLN may then be stimulated, and a response is detected via the sensing electrode contacting the vocal cords and movement of the vocal cords can be seen in the images captured by the VL camera and / or the endoscope camera. At the end or towards the end of surgery, the RLN may be stimulated again, and another response is detected. The Vagus nerve may also be stimulated again near the end of surgery to cause another response. Thus, the patient condition can be assessed at multiple times throughout the procedure, and the nerve data and images may be similarly recorded and / or integrated into the patient report throughout the procedure. In other examples, a continuous monitoring electrode may be implemented that provides stimulation at regular intervals (e.g., every second, every 10 seconds) throughout the procedure or a portion of the procedure, and the response signals are similarly detected and analyzed.

[0133] As will be appreciated from the foregoing, in an aspect, the technology relates to nerve monitoring system that includes a display; at least one processor; and memory storing instructions that, when executed by the at least one processor, cause theAttorney Docket No. A0013467W001nerve monitoring system to perform operations. The operations include wirelessly pairing with a video laryngoscope; generating nerve stimulation signals to stimulate a nerve; receiving response signals from a sensing electrode positioned at a target anatomy that responds to the stimulation of the nerve; generating nerve monitoring data based on the received response signals; receiving internal images from the wirelessly paired video laryngoscope, wherein the internal images include a view of the electrode, target anatomy, and muscle movement; and concurrently displaying, on the display, the received internal images with the generated nerve monitoring data.

[0134] In an example, the internal images received from the wirelessly paired video laryngoscope are images captured by a camera of the video laryngoscope. In another example, the internal images received from the wirelessly paired video laryngoscope are images captured by an endoscope camera of an endoscope removably coupled to the video laryngoscope. In yet another example, the electrode is attached to an outer surface of an endotracheal tube. In still another example, the target anatomy is vocal cords. In still yet another example, the operations further include receiving a selection to collapse the display of the internal images; and in response to receiving the selection, collapsing the display of the internal images and expanding the display of the nerve monitoring data.

[0135] In another example, the received internal images are a live video stream from one of a camera of the video laryngoscope or a camera of an endoscope coupled to the video laryngoscope. In yet another example, wirelessly pairing with the video laryngoscope further includes exchanging pairing data, via an optical signal, between the video laryngoscope and the nerve monitoring system; and based on the pairing data from the optical signal, establishing a non-optical wireless connection with the video laryngoscope, wherein the internal images are received via the non-optical wireless connection. In a further example, the nerve monitoring system further includes, within a housing of the nerve monitoring system, a pairing printed circuit board assembly (PCBA) with an optical transceiver and a wireless communications device for non-optical communication.

[0136] In another example, the display of the internal images and nerve monitoring data is part of a monitoring graphical user interface (GUI), wherein the monitoring GUI further includes a procedure time section that displays a procedure time. In still anotherAttorney Docket No. A0013467W001example, the operations further include receiving a selection of a report-generation GUI; and in response to receiving the selection of the report-generation GUI, displaying the report-generation GUI, wherein the report-generation GUI includes a report preview including at least one of the internal images. In yet another example, the operations further include receiving a selection of a setup GUI; and in response to receiving the selection of the setup GUI, displaying the setup GUI, wherein the setup GUI comprises at least one of the internal images displayed concurrently with a model patient image and an electrode indicator providing guidance for proper placement of the electrode. For example, a laryngoscope image of a Medtronic Tri Vantage™ EMG tube in a patient is correctly placed when a blue cross marking on the EMG tube is centered at the patient’s vocal folds.

[0137] In another aspect, the technology relates to a computer-implemented method, performed by a nerve monitoring system. The method includes wirelessly pairing with an imaging device with a camera that captures internal images of a patient; receiving response signals from an electrode positioned at a target anatomy that responds to stimulation of a nerve; generating nerve monitoring data based on the received response signals; receiving internal images from the wirelessly paired imaging device, wherein the internal images include a view of the electrode and the target anatomy; and concurrently displaying, on the display, the received internal images with the generated nerve monitoring data.

[0138] In an example, the imaging device is a video laryngoscope. In another example, the imaging device is an endoscope. In still another example, the electrode is positioned on an endotracheal tube and the target anatomy is vocal cords. In yet another example, wirelessly pairing with the imaging device includes exchanging pairing data, via an optical signal, between the imaging device and the nerve monitoring system; and based on the pairing data from the optical signal, establishing a non-optical wireless connection with the imaging device, wherein the internal images are received via the non-optical wireless connection. In a further example, the optical signals are received by an optical receiver within a housing of the nerve monitoring system or an optical receiver within a pluggable module coupled to the nerve monitoring system.

