Peter Kazanzides

Hao Ding, Jintan Zhang, Peter Kazanzides et al.

Vision-based segmentation of the robotic tool during robot-assisted surgery enables downstream applications, such as augmented reality feedback, while allowing for inaccuracies in robot kinematics. With the introduction of deep learning, many methods were presented to solve instrument segmentation directly and solely from images. While these approaches made remarkable progress on benchmark datasets, fundamental challenges pertaining to their robustness remain. We present CaRTS, a causality-driven robot tool segmentation algorithm, that is designed based on a complementary causal model of the robot tool segmentation task. Rather than directly inferring segmentation masks from observed images, CaRTS iteratively aligns tool models with image observations by updating the initially incorrect robot kinematic parameters through forward kinematics and differentiable rendering to optimize image feature similarity end-to-end. We benchmark CaRTS with competing techniques on both synthetic as well as real data from the dVRK, generated in precisely controlled scenarios to allow for counterfactual synthesis. On training-domain test data, CaRTS achieves a Dice score of 93.4 that is preserved well (Dice score of 91.8) when tested on counterfactually altered test data, exhibiting low brightness, smoke, blood, and altered background patterns. This compares favorably to Dice scores of 95.0 and 86.7, respectively, of the SOTA image-based method. Future work will involve accelerating CaRTS to achieve video framerate and estimating the impact occlusion has in practice. Despite these limitations, our results are promising: In addition to achieving high segmentation accuracy, CaRTS provides estimates of the true robot kinematics, which may benefit applications such as force estimation. Code is available at: https://github.com/hding2455/CaRTS

Hao Ding, Lalithkumar Seenivasan, Hongchao Shu et al.

Large language model-based (LLM) agents are emerging as a powerful enabler of robust embodied intelligence due to their capability of planning complex action sequences. Sound planning ability is necessary for robust automation in many task domains, but especially in surgical automation. These agents rely on a highly detailed natural language representation of the scene. Thus, to leverage the emergent capabilities of LLM agents for surgical task planning, developing similarly powerful and robust perception algorithms is necessary to derive a detailed scene representation of the environment from visual input. Previous research has focused primarily on enabling LLM-based task planning while adopting simple yet severely limited perception solutions to meet the needs for bench-top experiments, but lacks the critical flexibility to scale to less constrained settings. In this work, we propose an alternate perception approach -- a digital twin (DT)-based machine perception approach that capitalizes on the convincing performance and out-of-the-box generalization of recent vision foundation models. Integrating our DT representation and LLM agent for planning with the dVRK platform, we develop an embodied intelligence system and evaluate its robustness in performing peg transfer and gauze retrieval tasks. Our approach shows strong task performance and generalizability to varied environmental settings. Despite a convincing performance, this work is merely a first step towards the integration of DT representations. Future studies are necessary for the realization of a comprehensive DT framework to improve the interpretability and generalizability of embodied intelligence in surgery.

Baichuan Jiang, Keshuai Xu, Ahbay Moghekar et al.

Clear identification of bone structures is crucial for ultrasound-guided lumbar interventions, but it can be challenging due to the complex shapes of the self-shadowing vertebra anatomy and the extensive background speckle noise from the surrounding soft tissue structures. Therefore, we propose to use a patch-like wearable ultrasound solution to capture the reflective bone surfaces from multiple imaging angles and create 3D bone representations for interventional guidance. In this work, we will present our method for estimating the vertebra bone surfaces by using a spatiotemporal U-Net architecture learning from the B-Mode image and aggregated feature maps of hand-crafted filters. The methods are evaluated on spine phantom image data collected by our proposed miniaturized wearable "patch" ultrasound device, and the results show that a significant improvement on baseline method can be achieved with promising accuracy. Equipped with this surface estimation framework, our wearable ultrasound system can potentially provide intuitive and accurate interventional guidance for clinicians in augmented reality setting.

Open-H-Embodiment Consortium, Nigel Nelson, Juo-Tung Chen et al.

