Patent Publication Number: US-10314662-B2

Title: Medical device control interface

Description:
RELATED APPLICATIONS 
     The present application is a continuation of U.S. application Ser. No. 14/331,484 filed Jul. 15, 2014, the contents of which are incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The present disclosure is generally related to medical procedures using an access port, and more specifically to a medical device control interface. 
     BACKGROUND 
     Port-based surgery allows a surgeon, or robotic surgical system, to perform a surgical procedure involving tumor resection in which the residual tumor remaining after is minimized, while also minimizing the trauma to the intact white and grey matter of the brain. In such procedures trauma may occur, for example due to contact with the access port, stress to the brain matter, unintentional impact with surgical devices, and/or accidental resection of healthy tissue. 
     Minimally invasive brain surgery using access ports is a recently conceived method of performing surgery on brain tumors previously considered inoperable. To address intracranial surgical concerns, specific products such as the NICO BrainPath™ port have been developed for port-based surgery. 
     Referring to  FIG. 1 , the insertion of an access port into a human brain is shown for providing access to internal brain tissue during a medical procedure. In  FIG. 1 , access port  100  is inserted into a human brain  12 , providing access to internal brain tissue. Surgical tools and instruments may then be inserted within the lumen of the access port in order to perform surgical, diagnostic or therapeutic procedures, such as resecting tumors as necessary. 
     As seen in  FIG. 1 , port  100  comprises of a cylindrical assembly formed of an outer sheath. Port  100  may accommodate an introducer which is an internal cylinder that slidably engages the internal surface of port  100 . The introducer may have a distal end in the form of a conical atraumatic tip to allow for insertion into the sulcal folds of the brain  12 . Port  100  has a sufficient diameter to enable bimanual manipulation of surgical tools within its annular volume such as suctioning devices, scissors, scalpels, and cutting devices. 
     Referring to  FIG. 2 , an exemplary navigation system is shown to support minimally invasive access port-based surgery. As shown in  FIG. 2 , a surgeon  103  conducts a minimally invasive port-based surgery on a patient  120  in an operating room (OR) environment. A navigation system  107  comprising an equipment tower, tracking system, displays and tracked instruments assists the surgeon  103  during his procedure. An operator  121  is also present to operate, control and provide assistance for the navigation system  107 . 
     A foot pedal  155  is placed near the surgeon&#39;s foot and is utilized to actuate different elements during the procedure. For example, foot pedal  155  may be used to lift or lower the surgical bed, or control zoom of the navigation system  107  or tracking system. In certain instances, multiple foot pedals may be deployed. 
     Conventional foot pedals used by a surgeon during a surgical procedure, particularly when multiple foot pedals are used, can be a distracting and menial task, given the surgeon must sometimes remove his focus from the surgical field of interest, resulting in the surgeon having to reorient himself when his attention is returned. Therefore, there is an opportunity for improvement in the area of surgical controls. Thus, there is a need for mechanism to provide improved functionality and replacement of the foot pedal. 
     SUMMARY 
     One aspect of the present description provides an interface component for use with a first glove and a medical equipment component. The interface component comprises at least one switch located on the first glove, where each of the at least one switch provides a control signal to the medical equipment component. The interface component may further comprise a controller coupled to the at least one switch, a power supply module coupled to the controller, and a wireless communications interface coupled to the controller in communication with a wireless interface of said medical equipment component. 
     In one example, the first glove includes a surgical glove and the interface component is integrated into the surgical glove. In another example, the first glove is designed to be used with a second surgical glove and the first glove is wearable underneath the second surgical glove. In yet another example, the first glove is designed to be used with a second surgical glove and the first glove is wearable over top of the second surgical glove. 
     Another aspect of the present disclosure provides an interface component for use with a surgical glove and a medical equipment component. The interface component comprises at least one switch located on the interface component, each of the at least one switch providing a control signal to the medical equipment component. The interface component is wearable on a hand of a surgeon either over top of or underneath the surgical glove. 
     A further understanding of the functional and advantageous aspects of the disclosure can be realized by reference to the following detailed description and drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Embodiments will now be described, by way of example only, with reference to the drawings, in which: 
         FIG. 1  illustrates the insertion of an access port into a human brain, for providing access to internal brain tissue during a medical procedure; 
         FIG. 2  shows an exemplary navigation system to support minimally invasive access port-based surgery; 
         FIG. 3  is a diagram illustrating components of an exemplary surgical system used in port based surgery; 
         FIG. 4  illustrates various foot pedals and foot positioning of surgeons during commonly performed neurosurgeries; 
         FIG. 5  illustrates an exemplary surgical glove interface; 
         FIG. 6  is block diagram showing an exemplary navigation system or surgical system which may be used with the surgical glove interface shown in  FIG. 5 ; 
         FIG. 7  shows a number of tables describing input commands for exemplary surgical instruments that can be coupled with the surgical glove interface shown in  FIG. 5 ; 
         FIG. 8  is a flow chart describing the general steps in a port based neurosurgical procedure; 
         FIG. 9  is a chart illustrating features of various embodiments of the surgical glove interface when used in a surgical context; 
         FIG. 10  shows another exemplary surgical glove interface according to aspects of the present disclosure; and 
         FIG. 11  shows yet another exemplary surgical glove interface according to aspects of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     Various embodiments and aspects of the disclosure will be described with reference to details discussed below. The following description and drawings are illustrative of the disclosure and are not to be construed as limiting the disclosure. Numerous specific details are described to provide a thorough understanding of various embodiments of the present disclosure. However, in certain instances, well-known or conventional details are not described in order to provide a concise discussion of embodiments of the present disclosure. 
     As used herein, the terms, “comprises” and “comprising” are to be construed as being inclusive and open ended, and not exclusive. Specifically, when used in the specification and claims, the terms, “comprises” and “comprising” and variations thereof mean the specified features, steps or components are included. These terms are not to be interpreted to exclude the presence of other features, steps or components. 
     As used herein, the term “exemplary” means “serving as an example, instance, or illustration,” and should not be construed as preferred or advantageous over other configurations disclosed herein. 
     As used herein, the terms “about” and “approximately” are meant to cover variations that may exist in the upper and lower limits of the ranges of values, such as variations in properties, parameters, and dimensions. In one non-limiting example, the terms “about” and “approximately” mean plus or minus 10 percent or less. 
