Feasibility of using a low-cost head-mounted augmented reality device in the operating room

Background: Augmented reality (AR) has great potential for improving image-guided neurosurgical procedures, but until recently, hardware was mostly custom-made and difficult to distribute. Currently, commercially available low-cost AR devices offer great potential for neurosurgery, but reports on technical feasibility are lacking. The goal of this pilot study is to evaluate the feasibility of using a low-cost commercially available head-mounted holographic AR device (the Microsoft Hololens) in the operating room. The Hololens is operated by performing specific hand gestures, which are recognized by the built-in camera of the device. This would allow the neurosurgeon to control the device "touch free" even while wearing a sterile surgical outfit.Methods: The Hololens was tested in an operating room under two lighting conditions (general background theatre lighting only; and general background theatre lighting and operating lights) and wearing different surgical gloves (both bright and dark). All required hand gestures were performed, and voice recognition was evaluated against background noise consisting of two nurses talking at conversational speech level.Results: Wearing comfort was sufficient, with and without regular glasses. All gestures were correctly classified regardless of lighting conditions or the sort of sterile gloves. Voice recognition was good. The visibility of the holograms was good if the device was configured to use high brightness for display.Conclusions: We demonstrate that using a commercially available low-cost head-mounted holographic AR device is feasible in a sterile surgical setting, under different lighting conditions and using different surgical gloves. Given the availability of freely available software for application development, neurosurgery can benefit from new opportunities for image-guided surgery.