Autonomous medical robots hold promise to improve patient outcomes, reduce provider workload, democratize access to care, and enable superhuman precision. However, autonomous medical robotics has been limited by a fundamental data problem: existing medical robotic datasets are small, single-embodiment, and rarely shared openly, restricting the development of foundation models that the field needs to advance. We introduce Open-H-Embodiment, the largest open dataset of medical robotic video with synchronized kinematics to date, spanning more than 49 institutions and multiple robotic platforms including the CMR Versius, Intuitive Surgical's da Vinci, da Vinci Research Kit (dVRK), Rob Surgical BiTrack, Virtual Incision's MIRA, Moon Surgical Maestro, and a variety of custom systems, spanning surgical manipulation, robotic ultrasound, and endoscopy procedures. We demonstrate the research enabled by this dataset through two foundation models. GR00T-H is the first open foundation vision-language-action model for medical robotics, which is the only evaluated model to achieve full end-to-end task completion on a structured suturing benchmark (25% of trials vs. 0% for all others) and achieves 64% average success across a 29-step ex vivo suturing sequence. We also train Cosmos-H-Surgical-Simulator, the first action-conditioned world model to enable multi-embodiment surgical simulation from a single checkpoint, spanning nine robotic platforms and supporting in silico policy evaluation and synthetic data generation for the medical domain. These results suggest that open, large-scale medical robot data collection can serve as critical infrastructure for the research community, enabling advances in robot learning, world modeling, and beyond.

Haoying Zhou, Hao Yang, Brendan Burkhart et al.

The da Vinci Research Kit (dVRK) is widely used for research in robot-assisted surgery, but most modeling and control methods target the first-generation dVRK Classic. The recently introduced dVRK-Si, built from da Vinci Si hardware, features a redesigned Patient Side Manipulator (PSM) with substantially larger gravity loading, which can degrade control if unmodeled. This paper presents the first complete kinematic and dynamic modeling framework for the dVRK-Si PSM. We derive a modified DH kinematic model that captures the closed-chain parallelogram mechanism, formulate dynamics via the Euler-Lagrange method, and express inverse dynamics in a linear-in-parameters regressor form. Dynamic parameters are identified from data collected on a periodic excitation trajectory optimized for numerical conditioning and estimated by convex optimization with physical feasibility constraints. Using the identified model, we implement real-time gravity compensation and computed-torque feedforward in the dVRK control stack. Experiments on a physical dVRK-Si show that the gravity compensation reduces steady-state joint errors by 68-84% and decreases end-effector tip drift during static holds from 4.2 mm to 0.7 mm. Computed-torque feedforward further improves transient and position tracking accuracy. For sinusoidal trajectory tracking, computed-torque feedforward reduces position errors by 35% versus gravity-only feedforward and by 40% versus PID-only. The proposed pipeline supports reliable control, high-fidelity simulation, and learning-based automation on the dVRK-Si.

Zijian Wu, Adam Schmidt, Peter Kazanzides et al.

The Segment Anything Model (SAM) is a powerful vision foundation model that is revolutionizing the traditional paradigm of segmentation. Despite this, a reliance on prompting each frame and large computational cost limit its usage in robotically assisted surgery. Applications, such as augmented reality guidance, require little user intervention along with efficient inference to be usable clinically. In this study, we address these limitations by adopting lightweight SAM variants to meet the efficiency requirement and employing fine-tuning techniques to enhance their generalization in surgical scenes. Recent advancements in Tracking Any Point (TAP) have shown promising results in both accuracy and efficiency, particularly when points are occluded or leave the field of view. Inspired by this progress, we present a novel framework that combines an online point tracker with a lightweight SAM model that is fine-tuned for surgical instrument segmentation. Sparse points within the region of interest are tracked and used to prompt SAM throughout the video sequence, providing temporal consistency. The quantitative results surpass the state-of-the-art semi-supervised video object segmentation method XMem on the EndoVis 2015 dataset with 84.8 IoU and 91.0 Dice. Our method achieves promising performance that is comparable to XMem and transformer-based fully supervised segmentation methods on ex vivo UCL dVRK and in vivo CholecSeg8k datasets. In addition, the proposed method shows promising zero-shot generalization ability on the label-free STIR dataset. In terms of efficiency, we tested our method on a single GeForce RTX 4060/4090 GPU respectively, achieving an over 25/90 FPS inference speed. Code is available at: https://github.com/wuzijian1997/SIS-PT-SAM