     Unless defined otherwise, all technical and scientific terms used herein are intended to have the same meaning as commonly understood to one of ordinary skill in the art. Unless otherwise indicated, such as through context, as used herein, the following terms are intended to have the following meanings: 
     As used herein, the phrase “access port” refers to a cannula, conduit, sheath, port, tube, or other structure that is insertable into a subject, in order to provide access to internal tissue, organs, or other biological substances. In some embodiments, an access port may directly expose internal tissue, for example, via an opening or aperture at a distal end thereof, and/or via an opening or aperture at an intermediate location along a length thereof. In other embodiments, an access port may provide indirect access, via one or more surfaces that are transparent, or partially transparent, to one or more forms of energy or radiation, such as, but not limited to, electromagnetic waves and acoustic waves. 
     As used herein the phrase “intraoperative” refers to an action, process, method, event or step that occurs or is carried out during at least a portion of a medical procedure. Intraoperative, as defined herein, is not limited to surgical procedures, and may refer to other types of medical procedures, such as diagnostic and therapeutic procedures. 
     The use of switches in presently performed surgical procedures is a useful feature for convenient control of the surgical devices and systems involved. However, presently available actuation devices result in inefficiencies that must be overcome by the surgeon and/or surgical team. Examples of such inefficiencies will be described below. 
     There are many sources of ergonomic issues encountered during common thoracic surgeries shown using foot pedals. The use of foot pedals creates problems associated with physical, perceptual, and cognitive use. The present application aims to address these problems and others associated with presently used actuation or control devices. 
     In an ideal surgical procedure, a surgeon will minimize the amount of time in which his focus is away from the surgical site of interest. This includes minimizing the time during which the surgeon is not viewing the surgical site of interest as well as the time during which the surgeon is not in the bimanual procedural position or any other potential instance which can be avoided to minimize the time required for the surgery. When utilizing a foot pedal switch as described above, inefficiencies can be attributed to the situations described below. 
     Referring now to  FIG. 3 , a diagram is shown illustrating components of an exemplary surgical system such as the medical navigation system  107  used in port based surgery. Reference is also made to  FIG. 4 , which shows various foot pedals and foot positioning of a surgeon during commonly performed surgeries. In one instance the surgeon may have to reposition one or more foot pedals  155  when he changes his orientation relative to the patient during surgery, indicated by reference  300  ( FIG. 4 ). When this occurs, the surgeon&#39;s focus is removed from the surgical area of interest to correctly reposition the foot pedal  155 . In addition, this may also require the surgeon to remove his tools from the bimanual procedural position as well. 
     During a medical procedure a surgeon may have to use the foot pedals  155  in an inopportune (e.g., non-ergonomic) position. Various operating stances can require the surgeon to position himself awkwardly and therefore make the use of a pedal inefficient and difficult to do with accuracy. In one example, the surgeon may be leaning over the patient requiring the surgeon to fully extend his leg and even have to stand on his toes. It is apparent that in such a stance the resulting positioning of the foot would make it difficult for the surgical personnel to operate the foot pedal because in such a position the heel of the foot would be elevated from the ground. Even if the foot is located on the ground, but is fully extended, the ball of the foot will be difficult to use in a flexion as it would be required for stability of the surgeon. Therefore, using the foot to operate the foot pedal in such a position would reduce the amount of precision when engaging the foot pedal through a plantar flexion movement. This situation may also require the surgeon to move the pedal(s)  155  positioning on the floor of the operating room resulting in increased time required for the surgical procedure and hence decreasing efficiency of the operation. 
     The surgeon may also have to use multiple foot pedals  155  during a surgical procedure requiring him to differentiate between foot pedals through proprioception, estimated foot pedal placement knowledge, and his sense of touch as opposed to knowing with a greater certainty the location of the pedal  155  he wants to actuate relative to his foot position. This estimation of pedal  155  location using touch and proprioception may also be inhibited by the wearing of shoes. If the surgeon is unable to locate the pedal  155  using the three senses mentioned, the surgeon will be again required to remove his focus from the surgical site of interest and his tools from the bimanual procedural position in order to do so. It should be noted that this is a consequence of free placement of the pedals  155  on the floor, since the pedals  155  aren&#39;t placed at a “known” relative position (e.g., a position relative to the surgical bed or area of interest) that the surgeon could intuitively find using touch or proprioception knowledge in combination with previous surgical experience. Other issues in locating and engaging the foot pedal(s)  155  may be caused when the foot pedal  155  is placed under the surgical bed, where it would be out of site of the surgeon and may require the surgeon to spend more time locating the pedal(s)  155  as opposed to being positioned in clear site. 
     At points during the surgery the surgeon may have to stand and utilize motor functions in both his arms and legs to position a medical device and actuate it simultaneously using the foot pedal  155  respectively. This may be an inefficient way for the surgeon to operate a device as the simultaneous actuation of a foot pedal  155  and precise arm movement is not an intuitive function for most individuals. 
     The use of a foot pedal  155  in a surgical procedure may also impose additional wiring on the floor of the surgical suite, resulting in increased tripping hazards in the operating room, which are dangerous and may cause serious harm to the patient if surgical personnel were to trip over such wiring. 
     An alternate procedural element actuation device utilizes a tool with an attached or integrated switch such as the Stryker Smart Instruments. When using such a tool, inefficiencies may occur in the following contexts. The tool may have a limit on its available area for a given user interface control containing switches for manipulation of elements used during the surgical procedure. Reasons for such limits relate to the user interface being integrated into the tool as opposed to a separate control user interface. Since surgical tools are precise instruments to be manipulated by the surgeon, their weights, sizes, and overall features greatly affect the dexterity of the surgeon. Therefore, increasing the size of the user interface control area for more numerous and/or larger more easily identifiable and accessible buttons may result in heftier instruments again reducing the precision of the surgeon when using the tool. Additionally, when tools are engaged in minimally invasive surgeries, the tools must be manipulated within a small corridor. In this context increasing the size of the tool may not be feasible as it may occlude the view down the corridor or become too large as to restrict access of the tool into the corridor. Alternate issues are associated with placing an electronic user interface on a surgical tool. The electronics must be designed to withstand commonly used sterilization processes. Viable ways of achieving such an ability to withstand sterilization require the electronics to be bulkier and heavier than their non-integrated counterparts (e.g., the tool without the user interface controller) as sterilization occurs at high temperatures and pressures. Specifically, when sterilizing medical instruments using the autoclaving technique the instruments must withstand temperatures of 121 C-190 C and pressures of 15 psi-40 psi. 
