NeuroClick: Preserving Surgeon Autonomy through Hands-Free Earable Tooth-Click Control in Neurosurgery

Abstract

Neurosurgeons frequently interact with operating room (OR) technologies while sterility and occupied hands constrain control. We introduce earables as a direct, hands-free control platform for neurosurgery using tooth-click input. Formative OR observations and interviews with 10 domain experts grounded the design. Using OpenEarable 2.0 data from 12 participants, we developed a real-time recognition pipeline whose classifier achieved a median macro F1-score of 98.6% under leave-one-subject-out cross-validation. We evaluated the technique with 20 neurosurgeons during a simulated resection task in a neurosurgical OR. Participants reported few focus shifts and rated Earable favorably for workflow integration and perceived safety. Autonomous microscope control was rated significantly higher with Earable than Delegation, whereas Delegation enabled faster task completion under continuous assistant availability. Workload, usability, and task errors showed no significant differences. Preferences depended on training, reliability, context, and assistant availability. Earables thus add a direct, hands-free option for controlling selected functions alongside established workflows.