Jie Ying Wu, Peter Kazanzides, Mathias Unberath

Purpose Surgical simulations play an increasingly important role in surgeon education and developing algorithms that enable robots to perform surgical subtasks. To model anatomy, Finite Element Method (FEM) simulations have been held as the gold standard for calculating accurate soft-tissue deformation. Unfortunately, their accuracy is highly dependent on the simulation parameters, which can be difficult to obtain. Methods In this work, we investigate how live data acquired during any robotic endoscopic surgical procedure may be used to correct for inaccurate FEM simulation results. Since FEMs are calculated from initial parameters and cannot directly incorporate observations, we propose to add a correction factor that accounts for the discrepancy between simulation and observations. We train a network to predict this correction factor. Results To evaluate our method, we use an open-source da Vinci Surgical System to probe a soft-tissue phantom and replay the interaction in simulation. We train the network to correct for the difference between the predicted mesh position and the measured point cloud. This results in 15-30% improvement in the mean distance, demonstrating the effectiveness of our approach across a large range of simulation parameters. Conclusion We show a first step towards a framework that synergistically combines the benefits of model-based simulation and real-time observations. It corrects discrepancies between simulation and the scene that results from inaccurate modeling parameters. This can provide a more accurate simulation environment for surgeons and better data with which to train algorithms.

Hongbin Lin, C. W. Vincent Hui, Yan Wang et al.

External disturbance forces caused by nonlinear springy electrical cables in the Master Tool Manipulator (MTM) of the da Vinci Research Kit (dVRK) limits the usage of the existing gravity compensation methods. Significant motion drifts at the MTM tip are often observed when the MTM is located far from its identification trajectory, preventing the usage of these methods for the entire workspace reliably. In this paper, we propose a general and systematic framework to address the problems of the gravity compensation for the MTM of the dVRK. Particularly, high order polynomial models were used to capture the highly nonlinear disturbance forces and integrated with the Multi-step Least Square Estimation (MLSE) framework. This method allows us to identify the parameters of both the gravitational and disturbance forces for each link sequentially, preventing residual error passing among the links of the MTM with uneven mass distribution. A corresponding gravity compensation controller was developed to compensate the gravitational and disturbance forces. The method was validated with extensive experiments in the majority of the manipulator's workspace, showing significant performance enhancements over existing methods. Finally, a deliverable software package in MATLAB and C++ was integrated with dVRK and published in the dVRK community for open-source research and development.

Zijian Wu, Adam Schmidt, Randy Moore et al.

Accurate and efficient surgical robotic tool pose estimation is of fundamental significance to downstream applications such as augmented reality (AR) in surgical training and learning-based autonomous manipulation. While significant advancements have been made in pose estimation for humans and animals, it is still a challenge in surgical robotics due to the scarcity of published data. The relatively large absolute error of the da Vinci end effector kinematics and arduous calibration procedure make calibrated kinematics data collection expensive. Driven by this limitation, we collected a dataset, dubbed SurgPose, providing instance-aware semantic keypoints and skeletons for visual surgical tool pose estimation and tracking. By marking keypoints using ultraviolet (UV) reactive paint, which is invisible under white light and fluorescent under UV light, we execute the same trajectory under different lighting conditions to collect raw videos and keypoint annotations, respectively. The SurgPose dataset consists of approximately 120k surgical instrument instances (80k for training and 40k for validation) of 6 categories. Each instrument instance is labeled with 7 semantic keypoints. Since the videos are collected in stereo pairs, the 2D pose can be lifted to 3D based on stereo-matching depth. In addition to releasing the dataset, we test a few baseline approaches to surgical instrument tracking to demonstrate the utility of SurgPose. More details can be found at surgpose.github.io.

Yihao Liu, Yu-Chun Ku, Jiaming Zhang et al.