     The manufacture and purchase of tools with built in user interfaces is also problematic. Multiple surgical tools each having a built in user interface (UI), for example, both a resection tool and bipolar pituitary forceps, to be used within a surgical procedure will likely be more costly than having a single surgical glove interface that can be integrated with all potential tools the surgeon may use. An advantage to using a single entity surgical glove interface disclosed herein is that the surgical glove interface may be configured to adaptively switch output selection such that the detection of the tool being used by the system sets the output of each of the buttons, as opposed to having a separate user interface on each medical tool as would be required by a surgical tool with a built in user interface. 
     When utilizing a kinect based gesture control user interface to control surgical procedural elements, inefficiencies can occur in the following contexts. Such a user interface control requires the surgeon to remove his hands from the bimanual procedural position when performing the gestures required to control the user interface. In addition to this requirement, the surgeon must perform an initial gesture to initiate the Kinect sensors and begin controlling the user interface which in turn increases the time required for the surgery as opposed to being able to constantly control the interface. A consequence of this user interface control system is that the surgeon has to remove his attention from the surgical site of interest (or equivalently a display of the surgical site of interest) when performing gestures to control the system. This results in the surgeon having to directionally reorient himself with the display of the surgical site of interest with respect to the spatial orientation of the patient in the operating room when returning to the bimanual procedural position, which will also result in an increase of the total time of the surgical procedure. Since the Kinect sensor is a detector with an inherent field of view, the surgeon may additionally have to reposition himself away from his surgical procedural stance in order to enter the correct field of view, to gain full control over the functionality of the user interface. 
     Referring back to  FIG. 3 ,  FIG. 3  illustrates a medical navigation system  107  having an equipment tower  101 , a tracking system  113 , a display  111  (e.g., to show a graphical user interface), an intelligent positioning system  175  and tracking markers  165  used to track medical instruments or an access port  100 . Tracking system  113  may be considered an optical tracking device or tracking camera. 
     In  FIG. 3 , a surgeon  103  is performing a tumor resection through a port  100 , using an imaging device  104  to view down the port at a sufficient magnification to enable enhanced visibility of the instruments and tissues. The imaging device  104  may be an exoscope, videoscope, wide field camera, or an alternate image capturing device. The imaging sensor view is depicted on the visual display  111  which the surgeon  103  uses for navigating the port&#39;s distal end through the anatomical region of interest. The foot pedal  155  is located in an accessible vicinity to the surgeon&#39;s foot and is utilized to actuate an element used in the procedure. 
     The intelligent positioning system  175  receives as input the spatial position and pose data of the automated arm  102  and target (for example the port  100 ) as determined by tracking system  113  by detection of the tracking markers  165  on a wide field camera and the port  100 . 
     The foot pedal  155  is located in an accessible vicinity to the surgeon&#39;s foot. Foot pedal  155  may be used to actuate an element used in the procedure such as a neurosurgical drill, an illumination source, automated arm movement, a UI configuration, a resection device, an irrigation device, an imaging procedure, an imaging acquisition, a change of phase during surgery, or any other element requiring actuation during a surgical procedure. Foot pedal  155  may have multiple activation input configurations or modes as described in the following examples. 
     A first input configuration (or first mode) includes a binary switch mode in which a press of foot pedal  155  causes the foot pedal  155  to output a signal which actuates the state of a procedural element from “on” to “off” position. A second input configuration (or second mode) is a variable switch mode in which the output signal of the foot pedal is proportional to the degree of force applied to the pedal by the user. A third input configuration (or third mode) may be a multiple switch mode in which a press of the foot pedal cycles the element through various modes of function (i.e. modes of function of the element). It should be noted that all switches mentioned in this disclosure can be formed of any mechanism to allow for control of or actuation of a device. 
     These input configurations can also be implemented in combinations provided the system utilizes more than one foot pedal as shown as  310  in  FIG. 4 . For example, given two foot pedals as shown in  FIG. 4 , combinations can be two binary switches, in which the combined activation of both foot pedals can result in an alternate output from the output of each foot pedal activated individually. Another example combination using two foot pedals can be two multiple switch modes in which the foot pedal outputs when both are activated can be different from when the pedals are activated individually. Another example using two foot pedals would be a binary switch and a multiple switch in which the output of the activation of both foot pedals may be different than when the pedals are activated individually. 
     According to one aspect of the present description, a surgical glove interface described herein allows a surgeon to increase the efficiency of surgical procedures using the presently available tools and systems. 
     Referring to  FIG. 5 , an exemplary surgical glove interface  500  is shown according to one aspect of the present disclosure. The surgical glove interface  500  aims to provide a more efficient user interface control than those mentioned above, which may take advantage of the bimanual procedural position and commonly used finger positioning of a surgeon holding a surgical tool. 
     Typically, when performing a surgery, the surgeon&#39;s pinky and ring finger are located near the palm, while the thumb index and middle fingers are used to manipulate the tools on both hands. Given the pinky and ring fingers are free, the glove can be situated with a user interface positioned on the palm, as shown by reference  504 , to allow the free fingers to press switches of the surgical glove interface  500 , as illustrated by arcs  520  and  525 . 
       FIG. 5  depicts an exemplary embodiment of such an interface where the switches of the interface are integrated into the glove at the positioning where the ring and pinky fingers are located during surgery in region  504  during three finger bimanual manipulation of surgical tools. In  FIG. 5 , the switches are formed of four buttons ( 502 ,  505 ,  510 , and  515 ), which in one example may each have an individual tactile pattern for easier differentiation. 
