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To overcome this, we propose\n                    <jats:italic>InteractOR<\/jats:italic>\n                    , a mixed\u2010reality system that overlays preoperative images onto endoscopic video and enables surgeons to interact with these images using their surgical instruments.\n                    <jats:italic>InteractOR<\/jats:italic>\n                    integrates (i) real\u2010time laparoscopic instrument segmentation using TernausNet\u201016 trained on the CholecInstanceSeg dataset, (ii) a mixed\u2010reality interface that overlays preoperative images onto endoscopic video and (iii) an interaction technique that enables surgeons to control user interfaces using their instruments. An evaluation of the segmentation model is conducted, as well as a usability evaluation of the system. These results demonstrate the feasibility of the approach and its potential for interaction with preoperative images.\n                  <\/jats:p>","DOI":"10.1049\/htl2.70094","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T08:06:10Z","timestamp":1786781170000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>InteractOR<\/i>\n                    : Interacting with Images during Surgery in Mixed Reality Through Real\u2010Time Instrument Segmentation"],"prefix":"10.1049","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6144-8480","authenticated-orcid":false,"given":"Nour","family":"Karoui","sequence":"first","affiliation":[{"name":"Sorbonne Universit\u00e9, CNRS, INSERM Institut des Syst\u00e8mes Intelligents et de Robotique, ISIR  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6984-1532","authenticated-orcid":false,"given":"Isabelle","family":"Bloch","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, CNRS, LIP6 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1496-3794","authenticated-orcid":false,"given":"Ignacio","family":"Avellino","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, CNRS, INSERM Institut des Syst\u00e8mes Intelligents et de Robotique, ISIR  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"265","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2024.03.1239"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","unstructured":"T.Fran\u00e7ois L.Calvet C.S\u00e8ve\u2010d'Erceville N.Bourdel andA.Bartoli \u201cImage\u2010Based Incision Detection for Topological Intraoperative 3D Model Update in Augmented Reality Assisted Laparoscopic Surgery \u201d inMICCAI 2021 ed.M.deBruijne P. 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