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Purpose: Augmented Reality can improve surgical planning and performance in parotid surgery. For easier application we implemented a voice control manual for our augmented reality system. The aim of the study was to evaluate the feasibility of the voice control in real-life situations. Methods: We used the HoloLens 1® (Microsoft Corporation) with a special speech recognition software for parotid surgery. The evaluation took place in a audiometry cubicle and during real surgical procedures. Voice commands were used to display various 3D structures of the patient with the HoloLens 1®. Commands had different variations (male/female, 65 dB SPL)/louder, various structures). Results: In silence, 100% of commands were recognized. If the volume of the operation room (OR) background noise exceeds 42 dB, the recognition rate decreases significantly, and it drops below 40% at > 60 dB SPL. With constant speech volume at 65 dB SPL male speakers had a significant better recognition rate than female speakers (p = 0.046). Higher speech volumes can compensate this effect. The recognition rate depends on the type of background noise. Mixed OR noise (52 dB(A)) reduced the detection rate significantly compared to single suction noise at 52 dB(A) (p ≤ 0.00001). The recognition rate was significantly better in the OR than in the audio cubicle (p = 0.00013 both genders, 0.0086 female, and 0.0036 male). Conclusions: The recognition rate of voice commands can be enhanced by increasing the speech volume and by singularizing ambient noises. The detection rate depends on the loudness of the OR noise. Male voices are understood significantly better than female voices. [ABSTRACT FROM AUTHOR]

Purpose: Augmented reality improves planning and execution of surgical procedures. The aim of this study was to evaluate the feasibility of a 3D augmented reality hologram in live parotic surgery. Another goal was to develop an accuracy measuring instrument and to determine the accuracy of the system. Methods: We created a software to build and manually align 2D and 3D augmented reality models generated from MRI data onto the patient during surgery using the HoloLens® 1 (Microsoft Corporation, Redmond, USA). To assess the accuracy of the system, we developed a specific measuring tool applying a standard electromagnetic navigation device (Fiagon GmbH, Hennigsdorf, Germany). Results: The accuracy of our system was measured during real surgical procedures. Training of the experimenters and the use of fiducial markers significantly reduced the accuracy of holographic system (p = 0.0166 and p = 0.0132). Precision of the developed measuring system was very high with a mean error of the basic system of 1.3 mm. Feedback evaluation demonstrated 86% of participants agreed or strongly agreed that the HoloLens will play a role in surgical education. Furthermore, 80% of participants agreed or strongly agreed that the HoloLens is feasible to be introduced in clinical routine and will play a role within surgery in the future. Conclusion: The use of fiducial markers and repeated training reduces the positional error between the hologram and the real structures. The developed measuring device under the use of the Fiagon navigation system is suitable to measure accuracies of holographic augmented reality images of the HoloLens. [ABSTRACT FROM AUTHOR]