     The use of the surgical glove interface  500  may eliminate the need for the surgeon to utilize his eyes to locate a switch, such as in the case of foot pedals and the tool integrated controller user interface as described above, as the controller of the surgical glove interface  500  may be located in an easily accessible vicinity to the surgeon&#39;s ring and pinky fingertips throughout the performance of the surgery. This makes determining the position of the interface and associated switches  502 ,  505 ,  510 ,  515  simply a matter of using the proprioception sense. In contrast, both the use of the foot pedal and the tool integrated user interface would require the surgeon to estimate the relative location of the switches on the foot pedal and the tool respectively relative to the engaging body part (e.g., the surgeon&#39;s foot and finger(s) respectively) in addition to using proprioception. The use of the surgical glove interface  500  may also substantially reduce or eliminate the need for the surgeon to retract the tools from the bimanual procedural position prematurely during the surgery to allow for control of the user interface, such as when using the Kinect user interface controller. 
     A disadvantage of a tool integrated user interface controller is that it may require the surgeon to alter his finger positioning to engage the relevant switches while performing surgery. This may reduce the surgeon&#39;s precision with the tools as the finger positioning is not optimized for dexterity. In contrast, the surgical glove interface  500  depicted in  FIG. 5  does not require the surgeon to substantially alter his finger positioning to engage the relevant switches  502 ,  505 ,  510 ,  515  while performing surgery. It should be noted that this positioning involves using the index finger, middle finger, and thumb to manipulate the tool while the ring finger and pinky fingers are retracted into the palm. The advantage of utilizing the surgical glove interface  500  is important as it allows the surgeon to freely manipulate the tools with maximized precision, as opposed to manipulating the tools with inopportune finger positioning as in the conventional solutions. The location of the region  504  of button interface depicted in  FIG. 5  is aimed to be an ergonomic position and hence also allows the surgeon to remain comfortable throughout the procedure reducing fatigue in the surgeon&#39;s hands while providing gains of in-hand control of procedural elements. 
     The use of the surgical glove interface  500  may be implemented for multiple tools in a single surgical procedure where the surgical glove interface  500  configuration will change depending on what tools are used. This may make the surgical glove interface  500  a more economically viable option than having multiple tools with integrated user interface controllers. 
     As mentioned above, having a tool integrated user interface controller decreases the tools precision as a result of various dimensional considerations such as size of an access corridor in a minimally invasive surgery, increased dimensions of the tool, such as weight, height, length, width, etc. In contrast, when using the surgical glove interface  500 , the interface is situated on the palm of the surgeon, and therefore adding or reducing the features of the interface, such as a touch pad (described below), buttons, etc., do not affect the precision of the tool being used. In addition, the palm of a surgeon will generally have more available space in comparison to a surgical tool handle (e.g., without integrated user interface controller) allowing for a larger user interface controller area. 
     When presently performing surgery many surgeons utilize a foot pedal while simultaneously maneuvering their surgical tools in the surgical area of interest, for example when resecting a tumor a surgeon will control the removal rate of the resection device with his foot and the resection device&#39;s position in the surgical area of interest with his hand, inclusive of the arm. In general, a surgeon&#39;s fingers are more agile and precise in applying force than his foot. The surgical glove interface  500  takes advantage of this fact and allows both the positioning of the tool and its control user interface to be managed by the hand of an individual surgeon. Also, since the surgical glove interface  500  is not located on the ground, the additional hazardous wiring mentioned above will be alleviated in the operating room. 
     Referring to  FIG. 6 , a block diagram is shown illustrating an exemplary medical navigation system  600  that may be used in the systems shown in  FIGS. 2 and 3 , and may also be used with the surgical glove interface  500  shown in  FIG. 5 . An example embodiment of a medical navigation system  600  inclusive of an exemplary surgical glove interface  500  disclosed herein is provided in  FIG. 6  in a block diagram. The exemplary surgical glove interface  500  is illustrated by reference  620  in  FIG. 6 . Surgical glove interface  620  (also referred to hereafter as an interface component  620 ) contains a controller  622 , emergency stop  601 , switches  615 , power source or power supply module  625 , and a wireless communications interface  605  (which, in one example, maybe a Bluetooth transmitter). The exemplary power supply module  625  may be portable and rechargeable and may be connected to each of the other exemplary components of the interface component  620 . The exemplary surgical glove interface  620  may function in the manner described as follows. 
     When the switch  615  is triggered, switch  615  provides a control signal  675 , which corresponds to a command to the controller  622 . The controller  622  then encodes the control signal  675  into a digital signal  623  and relays this digital signal to the wireless communications interface  605 . This signal is then encoded and relayed by the wireless communications interface  605  over a radio frequency wireless communication channel  680  using, for example, Bluetooth protocol. The output signal is then received by a wireless interface  610 , which in one example may be a Bluetooth transceiver employing the Bluetooth protocol, and is decoded and relayed to the medical navigation system controller  660 . The medical navigation system controller  660  then reads the control signal  675  and outputs the corresponding control signals  665  to the various devices used in the medical procedure. While a Bluetooth protocol is provided as an example, any suitable wireless communications system and protocol may be used to meet the design criteria of a particular application, such as Wi-Fi, irDA, or any other suitable system and/or protocol. 
     The medical navigation system  600  may further interface with tracked tools  645  and control optical electronics or light sources  655  using control signal  665  provided to the optical payload  650 . 
     Examples of various devices  635  and their exemplary command inputs are depicted in the charts shown in  FIG. 7  and are described in detail as follows. Chart  700  describes exemplary surgical glove interface  500  output commands that can be used to control the listed surgical tools. An exemplary surgical tool that is commonly utilized in surgery is the bipolar forceps (e.g., electrocautery device), with which a surgeon is able to cauterize vital blood vessels to prevent excessive bleeding. A command that can be actuated using the surgical glove interface  500  (e.g., as depicted in  FIG. 5 ) would be to activate the forceps for cauterization, such as by applying a voltage across the separated tips. A second commonly used surgical tool would be a resection device. The surgical glove interface  500  can be used to implement commands to this device such as the implemented suction force and whether the device is in tissue removal mode (e.g., tissue removal blade activated) or tissue manipulation mode (e.g., tissue removal blade deactivated). The suction force command will determine at what rate tissue will be resected by the device while the removal mode command will indicate to the device to cut the tissue or not. The resection tool commands are analogous to the third surgical tool, the neurosurgical drill, which may also be controlled by the surgical glove interface  500  by the surgeon. Commands for this device may turn the drill on and off and may also dictate the speed of the drill as to minimize trauma to the patient in the form of vibrational pressure and increase the drill&#39;s effectiveness. Another exemplary surgical tool that may be controlled by the surgical glove interface  500  is a Raman imaging probe. The surgical glove interface  500  may send commands via the various controllers  622 ,  660  to this device to dictate its acquisition rate, its acquisition area, its acquisition wavelength band, and when it acquires data. 
