title: Use of natural user interfaces for image navigation during laparoscopic surgery: initial experience.
abstract: BACKGROUND
  Surgical environments require special aseptic conditions for direct interaction with the preoperative images. We aim to test the feasibility of using a set of gesture control sensors combined with voice control to interact in a sterile manner with preoperative information and an integrated operating room (OR) during laparoscopic surgery.
  
  
  METHODS
  Two hepatectomies and two partial nephrectomies were performed by three experienced surgeons in a porcine model. The Kinect, Leap Motion, and MYO armband in combination with voice control were used as natural user interfaces (NUIs). After surgery, surgeons completed a questionnaire about their experience.
  
  
  RESULTS
  Surgeons required <10 min training with each NUI. They stated that NUIs improved the access to preoperative patient information and kept them more focused on the surgical site. The Kinect system was reported as the most physically demanding NUI and the MYO armband in combination with voice commands as the most intuitive and accurate. The need to release one of the laparoscopic instruments in order to use the NUIs was identified as the main limitation.
  
  
  CONCLUSIONS
  The presented NUIs are feasible to directly interact in a more intuitive and sterile manner with the preoperative images and the integrated OR functionalities during laparoscopic surgery.
authors.affiliation: a Laparoscopy Unit , Jesús Usón Minimally Invasive Surgery Centre , Cáceres , Spain.
authors.forename: Francisco M
authors.identifier: http://orcid.org/0000-0003-2138-988X
authors.initials: FM
authors.lastname: Sánchez-Margallo
authors.affiliation: b Bioengineering and Health Technologies Unit , Jesús Usón Minimally Invasive Surgery Centre , Cáceres , Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Sánchez-Margallo
authors.affiliation: b Bioengineering and Health Technologies Unit , Jesús Usón Minimally Invasive Surgery Centre , Cáceres , Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Moyano-Cuevas
authors.affiliation: c Department of Surgery , University of Extremadura , Cáceres , Spain.
authors.forename: Eva María
authors.initials: EM
authors.lastname: Pérez
authors.affiliation: d General Surgery Unit , Jesús Usón Minimally Invasive Surgery Centre , Cáceres , Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Maestre
mesh_terms: D000818:Animals; D005240:Feasibility Studies; D006498:Hepatectomy; D007090:Image Interpretation, Computer-Assisted; D017053:Infection Control / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D009392:Nephrectomy; D009870:Operating Room Information Systems; D009873:Operating Rooms / Q000592:standards; D010865:Pilot Projects; D025321:Surgery, Computer-Assisted; D013552:Swine; D013647:Task Performance and Analysis; D014584:User-Computer Interface
keywords: Human–computer interaction; gesture control; image-guided surgery; natural user interface