Data scarcity has long been an issue in the robot learning community. Particularly, in safety-critical domains like surgical applications, obtaining high-quality data can be especially difficult. It poses challenges to researchers seeking to exploit recent advancements in reinforcement learning and imitation learning, which have greatly improved generalizability and enabled robots to conduct tasks autonomously. We introduce dARt Vinci, a scalable data collection platform for robot learning in surgical settings. The system uses Augmented Reality (AR) hand tracking and a high-fidelity physics engine to capture subtle maneuvers in primitive surgical tasks: By eliminating the need for a physical robot setup and providing flexibility in terms of time, space, and hardware resources-such as multiview sensors and actuators-specialized simulation is a viable alternative. At the same time, AR allows the robot data collection to be more egocentric, supported by its body tracking and content overlaying capabilities. Our user study confirms the proposed system's efficiency and usability, where we use widely-used primitive tasks for training teleoperation with da Vinci surgical robots. Data throughput improves across all tasks compared to real robot settings by 41% on average. The total experiment time is reduced by an average of 10%. The temporal demand in the task load survey is improved. These gains are statistically significant. Additionally, the collected data is over 400 times smaller in size, requiring far less storage while achieving double the frequency.

Hao Yang, Ayberk Acar, Keshuai Xu et al.

Robot-assisted minimally invasive surgery, such as through the da Vinci systems, improves precision and patient outcomes. However, da Vinci systems prior to da Vinci 5, lacked direct force-sensing capabilities, forcing surgeons to operate without the haptic feedback they get through laparoscopy. Our prior work restored force sensing through machine learning-based force estimation for the da Vinci Research Kit (dVRK) Classic. This study extends our previous method to the newer dVRK system, the dVRK-Si. Additionally, we benchmark the performance of the learning-based algorithm against baseline methods (which make simplifying assumptions on the torque) to study how the two systems differ. Results show the learning-based method achieves an average root-mean-square-error (RMSE) of 5.21\%, for the dVRK-Si, which is comparable to the dVRK Classic. In both systems, the learning-based method outperforms baselines, but the difference is much larger in the dVRK-Si. Nonetheless, dVRK-Si force estimation accuracy lags behind the dVRK Classic, with RMSE 2 to 3 times higher. Further analysis reveals poor PID control in the dVRK-Si. We hypothesize that this is due to the lack of gravity compensation, as unlike the dVRK Classic, the dVRK-Si is not mechanically balanced. This study advances the understanding of learning-based force estimation and is the first work to characterize the dynamics of the new dVRK-Si system.

Zheng Han, Zixin Yang, Yonghao Long et al.

Purpose: Precise port placement is a critical step in robot-assisted surgery, where port configuration influences both visual access to the operative field and instrument maneuverability. To bridge the gap between preoperative planning and intraoperative execution, we present ARport, an augmented reality (AR) system that automatically maps pre-planned trocar layouts onto the patient's body surface, providing intuitive spatial guidance during surgical preparation. Methods: ARport, implemented on an optical see-through head-mounted display (OST-HMD), operates without any external sensors or markers, simplifying setup and enhancing workflow integration. It reconstructs the operative scene from RGB, depth, and pose data captured by the OST-HMD, extracts the patient's body surface using a foundation model, and performs surface-based markerless registration to align preoperative anatomical models to the extracted patient's body surface, enabling in-situ visualization of planned trocar layouts. A demonstration video illustrating the overall workflow is available online. Results: In full-scale human-phantom experiments, ARport accurately overlaid pre-planned trocar sites onto the physical phantom, achieving consistent spatial correspondence between virtual plans and real anatomy. Conclusion: ARport provides a fully marker-free and hardware-minimal solution for visualizing preoperative trocar plans directly on the patient's body surface. The system facilitates efficient intraoperative setup and demonstrates potential for seamless integration into routine clinical workflows.

Juan Antonio Barragan, Hisashi Ishida, Adnan Munawar et al.

The development of algorithms for automation of subtasks during robotic surgery can be accelerated by the availability of realistic simulation environments. In this work, we focus on one aspect of the realism of a surgical simulator, which is the positional accuracy of the robot. In current simulators, robots have perfect or near-perfect accuracy, which is not representative of their physical counterparts. We therefore propose a pair of neural networks, trained by data collected from a physical robot, to estimate both the controller error and the kinematic and non-kinematic error. These error estimates are then injected within the simulator to produce a simulated robot that has the characteristic performance of the physical robot. In this scenario, we believe it is sufficient for the estimated error used in the simulation to have a statistically similar distribution to the actual error of the physical robot. This is less stringent, and therefore more tenable, than the requirement for error compensation of a physical robot, where the estimated error should equal the actual error. Our results demonstrate that error injection reduces the mean position and orientation differences between the simulated and physical robots from 5.0 mm / 3.6 deg to 1.3 mm / 1.7 deg, respectively, which represents reductions by factors of 3.8 and 2.1.