     Referring now to  FIG. 7 , a number of tables are shown describing input commands for exemplary surgical instruments that can be coupled with the surgical glove interface  500  shown in  FIG. 5 . Chart  705  in  FIG. 7  describes specific surgical glove interface  500  output commands that can be implemented by the medical navigation system  600  graphical user interface (GUI). These commands have various functions that can allow the surgeon to remotely manipulate, navigate, and utilize the GUI without having to remove tools from the bimanual procedural position. The four exemplary commands depicted in the chart will be described in more detail as follows. The first command, scroll, can be used to scroll through various menus on the UI such as “Choose Display Image”, “Display Options”, “Display Configurations”, “Next Phase”, etc. These various options can be chosen using the scroll select command, and may result in an additional drop down menu that can be scrolled through and selected using the same system of commands (i.e. scroll and scroll select). An example additional drop down menu for “Display Options” may be comprised of the following options “Brightness”, “Contrast”, “Colour Balance”, etc. and can be used to configure the picture properties displayed on the screen. Additional commands that can be implemented by the surgical glove interface  500  can be used to directly actuate the GUI to execute an option or configuration. Given a surgical glove interface  500  such as depicted in  FIG. 5 , each button may be used to actuate a different option or configuration of the GUI directly. For example, buttons  505  and  510  may be used to configure the GUI in “Fine Resection Phase” and “Cannulation Phase” layouts as predetermined by the system. For example, in the “Cannulation Phase” layout the GUI may automatically display the depth that the port  100  is penetrated into the brain. The alternative buttons  502  and  515  may be used to directly auto adjust the brightness of the display and scroll through displayed images such as a T1, T2, and DTI. 
     In addition to or in place of the buttons  502 ,  505 ,  510 ,  515  shown in the surgical glove interface  500 , a joy stick, touch pad, directional pad, or scroll pad may be used on the surgical glove to allow the user to navigate the GUI using a cursor as opposed to iteratively scrolling through options using a button switch. 
     Chart  710  describes specific surgical glove interface  500  output commands that may be used to control an imaging device  104  ( FIG. 3 ). These commands have various functions that can allow the surgeon to manipulate and configure the imaging device to acquire desired intraoperative imaging, without having to remove his tools from the bimanual procedural position at the surgical area of interest. The four exemplary commands depicted in the chart will be described in more detail as follows. The first command scroll can be used to scroll through various options of the imaging device such as “Zoom”, “Imaging Mode”, “Illumination”, “Next Phase”, etc. These various options can be chosen using the scroll select command, and may result in an additional drop down menu if selected that can be scrolled through and selected using the same system of commands. An example additional drop down menu for “Imaging Mode” may be comprised of the following additional options “Visible”, “NIR”, “Hyperspectral”, etc. If any of the mentioned exemplary drop down menu commands are selected the imaging device will begin to image in the selected mode. Additional commands that can be implemented by the surgical glove interface  500  can be used to directly actuate the imaging device to execute an option or configuration. For example, buttons  505 ,  510 , and  515  shown in  FIG. 5  may be used to directly configure the imaging device in “NIR”, “Hyperspectral”, and “Visible Light” imaging modes as predetermined by the system. The alternate button  502  may be used to directly automatically adjust the illumination spectrum to optimize the colour balance. 
     Chart  715  describes specific surgical glove interface  500  output commands that can be used to control an automated arm  102  ( FIG. 3 ). These commands have various functions that can allow the surgeon to manipulate and configure the automated arm to mobilize in a particular manner of movement, without having to remove the tools from the bimanual procedural position at the surgical area of interest. The two exemplary commands depicted in the chart will be described in more detail as follows. The first command actuate can be used to scroll through two movement options listed as “Coaxial Alignment” and “Cannulation Alignment”. These movement options will result in the automated arm coaxially aligning with the port  100  or aligning at a predetermined angle to the port  100  optimized for cannulation into the brain respectively. The second command “control” can be used to manually position the arm through the use of a controller located on the surgical glove interface  500 , such as a joystick, a directional pad, or a touch pad. 
     In another example, the switches  502 ,  505 ,  510 ,  515  may be manufactured with physical patterns that can be used to differentiate between the buttons using touch, for example a textured surface for tactile identification by a wearer. In the example depicted in  FIG. 5 , the buttons  502 ,  505 ,  510 , and  515  were produced with physical patterns that can be used to identify, through the sensation of touch, each button uniquely. This is advantageous because it allows the surgeon to readily determine which button he is pressing with reduced chance of the surgeon removing his visual focus from the surgical site of interest because the buttons  502 ,  505 ,  510 , and  515  are strategically placed so the buttons  502 ,  505 ,  510 ,  515  may be easily located using proprioception and easily identified given the patterns render them differentiable through the sensation of touch. 
     Referring to  FIG. 8 , a flow chart is shown describing a method  800  illustrating the general steps in a port based neurosurgical procedure. An example phase breakdown of the port based surgical operation mentioned is shown in  FIG. 8 . A description of an exemplary surgical glove interface  500  corresponding applicability in each of the phases is provided below. The description exemplifies the use of the surgical glove interface  500  in streamlining the surgical process during each phase. 
     At  810 , the first phase in the port based neurosurgical procedure is the incision of the scalp and craniotomy. During this stage, the surgical glove interface  500  depicted in  FIG. 5  can be implemented to control the neurosurgical drill. Exemplary commands provided by the surgical glove interface  500  to be configured with the drill are shown in chart  700  in  FIG. 7  and described above in further detail. 