[0139] In another aspect, the technology relates to a medical system that includes a video laryngoscope comprising a video laryngoscope camera; a flexible endoscope,Attorney Docket No. A0013467W001removably couplable to the video laryngoscope, comprising an endoscope camera; an endotracheal tube including at least one electrode; and a nerve monitoring system. The nerve monitoring system includes a display; at least one processor; and memory storing instructions that, when executed by the at least one processor, cause the nerve monitoring system to perform operations. The operations include wirelessly pairing with the video laryngoscope; receiving response signals from the electrode positioned at vocal cords of a patient; generating nerve monitoring data based on the received response signals; during initial positioning of the endotracheal tube, receiving, from the wirelessly paired video laryngoscope, first internal images captured by the video laryngoscope camera, wherein the first internal images include a view of the electrode and the vocal cords; concurrently displaying, on the display, the received first internal images with the generated nerve monitoring data; subsequent to the initial positioning of the endotracheal tube, receiving, from the wirelessly paired video laryngoscope, second internal images captured by the endoscope camera, wherein the second internal images include a view of the electrode and the vocal cords; and concurrently displaying, on the display, the received second internal images with the generated nerve monitoring data. In an example, the operations further comprise generating a patient report that includes at least one of the first internal images or the second internal images.

[0140] Those skilled in the art will recognize that the methods and systems of the present disclosure may be implemented in many manners and as such are not to be limited by the foregoing aspects and examples. In other words, functional elements being performed by a single component or multiple components, in various combinations of hardware and software or firmware, and individual functions, can be distributed among software applications at either the client or server level or both. In this regard, any number of the features of the different aspects described herein may be combined into single or multiple aspects, and alternate aspects having fewer than or more than all of the features herein described are possible.

[0141] Functionality may also be, in whole or in part, distributed among multiple components, in manners now known or to become known. Thus, a myriad of software / hardware / firmware combinations are possible in achieving the functions, features, interfaces, and preferences described herein. Moreover, the scope of the present disclosureAttorney Docket No. A0013467W001covers manners for carrying out the described features and functions and interfaces, and those variations and modifications that may be made to the hardware or software firmware components described herein as would be understood by those skilled in the art now and hereafter. In addition, some aspects of the present disclosure are described above with reference to block diagrams and / or operational illustrations of systems and methods according to aspects of this disclosure. The functions, operations, and / or acts noted in the blocks may occur out of the order that is shown in any respective flowchart. For example, two blocks shown in succession may in fact be executed or performed substantially concurrently or in reverse order, depending on the functionality and implementation involved.

[0142] Further, as used herein and in the claims, the phrase “at least one of element A, element B, or element C” is intended to convey any of: element A, element B, element C, elements A and B, elements A and C, elements B and C, and elements A, B, and C. In addition, one having skill in the art will understand the degree to which terms such as “about” or “substantially” convey in light of the measurement techniques utilized herein. To the extent such terms may not be clearly defined or understood by one having skill in the art, the term “about” shall mean plus or minus ten percent.

[0143] Numerous other changes may be made which will readily suggest themselves to those skilled in the art and which are encompassed in the spirit of the disclosure and as defined in the appended claims. While various aspects have been described for purposes of this disclosure, various changes and modifications may be made which are well within the scope of the disclosure. Numerous other changes may be made which will readily suggest themselves to those skilled in the art and which are encompassed in the spirit of the disclosure and as defined in the claims.

[0144] The following examples are illustrative of the techniques described herein.

[0145] Example 1. A nerve monitoring system comprising: a display; at least one processor; and memory storing instructions that, when executed by the at least one processor, cause the nerve monitoring system to perform operations comprising: wirelessly pairing with a video laryngoscope; generating nerve stimulation signals to stimulate a nerve; receiving response signals from a sensing electrode positioned at a target anatomy thatAttorney Docket No. A0013467W001responds to the stimulation of the nerve; generating nerve monitoring data based on the received response signals; receiving internal images from the wirelessly paired video laryngoscope, wherein the internal images include a view of the electrode, target anatomy, and muscle movement; and concurrently displaying, on the display, the received internal images with the generated nerve monitoring data.

[0146] Example 2. The nerve monitoring system of Example 1, wherein the internal images received from the wirelessly paired video laryngoscope are images captured by a camera of the video laryngoscope.

