A voice-controlled network for universal control of devices in the OR

"Alexa, Cycle The Blood Pressure": A Voice Control Interface Method for Anesthesia Monitoring

BACKGROUND

Anesthesia monitors and devices are usually controlled with some combination of dials, keypads, a keyboard, or a touch screen. Thus, anesthesiologists can operate their monitors only when they are physically close to them, and not otherwise task-loaded with sterile procedures such as line or block placement. Voice recognition technology has become commonplace and may offer advantages in anesthesia practice such as reducing surface contamination rates and allowing anesthesiologists to effect changes in monitoring and therapy when they would otherwise presently be unable to do so. We hypothesized that this technology is practicable and that anesthesiologists would consider it useful.

METHODS

A novel voice-driven prototype controller was designed for the GE Solar 8000M anesthesia patient monitor. The apparatus was implemented using a Raspberry Pi 4 single-board computer, an external conference audio device, a Google Cloud Speech-to-Text platform, and a modified Solar controller to effect commands. Fifty anesthesia providers tested the prototype. Evaluations and surveys were completed in a nonclinical environment to avoid any ethical or safety concerns regarding the use of the device in direct patient care. All anesthesiologists sampled were fluent English speakers; many with inflections from their first language or national origin, reflecting diversity in the population of practicing anesthesiologists.

RESULTS

The prototype was uniformly well-received by anesthesiologists. Ease-of-use, usefulness, and effectiveness were assessed on a Likert scale with means of 9.96, 7.22, and 8.48 of 10, respectively. No population cofactors were associated with these results. Advancing level of training (eg, nonattending versus attending) was not correlated with any preference. Accent of country or region was not correlated with any preference. Vocal pitch register did not correlate with any preference. Statistical analyses were performed with analysis of variance and the unpaired t -test.

CONCLUSIONS

The use of voice recognition to control operating room monitors was well-received anesthesia providers. Additional commands are easily implemented on the prototype controller. No adverse relationship was found between acceptability and level of anesthesia experience, pitch of voice, or presence of accent. Voice recognition is a promising method of controlling anesthesia monitors and devices that could potentially increase usability and situational awareness in circumstances where the anesthesiologist is otherwise out-of-position or task-loaded.

Evaluation of a Touchless Angiography Suite Computer Controller for Neuroendovascular Procedures

BACKGROUND AND PURPOSE

The GestSure system is an Food and Drugs Administration (FDA)-registered depth-sensing infrared device initially developed for touchless image navigation during open surgery. The goal of this study was to explore the feasibility of this technology with medical students, residents, fellows and staff neurointerventionalists, using cases of intracranial aneurysm coiling.

MATERIAL AND METHODS

This was a prospective cohort study of operative performance using standard keyboard and mouse against a gestural interface. A total of four medical students, six residents, six fellows and five staff neurointerventionalists were involved in the training and subsequent testing. Training involved description and demonstration of a set of gestures optimized for 3D software functions. Cases were selected from the set of patients who underwent endovascular aneurysm coiling at the Toronto Western Hospital.

RESULTS AND CONCLUSION

For the overall group 15/21 (71.4%) individuals learned the left anterior oblique 30 degrees (LAO30) task within 20 cases, 17/21 (80.9%) learned the aneurysm neck task within 20 cases, 16/21 (76.2%) learned the parent vessel task and 14/21 (66%) learned the neck and parent vessel (anatomical) tasks. Staff were more consistent (i.e. smallest standard deviation) amongst the groups compared to medical students and residents; however, it was noted that a significant learning effect was observed in participants across every level of medical and angiographic expertise. Touchless angiography suite control with a gestural interface is feasible for the manipulation of angiographic images for neuroendovascular procedures. Learning to use the system was rapid across any level of medical training but greatest for staff neurointerventionalists.

Technical and instrumental prerequisites for single-port laparoscopic solo surgery: State of art

With the aid of advanced surgical techniques and instruments, single-port laparoscopic surgery (SPLS) can be accomplished with just two surgical members: an operator and a camera assistant. Under these circumstances, the reasonable replacement of a human camera assistant by a mechanical camera holder has resulted in a new surgical procedure termed single-port solo surgery (SPSS). In SPSS, the fixation and coordinated movement of a camera held by mechanical devices provides fixed and stable operative images that are under the control of the operator. Therefore, SPSS primarily benefits from the provision of the operator’s eye-to-hand coordination. Because SPSS is an intuitive modification of SPLS, the indications for SPSS are the same as those for SPLS. Though SPSS necessitates more actions than the surgery with a human assistant, these difficulties seem to be easily overcome by the greater provision of static operative images and the need for less lens cleaning and repositioning of the camera. When the operation is expected to be difficult and demanding, the SPSS process could be assisted by the addition of another instrument holder besides the camera holder.

Using a depth-sensing infrared camera system to access and manipulate medical imaging from within the sterile operating field

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.

CONCLUSION

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.

Evaluation of voice control, touch panel control and assistant control during steering of an endoscope

The increasing amount of equipment used in the Operating Room (OR) asks for ergonomical user interfaces. The aim of this study was to investigate in a pelvi-trainer setting the efficiency, reliability and user satisfaction of voice control, touch panel control and conventional manual control by an assistant. Ten subjects had to control the zoom and light intensity of an endoscope, using voice, a touch panel or an assistant. For each interface, the subject received nine tasks to control to a certain level, light, zoom or both. The experiment was repeated three times (three cycles) and the sequences of interfaces were varied per cycle. Experiments were recorded on video and off-line time needed per task and the number of wrongly interpreted tasks were measured. A questionnaire was used to investigate user satisfaction. Voice control was slower than assistant control and touch panel control (92.5 s, 80.2 s and 76.0 s, respectively, p<0.02). There was no significant difference between touch panel control and assistant control. With voice control, 3.1% of the commands were not interpreted and 1.7% were wrongly interpreted. 40% of the subjects experienced voice control as the quickest, 30% touch panel control and 30% assistant control. 48% of the subjects preferred voice control, 28% the touch panel and 24% assistant control. Voice control was less efficient than touch panel control and manual control by an assistant. The subjects experienced voice control as more efficient, however. In the future, voice control should be improved to overcome wrongly interpreted commands. Furthermore, experiments should be performed in a clinical setting in which the surgeon has to perform two-handed tasks to evaluate the effects on the surgeon's performance.