     At  820 , once the incision and craniotomy are completed, the surgery enters the “Guidance of Access Port” phase and the surgical glove interface  500  can be implemented to control the automated arm  102  ( FIG. 3 ). During this phase the port is penetrated into the brain until it reaches the target (e.g., usually a tumor) depth. Exemplary commands the surgical glove interface  500  may be configured to provide to the automated arm are shown in chart  710  in  FIG. 7  and are described above in further detail. One specific command relevant to this phase of the surgery may be “Activate cannulation alignment movement”. This command when activated by the surgeon will cause the automated arm to align at such a position to allow the imaging device to view the cannulation of the port at an angle. This would expose the graduation marks on the port to the surgeon to inform him of the depth of the port penetrated within the brain. 
     In the next phases  830  and  840 , which are usually simultaneous, the surgical glove interface  500  shown in  FIG. 5  may be used to aid in both the resection control during gross de-bulking of unhealthy brain tissue as well as imaging control in case an alternate imaging modality may be required. During these steps, the surgeon  103  may activate the surgical glove interface  500  to control a resection tool suction speed when resecting unhealthy tissue, as shown in chart  700  in  FIG. 7 . An exemplary resection tool is the Myriad™ produced by NICO. An additional control the surgeon has over a resection tool is the ability to activate and deactivate the device as required. The second simultaneous step in this procedure is managing any bleeding that may occur within the surgical area of interest. During surgery a common occurrence is the rupturing of a blood vessel. If such a situation occurs, heavy bleeding precedes it, which can be problematic for viewing the surgical area of interest and closing the wound accordingly. The surgical glove interface  500  can be utilized in this situation to configure the imaging device to utilize near infrared (NIR) imaging. The advantages of NIR imaging when viewing blood is its increased penetration depth in blood, rendering it more transparent when compared to imaging using visible light. 
     After the bulk resection phase the surgical procedure enters the next two phases of fine-resection  860  and bleeding management  850 , which are usually done simultaneously. In these phases, the surgeon removes the tumor from the fringes of healthy tissue, by differentiating, using his knowledge, between the healthy and unhealthy tissue. During fine-resection, the surgical glove interface  500  may be configured to implement the Raman probe surgical tool to acquire spectrums and utilize the spectrums to differentiate more effectively between healthy and unhealthy brain tissue at the boundary of a tumor  102 , for example. Exemplary commands of such a device are provided in chart  700  in  FIG. 7  and described above in further detail. Another tool that can be actuated using the surgical glove interface  500  to manage bleeding once the source is located is the electrocautery tool. This tool can be used to cauterize a blood vessel or other bodily tissue to effectively close the wound. Exemplary commands that can be integrated into the surgical glove interface  500  for this tool are also depicted in chart  700  in  FIG. 7  and are described above in further detail. 
     At  870 , the next phase of surgery, tissue margin treatment involves delivering therapeutic agents to the surgical site to treat any remaining unhealthy tissue in the area and assure an optimal recovery of the patient. The surgical glove interface  500  may be implemented in this step to control a device to deliver a therapeutic solution. In this example, the surgical glove interface  500  may be used to configure the device to deliver a specific type of therapeutic solution. In another example, the surgical glove interface  500  may be used to control the GUI to create a mixture of the correct solution similar to a user interface control device such as a computer mouse. 
     At  880 , the final step involves the removal of the port and closure of the wound in addition to the application of materials to assist in healing the surgical area. In this step the surgical glove interface  500  may be used to control an irrigation device to clean the surgical area of interest before the surgeon exits. Exemplary commands that can be integrated into the surgical glove interface  500  for this tool are provided in chart  700  shown in  FIG. 7  and are described above in further detail. 
     While a number of examples of commands are provided that can be implemented using the surgical glove interface  500 , the controller  622  and the medical navigation system  600  can be configured to implement any suitable control configuration for any number of medical tools or equipment according to the design criteria of a particular application. 
     While the surgical glove interface  500  described above allows for improved efficacy of surgical procedures, instruments in the surgical suite should adhere to minimum standards and requirements to be implemented safely. In particular, there exist design considerations that must be taken into account to allow for the glove  500  to improve the efficacy of surgical procedures as mentioned. 
     Referring to  FIG. 9 , some exemplary non-limiting considerations are provided in the table  900 . In particular, the interface  500  to be applied to a surgical glove may be integrated: (a) on top of a presently used surgical glove, (b) into a surgical glove, or (c) below or underneath a surgical glove. 
     The first row of the table  900  refers to the need to sterilize the surgical glove interface  500  before use by the surgeon. This requirement stems from the fact that a strict requirement during surgical procedures is the sterility of the environment around the patient. Any equipment and personnel in and around the patient must adhere to these strict sterility standards to ensure no diseases are transferred to the patient through their open wounds. This results in the application of harsh but effective sterilization methods to equipment used directly on or within the vicinity of the surgical site of interest. The most common sterilization method used presently in hospitals is autoclaving. This method involves exposing all equipment to steam under high temperature and pressure. Given the pressures and temperatures in this process can reach up to 40 psi and 375° F., this method can be problematic for any materials without the required structural integrity. 
     Since the example of the surgical glove interface  500  being integrated below or underneath a surgical glove results in the surgical glove interface  500  not being in direct contact with the patient, the sterilization requirement can be omitted. Alternatively, since both the example of the surgical glove interface  500  being integrated on top of a surgical glove and into a surgical glove may result in some of the parts being exposed to the area around the patient when the glove is in use, these surgical glove interfaces  500  may have to be sterilizable. 
     In the case of the autoclave example mentioned above, surgical glove interfaces  500  must be able to withstand 40 psi and 375° F. Since the surgical glove interfaces  500  may involve the use of electronics for functionality, the electronic components must be either shielded from the mentioned environmental factors or able to withstand these factors. Some examples of shielding components that can be used in conjunction with electronics are provided by Schott North America Inc.™. Particular considerations for the surgical glove interface  500  being integrated into a surgical glove design is the sterilization barrier and methods of manufacturing such a connection. The sterilization barrier refers to the connection of two materials and how that connection is ensured to be sterile and preventative of disease passing from one side of the barrier to the other. In one example, this may be a barrier between a button and the surgical glove interface. Other requirements for sterility include ensuring the barrier of the glove does not tear. 