[0147] Example 3. The nerve monitoring system of Example 1, wherein the internal images received from the wirelessly paired video laryngoscope are images captured by an endoscope camera of an endoscope removably coupled to the video laryngoscope.

[0148] Example 4. The nerve monitoring system of Example 1, wherein the electrode is attached to an outer surface of an endotracheal tube.

[0149] Example 5. The nerve monitoring system of Example 1, wherein the target anatomy is vocal cords.

[0150] Example 6. The nerve monitoring system of Example 1, wherein the operations further comprise: receiving a selection to collapse the display of the internal images; and in response to receiving the selection, collapsing the display of the internal images and expanding the display of the nerve monitoring data.

[0151] Example 7. The nerve monitoring system of Example 1, wherein the received internal images are a live video stream from one of a camera of the video laryngoscope or a camera of an endoscope coupled to the video laryngoscope.

[0152] Example 8. The nerve monitoring system of Example 1, wherein wirelessly pairing with the video laryngoscope further comprises: exchanging pairing data, via an optical signal, between the video laryngoscope and the nerve monitoring system; and based on the pairing data from the optical signal, establishing a non-optical wireless connection with the video laryngoscope, wherein the internal images are received via the non-optical wireless connection.Attorney Docket No. A0013467W001

[0153] Example 9. The nerve monitoring system of Example 6, further comprising, within a housing of the nerve monitoring system, a pairing printed circuit board assembly (PCBA) with an optical transceiver and a wireless communications device for non-optical communication.

[0154] Example 10. The nerve monitoring system of Example 1, wherein the display of the internal images and nerve monitoring data is part of a monitoring graphical user interface (GUI), wherein the monitoring GUI further includes a procedure time section that displays a procedure time.

[0155] Example 11. The nerve monitoring system of Example 1, wherein the operations further comprise: receiving a selection of a report-generation GUI; and in response to receiving the selection of the report-generation GUI, displaying the reportgeneration GUI, wherein the report-generation GUI includes a report preview including at least one of the internal images.

[0156] Example 12. The nerve monitoring system of Example 1, wherein the operations further comprise: receiving a selection of a setup GUI; and in response to receiving the selection of the setup GUI, displaying the setup GUI, wherein the setup GUI comprises at least one of the internal images displayed concurrently with a model patient image and an electrode indicator providing guidance for placement of the electrode.

[0157] Example 13. A computer-implemented method, performed by a nerve monitoring system, the method comprising: wirelessly pairing with an imaging device with a camera that captures internal images of a patient; receiving response signals from an electrode positioned at a target anatomy that responds to stimulation of a nerve; generating nerve monitoring data based on the received response signals; receiving internal images from the wirelessly paired imaging device, wherein the internal images include a view of the electrode and the target anatomy; and concurrently displaying, on the display, the received internal images with the generated nerve monitoring data.

[0158] Example 14. The computer-implemented method of Example 13, wherein the imaging device is a video laryngoscope.Attorney Docket No. A0013467W001

[0159] Example 15. The computer-implemented method of Example 13, wherein the imaging device is an endoscope.

[0160] Example 16. The computer-implemented method of Example 13, wherein the electrode is positioned on an endotracheal tube and the target anatomy is vocal cords.

[0161] Example 17. The computer-implemented method of Example 13, wherein wirelessly pairing with the imaging device comprises: exchanging pairing data, via an optical signal, between the imaging device and the nerve monitoring system; and based on the pairing data from the optical signal, establishing a non-optical wireless connection with the imaging device, wherein the internal images are received via the non-optical wireless connection.

[0162] Example 18. The computer-implemented method of Example 17, wherein the optical signals are received by an optical receiver within a housing of the nerve monitoring system or an optical receiver within a pluggable module coupled to the nerve monitoring system.

[0163] Example 19. A medical system comprising: a video laryngoscope comprising a video laryngoscope camera; a flexible endoscope, removably couplable to the video laryngoscope, comprising an endoscope camera; an endotracheal tube including at least one electrode; and a nerve monitoring system comprising: a display; at least one processor; and memory storing instructions that, when executed by the at least one processor, cause the nerve monitoring system to perform operations comprising: wirelessly pairing with the video laryngoscope; receiving response signals from the electrode positioned at vocal cords of a patient; generating nerve monitoring data based on the received response signals; during initial positioning of the endotracheal tube, receiving, from the wirelessly paired video laryngoscope, first internal images captured by the video laryngoscope camera, wherein the first internal images include a view of the electrode and the vocal cords; concurrently displaying, on the display, the received first internal images with the generated nerve monitoring data; subsequent to the initial positioning of the endotracheal tube, receiving, from the wirelessly paired video laryngoscope, second internal images captured by the endoscope camera, wherein the second internal images include aAttorney Docket No. A0013467W001view of the electrode and the vocal cords; and concurrently displaying, on the display, the received second internal images with the generated nerve monitoring data.

