title: Using a depth-sensing infrared camera system to access and manipulate medical imaging from within the sterile operating field.
abstract: BACKGROUND
  As surgical procedures become increasingly dependent on equipment and imaging, the need for sterile members of the surgical team to have unimpeded access to the nonsterile technology in their operating room (OR) is of growing importance. To our knowledge, our team is the first to use an inexpensive infrared depthsensing camera (a component of the Microsoft Kinect) and software developed inhouse to give surgeons a touchless, gestural interface with which to navigate their picture archiving and communication systems intraoperatively.
  
  
  METHODS
  The system was designed and developed with feedback from surgeons and OR personnel and with consideration of the principles of aseptic technique and gestural controls in mind. Simulation was used for basic validation before trialing in a pilot series of 6 hepatobiliary-pancreatic surgeries.
  
  
  RESULTS
  The interface was used extensively in 2 laparoscopic and 4 open procedures. Surgeons primarily used the system for anatomic correlation, real-time comparison of intraoperative ultrasound with preoperative computed tomography and magnetic resonance imaging scans and for teaching residents and fellows.
  
  
  CONCLUSIONS
  The system worked well in a wide range of lighting conditions and procedures. It led to a perceived increase in the use of intraoperative image consultation. Further research should be focused on investigating the usefulness of touchless gestural interfaces in different types of surgical procedures and its effects on operative time.
authors.affiliation: The Division of General Surgery, Department of Surgery, University of Toronto, and the Banting Institute, Toronto, Ont., Canada. matt.strickland@utoronto.ca
authors.forename: Matt
authors.initials: M
authors.lastname: Strickland
authors.forename: Jamie
authors.initials: J
authors.lastname: Tremaine
authors.forename: Greg
authors.initials: G
authors.lastname: Brigley
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
mesh_terms: D000315:Adrenalectomy / Q000295:instrumentation; D000368:Aged; D004867:Equipment Design; D005260:Female; D005868:Gestures; D006498:Hepatectomy / Q000295:instrumentation; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D010180:Pancreatectomy / Q000295:instrumentation; D010865:Pilot Projects; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014584:User-Computer Interface