     The second row of the table  900  in  FIG. 9  refers to the structural integrity of the glove that must adhere to particular standards to be utilized in the surgical suite. This requirement is a result of sterility requirement, explained above. To preserve sterility the glove must not tear from regular use, the specific requirements of which are well documented and known to those skilled in the relevant arts. For example, the minimum tensile strength of synthetic rubber gloves may be 17 MPa and the minimum ultimate elongation may be 650%. Therefore, when designing the surgical glove interface  500  described herein, the mentioned mechanical properties may adhere to the known minimum requirements. Another result of these requirements is that any surgical glove interface  500  should not cause the mechanical properties of the glove with which it is used to be jeopardized. Example considerations may include smooth device edges to prevent catching of the glove on the edges resulting in accidental tearing. 
     The third row of the table  900  in  FIG. 9  refers to the desire to conserve the dexterity of the surgeon. During surgical procedures, minimizing the hindrance of a surgeon&#39;s dexterity when using his surgical tools is a high priority. Various design parameters can be implemented to meet this priority with respect to the surgical glove interface  500 , disclosed herein. Example parameters which optimize dexterity of the surgeon when utilizing the surgical glove interface  500  are provided as follows. Firstly, the surgical glove interface  500  may provide the surgeon functionality with his hands that most closely mimics the surgeon&#39;s functionality with his hands without the use of the surgical glove interface  500  (such as making the glove very thin and light). This parameter allows the surgeon greater comfort in movement and maneuverability of his hands without having to adjust his motor control for less flexibility and also allows the surgeon the greatest use of his touch sense to maneuver any tissues and surgical instruments he may be operating with. Secondly, the surgical glove interface  500  may provide improved grip, which increases the surgeon&#39;s ability to precisely maneuver any surgical instruments and tissues the surgeon operates on, for example loss of grip due to fluid on the hands such as sweat, blood, or other bodily fluids. Presently manufactured surgical gloves address these needs by providing gloves made of a material to minimize thickness, maximize flexibility, maximize grip, and adhere to the structural integrity required to resist active wear and tear over a single surgery. Thinner gloves allow for a better sense of feel as there is less material between the hands and the object and therefore perturbations of the surface of the glove are more easily transferred through the material. Choosing a glove with the correct material composition may allow the glove to be flexible enough so as to not restrict the surgeon&#39;s movement, have a stronger grip depending on its surface friction, and adhere to structural integrity requirements to not endanger the sterility barrier by accidental tearing through regular use. 
     Given that the fingers are the part of the hand most associated with dexterity when utilizing surgical tools to perform operations, it would also be advantageous to provide a surgical glove interface  500  that leaves the finger segments of the glove unobstructed, as discusses below in connection with  FIGS. 10 and 11 . 
     The fourth row of the table  900  in  FIG. 9  refers to the desire to reduce the amount of fatigue experienced by the surgeon during a surgical operation. This consideration in the design of the surgical glove interface  500  disclosed herein may refer to the weight of the glove in that heavier gloves would result in the surgeon&#39;s arms becoming fatigued faster as compared to using a glove of lesser weight. While including a device on the surgical glove interface  500  will definitively increase the weight of the surgical glove interface  500 , minimizing this weight to not significantly increase the weight from the presently used gloves would result in an optimal outcome of the design. 
     The fifth row of the table  900  in  FIG. 9  refers to the desire to maximize the tactical feel of any switches located on the surgical glove interface  500 . Given the surgical glove interface  500  disclosed herein may involve the use of touch for actuation of the switches  502 ,  510 ,  515 ,  520 , tactile feel becomes an important consideration when designing a surgical glove interface  500  for use in the surgical suite. In general, the surgeon should be able to maneuver and utilize the switches  502 ,  510 ,  515 ,  520  with minimal effort and maximum accuracy. To minimize effort, the switches  502 ,  510 ,  515 ,  520  may be placed such that the switches  502 ,  510 ,  515 ,  520  are easy to access from the bimanual manipulation position and easy to actuate without requiring more force than necessary to ensure purposeful actuation. Meeting the mentioned design considerations would not only allow for greater ergonomic ease in utilization of the switches  502 ,  510 ,  515 ,  520 , but would also reduce the fatigue of the surgeon by requiring less force application. 
     The sixth row of the table  900  in  FIG. 9  refers to the consideration of the use of multiple tools during a surgery. During a surgical procedure, a surgeon typically utilizes a multiplicity of instruments which involve a multiplicity of hand placements. Some examples are endosurgical forceps, resection devices, tissue maneuvering devices, and surgical drilling devices. Where the surgical forceps would require the surgeon to hold a device in a similar manner to holding a pair of scissors the surgical drill would require the surgeon to grasp the handle with his entire palm. From these two hand placement examples, it is apparent that the surgical glove interface  500  may aim to compensate for the use of multiple devices without hindering the surgeon&#39;s ability to utilize such devices. 
     In addition, when in use the surgical glove interface  500  may be used to control multiple devices so as the surgeon changes devices the UI configuration of the surgical glove interface  500  changes to support each device. This consideration may result in the surgical glove interface  500  being designed such that all of the required devices are supported, as well as having a layout to accommodate all the instruments the surgical glove interface  500  would be able to control. 
     The seventh row of the table  900  in  FIG. 9  refers to the desire to utilize a wireless connection to communicate between the surgical glove interface  500  (e.g., outputs of the switches  502 ,  505 ,  510 ,  515 ) and the medical navigation system  600 , such as the systems shown in  FIGS. 2, 3, and 6 . During a surgical operation the surgeon needs to orient himself in the surgical suite to perform any necessary movements and actions required to assure patient trauma is minimized. If the surgical glove interface  500  is not wireless, this could lead to issues such as the surgeon being bound to a particular zone. In most cases this binding wouldn&#39;t be an issue but in cases were irregularities occur and emergency procedures come into play this may present a detrimental constraint. Therefore, one aspect of the present description includes the surgical glove interface  500  being compatible with a wireless communicator. 
     The table provided in  FIG. 9  indicates which features are desirable for each of the three examples where the surgical glove interface  500  may be integrated: (a) on top of a presently used surgical glove (e.g., “over glove” shown in  FIG. 9 , (b) into a surgical glove (“integrated into glove” shown in  FIG. 9 , or (c) below or underneath a surgical glove (“under glove” shown in  FIG. 9 ). Some examples of these are discussed below. 