[0164] Example 20. The medical system of Example 19, wherein the operations further comprise generating a patient report that includes at least one of the first internal images or the second internal images.

Claims

Attorney Docket No. A0013467W001CLAIMSWhat is claimed is:

1. A nerve monitoring system (600) comprising:a display (622);at least one processor (612, 634); andmemory (614, 636) storing instructions that, when executed by the at least one processor, cause the nerve monitoring system to perform operations comprising:wirelessly pairing (704) with a video laryngoscope;generating (706) nerve stimulation signals to stimulate a nerve; receiving (708) response signals from a sensing electrode positioned at a target anatomy that responds to the stimulation of the nerve;generating (710) nerve monitoring data based on the received response signals;receiving (712) internal images from the wirelessly paired video laryngoscope, wherein the internal images include a view of the electrode, target anatomy, and muscle movement; andconcurrently displaying (714), on the display, the received internal images with the generated nerve monitoring data.

2. The nerve monitoring system of claim 1, wherein the internal images received from the wirelessly paired video laryngoscope are images captured by a camera of the video laryngoscope.

3. The nerve monitoring system of any one of claims 1-2, wherein the internal images received from the wirelessly paired video laryngoscope are images captured by an endoscope camera of an endoscope removably coupled to the video laryngoscope.

4. The nerve monitoring system of any one of claims 1-3, wherein the electrode is attached to an outer surface of an endotracheal tube.

5. The nerve monitoring system of any one of claims 1-4, wherein the target anatomy is vocal cords.Attorney Docket No. A0013467W0016. The nerve monitoring system of any one of claims 1-5, wherein the operations further comprise:receiving a selection to collapse the display of the internal images; andin response to receiving the selection, collapsing the display of the internal images and expanding the display of the nerve monitoring data.

7. The nerve monitoring system of any one of claims 1-6, wherein the received internal images are a live video stream from one of a camera of the video laryngoscope or a camera of an endoscope coupled to the video laryngoscope.

8. The nerve monitoring system of any one of claims 1-7, wherein wirelessly pairing with the video laryngoscope further comprises:exchanging pairing data, via an optical signal, between the video laryngoscope and the nerve monitoring system; andbased on the pairing data from the optical signal, establishing a non-optical wireless connection with the video laryngoscope, wherein the internal images are received via the non-optical wireless connection.

9. The nerve monitoring system of claim 6, further comprising, within a housing of the nerve monitoring system, a pairing printed circuit board assembly (PCBA) with an optical transceiver and a wireless communications device for non-optical communication.

10. The nerve monitoring system of any one of claims 1-9, wherein the display of the internal images and nerve monitoring data is part of a monitoring graphical user interface (GUI), wherein the monitoring GUI further includes a procedure time section that displays a procedure time.Attorney Docket No. A0013467W00111. The nerve monitoring system of any one of claims 1-10, wherein the operations further comprise:receiving a selection of a report-generation GUI; andin response to receiving the selection of the report-generation GUI, displaying the report-generation GUI, wherein the report-generation GUI includes a report preview including at least one of the internal images.

12. The nerve monitoring system of any one of claims 1-11, wherein the operations further comprise:receiving a selection of a setup GUI; andin response to receiving the selection of the setup GUI, displaying the setup GUI, wherein the setup GUI comprises at least one of the internal images displayed concurrently with a model patient image and an electrode indicator providing guidance for placement of the electrode.

13. A computer-implemented method, performed by a nerve monitoring system, the method comprising:wirelessly pairing (704) with an imaging device with a camera that captures internal images of a patient;receiving (708) response signals from an electrode positioned at a target anatomy that responds to stimulation of a nerve;generating (710) nerve monitoring data based on the received response signals; receiving (712) internal images from the wirelessly paired imaging device, wherein the internal images include a view of the electrode and the target anatomy; and concurrently displaying (714), on the display, the received internal images with the generated nerve monitoring data.

14. The computer-implemented method of claim 13, wherein the imaging device is a video laryngoscope.

15. The computer-implemented method any one of claims 13-14, wherein the imaging device is an endoscope.

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