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Novel imaging using a touchless display for computer-assisted hepato-biliary surgery



We developed a touchless display system that allows the user to control the medical imaging software via hand gestures in the air. We conducted this study to verify the effectiveness of this novel touchless display system as a tool for assisting with surgical imaging.


The patient’s computed tomography (CT) data are generally observed on a display during surgery. The “Dr. aeroTAP” touchless display system was developed to generate virtual mouse events based on the position of one hand. We conducted comparative analyses of using the Dr. aeroTAP vs. using a regular mouse (control group) by measuring the time to select a 3D image from 24 thumbnail images on a screen (study 1) and to then see the CT image on the DICOM viewer (study 2).


We used the Dr. aeroTAP in 31 hepato-biliary operative procedures performed at our hospital. In study 1, which measured the time required to select one of 24 thumbnails, there were significant differences between the mouse and Dr. aeroTAP groups for all five surgeons who participated (P < 0.001). In study 2, there were also significant differences in the time required for CT DICOM images to be displayed (P < 0.001).


The touchless interface proved efficient for allowing the observation of surgical images while maintaining a sterile field during surgery.

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  1. 1.

    Miyamoto R, Oshiro Y, Hashimoto S, Kohno K, Fukunaga K, Oda T, et al. Three-dimensional imaging identified the accessory bile duct in a patient with cholangiocarcinoma. World J Gastroenterol. 2014;20:11451–5.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Oshiro Y, Mitani J, Okada T, Ohkohchi N. A novel three-dimensional print of liver vessels and tumors in hepatectomy. Surg Today. 2017;47:521–4.

    Article  PubMed  Google Scholar 

  3. 3.

    Takamoto T, Hashimoto T, Ogata S, Inoue K, Maruyama Y, Miyazaki A, et al. Planning of anatomical liver segmentectomy and subsegmentectomy with 3-dimensional simulation software. Am J Surg. 2013;206:530–8.

    Article  PubMed  Google Scholar 

  4. 4.

    Lamadé W, Glombitza G, Fischer L, Chiu P, Cárdenas CE, Thorn M, et al. The impact of 3-dimensional reconstructions on operation planning in liver surgery. Arch Surg. 2000;135:1256–61.

    Article  PubMed  Google Scholar 

  5. 5.

    Rosa GM, Elizondo ML. Use of a gesture user interface as a touchless image navigation system in dental surgery: case series report. Imaging Sci Dent. 2014;44:155–60.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Oshiro Y, Yano H, Mitani J, Kim S, Kim J, Fukunaga K, et al. Novel 3-dimensional virtual hepatectomy simulation combined with real-time deformation. World J Gastroenterol. 2015;21:9982–92.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Saito S, Yamanaka J, Miura K, Nakao N, Nagao T, Sugimoto T, et al. A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation. Hepatology. 2005;41:1297–304.

    Article  PubMed  Google Scholar 

  8. 8.

    Radtke A, Sotiropoulos GC, Molmenti EP, Schroeder T, Peitgen HO, Frilling A, et al. Computer-assisted surgery planning for complex liver resections: when is it helpful? A single-center experience over an 8-year period. Ann Surg. 2010;252:876–83.

    Article  PubMed  Google Scholar 

  9. 9.

    Strickland M, Tremaine J, Brigley G, Law C. Using a depth-sensing infrared camera system to access and manipulate medical imaging from within the sterile operating field. Can J Surg. 2013;56:E1–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Ruppert GC, Reis LO, Amorim PH, de Moraes TF, da Silva JV. Touchless gesture user interface for interactive image visualization in urological surgery. World J Urol. 2012;30:687–91.

    Article  PubMed  Google Scholar 

  11. 11.

    Jacob MG, Wachs JP, Packer RA. Hand-gesture-based sterile interface for the operating room using contextual cues for the navigation of radiological images. J Am Med Inform Assoc. 2013;20:e183–6.

    Article  PubMed  Google Scholar 

  12. 12.

    Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668.

    Article  PubMed  Google Scholar 

  13. 13.

    Tan JH, Chao C, Zawaideh M, Roberts AC, Kinney TB. Informatics in radiology: developing a touchless user interface for intraoperative image control during interventional radiology procedures. RadioGraphics. 2013;33:E61–70.

    Article  PubMed  Google Scholar 

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We thank Dr. S. Kuroshima of JSPS/Chiba University for their support. We especially thank Mr. T. Sakamoto of nextEDGE Technology K.K. for the joint development of the “Dr. aeroTAP” based on the aero TAP touchless interface system originally developed by nextEDGE Technology K.K. under the joint research and development agreement between our institute and the nextEDGE Technology K.K.

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Corresponding author

Correspondence to Yukio Oshiro.

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Department of Surgery, Division of Gastroenterological and Hepato-biliary Surgery, and Organ Transplantation, Faculty of Medicine, University of Tsukuba.

Ethical standards

This study was approved by a research ethics committee at the University of Tsukuba Hospital.

Conflict of interest

We have no potential conflicts of interest to declare.

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Oshiro, Y., Ohuchida, K., Okada, T. et al. Novel imaging using a touchless display for computer-assisted hepato-biliary surgery. Surg Today 47, 1512–1518 (2017).

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  • Computer-assisted surgery
  • Hepato-biliary surgery
  • Touchless interface
  • CT