     In one example, an interface component is provided for use with a first glove and a medical equipment component. The interface component comprises a plurality of switches located on the first glove. Each of the plurality of switches provides a control signal to the medical equipment component. The interface component may further comprise a controller coupled to the plurality of switches; a power supply module coupled to the controller; and a wireless communications interface coupled to the controller in communication with a wireless interface of the medical equipment component. 
     Referring to  FIG. 10 , an example surgical glove interface (e.g., also referred to generally as an interface component), such as the surgical glove interface  500 , to be applied to a surgical glove  1000 , where the interface is positioned below or underneath the surgical glove  1000  is shown. The interface component may be used with a first glove  1020  with an integrated user interface device  1040 . In one example, the first glove  1020  may be fingerless and the user interface device  1040  may be positioned on the palm. A benefit of the first glove  1020  being below or underneath a second glove such as the surgical glove  1000  is that the surgical glove  1000  performs as an outer barrier to protect the patient and the surgical glove  1000  already adheres to the required structural integrity standards needed to be used in the surgical suite. The first glove  1020  may be made of a flexible elastic material, such as spandex, a polyester cotton blend, latex, neoprene, vinyl, nitrile rubber, or other applicable polymers and materials. However, any other suitable material may be used to meet the design criteria of a particular application. Spandex would allow the first glove  1020  to conform to the needs for dexterity as spandex does not constrain the surgeon&#39;s hand movements. In the example where the first glove  1020  is fingerless, the surgeon&#39;s fingers, which are primarily used to handle the surgical instruments, may not incur any significant reduction in dexterity. The user interface device  1040  may be formed of a plurality of switches  1025  (e.g., the switches  502 ,  505 ,  510 ,  515  shown in  FIG. 5 ), where each of the plurality of switches  1025  may provide a control signal to a medical equipment component, such as the medical navigation systems shown in  FIGS. 2, 3, and 6 . In one example, the plurality of switches  1025  may include flexible pressure sensors that may be configured to actuate at a given minimum pressure and may be used in either binary or variable switch modes. Using flexible pressure sensors may not constrain the surgeon&#39;s movements allowing the surgeon to maintain his dexterity. 
     The plurality of switches  1025  may also be lightweight, thereby minimizing fatigue of the surgeon&#39;s arms and may be autoclavable allowing the switches  1025  to be sterilized. The switches  1025  may be thin in addition to being flexible, which reduces the likeliness of the switches  1025  catching the second surgical glove  1000  and potentially causing unsafe tears. An example of a suitable sensor for use as the switches  1025  is the FlexiForce® Model HT201. For tactility, the flexible sensors may be designed similar to the buttons  502 ,  505 ,  510 , and  515  shown in  FIG. 5 , where each button has a unique raised pattern that can be felt through the surgical glove  1000  by the surgeon. In other words, the plurality of switches  1025  may each have a textured surface for tactile identification by a wearer of the first glove  1000 . In another example, the second surgical glove  1000  to be worn over the surgical glove interface  500  (e.g., the first glove  1020  including the user interface device  1040 ) may be designed with additional slack and less material specifically positioned where the flexible switches  1025  would be located during use. 
     The interface component may also include a controller (e.g., the controller  622 ) coupled to the plurality of switches  1025  (e.g., switches  615 ), a power supply module (e.g., the power supply module  625 ) coupled to the controller, and a wireless communications interface (e.g., the interface  605 ) coupled to the controller in communication with a wireless interface (e.g., the interface  610 ) of the medical equipment component (e.g., the medical navigation system  600 ). In another example, the plurality of switches  1025  may each be coupled to the medical equipment component with physical wire  1010 , which may make it unnecessary for the first glove  1020  to have a controller, power supply, and wireless communications interface integrated therein. The plurality of switches  1025  may be in a location on a palm of the first glove  1020  that is accessible to fingers of a hand that is insertable into the first glove  1020 . The plurality of switches may alternatively be located either at the back of the first glove  1020  and or the side of the first glove  1020 . Alternatively, the wires  1010  may lead to a controller (e.g., the controller  622 ), a power supply module (e.g., the power supply module  625 ) coupled to the controller, and a wireless communications interface (e.g., the interface  605 ) that is placed in a location away from the first glove  1020 , such as attached to an arm or belt of the surgeon. 
     Referring now to  FIG. 11 , another example of the surgical glove interface (e.g., an interface component) shown in  FIG. 10  is shown. In the example shown in  FIG. 11 , a thin, semi-rigid or substantially rigid board  1100  may be placed underneath the switches  1025  to help more evenly distribute the force over the palm resulting in less compression to the skin of the hand and more force transfer to the switches  1025 . The use of the board  1100  may also aid in increasing the tactility of the switches  1025 . To compensate for the use of multiple instruments, a detection system could be used to identify which medical instruments were being used. Based on the instrument, the interface component may be configured with new switch outputs and consequent functionality including being in a disabled state to allow for manual use of tools such as a drill. Methods of detecting which instruments would be in use include using radio frequency ID (RFID) tags on the instruments for detection, as well as optical detection methods such as active markers on the instruments. Since a wireless connection may be used between the interface component and the medical navigation system (e.g., the systems shown in  FIGS. 2, 3, and 6 ), a Bluetooth dongle may be coupled to the interface component and used to transmit the output of the interface component. The dongle may be located on the surgeon anywhere under the sterile barrier and attached to the interface component via the wires  1130  shown in  FIG. 11 . 
     Alternate embodiments of the interface component include the interface component including the first glove  1020  being placed on top of the second surgical glove  1000 . An example of this can be seen in  FIG. 11 , where the interface component includes a flexible touch pad  1120 . In another example, surgical glove interface  500  shown in  FIG. 5 , employs the buttons  502 ,  505 ,  510 , and  515 . 
     An additional embodiment integrates the interface component including the first glove into a surgical glove (e.g., the first glove is, in fact, a surgical glove itself—shown as  1030  in  FIG. 10 ) where any of the features discusses above may be built right into the material of a presently used or specially designed surgical glove interfaces so they come as a single piece. 
     The specific embodiments described above have been shown by way of example, and it should be understood that these embodiments may be susceptible to various modifications and alternative forms. It should be further understood that the claims are not intended to be limited to the particular forms disclosed, but rather to cover all modifications, equivalents, and alternatives falling within the spirit and scope of this disclosure.