Juan Antonio Barragan, Jintan Zhang, Haoying Zhou et al.

Automation in surgical robotics has the potential to improve patient safety and surgical efficiency, but it is difficult to achieve due to the need for robust perception algorithms. In particular, 6D pose estimation of surgical instruments is critical to enable the automatic execution of surgical maneuvers based on visual feedback. In recent years, supervised deep learning algorithms have shown increasingly better performance at 6D pose estimation tasks; yet, their success depends on the availability of large amounts of annotated data. In household and industrial settings, synthetic data, generated with 3D computer graphics software, has been shown as an alternative to minimize annotation costs of 6D pose datasets. However, this strategy does not translate well to surgical domains as commercial graphics software have limited tools to generate images depicting realistic instrument-tissue interactions. To address these limitations, we propose an improved simulation environment for surgical robotics that enables the automatic generation of large and diverse datasets for 6D pose estimation of surgical instruments. Among the improvements, we developed an automated data generation pipeline and an improved surgical scene. To show the applicability of our system, we generated a dataset of 7.5k images with pose annotations of a surgical needle that was used to evaluate a state-of-the-art pose estimation network. The trained model obtained a mean translational error of 2.59mm on a challenging dataset that presented varying levels of occlusion. These results highlight our pipeline's success in training and evaluating novel vision algorithms for surgical robotics applications.

Adnan Munawar, Zhaoshuo Li, Punit Kunjam et al.

Surgical simulators not only allow planning and training of complex procedures, but also offer the ability to generate structured data for algorithm development, which may be applied in image-guided computer assisted interventions. While there have been efforts on either developing training platforms for surgeons or data generation engines, these two features, to our knowledge, have not been offered together. We present our developments of a cost-effective and synergistic framework, named Asynchronous Multibody Framework Plus (AMBF+), which generates data for downstream algorithm development simultaneously with users practicing their surgical skills. AMBF+ offers stereoscopic display on a virtual reality (VR) device and haptic feedback for immersive surgical simulation. It can also generate diverse data such as object poses and segmentation maps. AMBF+ is designed with a flexible plugin setup which allows for unobtrusive extension for simulation of different surgical procedures. We show one use case of AMBF+ as a virtual drilling simulator for lateral skull-base surgery, where users can actively modify the patient anatomy using a virtual surgical drill. We further demonstrate how the data generated can be used for validating and training downstream computer vision algorithms

Claudia D'Ettorre, Andrea Mariani, Agostino Stilli et al.

Robotic-assisted surgery is now well-established in clinical practice and has become the gold standard clinical treatment option for several clinical indications. The field of robotic-assisted surgery is expected to grow substantially in the next decade with a range of new robotic devices emerging to address unmet clinical needs across different specialities. A vibrant surgical robotics research community is pivotal for conceptualizing such new systems as well as for developing and training the engineers and scientists to translate them into practice. The da Vinci Research Kit (dVRK), an academic and industry collaborative effort to re-purpose decommissioned da Vinci surgical systems (Intuitive Surgical Inc, CA, USA) as a research platform for surgical robotics research, has been a key initiative for addressing a barrier to entry for new research groups in surgical robotics. In this paper, we present an extensive review of the publications that have been facilitated by the dVRK over the past decade. We classify research efforts into different categories and outline some of the major challenges and needs for the robotics community to maintain this initiative and build upon it.

Guanhao Fu, Ehsan Azimi, Peter Kazanzides

Teleoperation platforms often require the user to be situated at a fixed location to both visualize and control the movement of the robot and thus do not provide the operator with much mobility. One example is in existing robotic surgery solutions that require the surgeons to be away from the patient, attached to consoles where their heads must be fixed and their arms can only move in a limited space. This creates a barrier between physicians and patients that does not exist in normal surgery. To address this issue, we propose a mobile telesurgery solution where the surgeons are no longer mechanically limited to control consoles and are able to teleoperate the robots from the patient bedside, using their arms equipped with wireless sensors and viewing the endoscope video via optical see-through head-mounted displays (HMDs). We evaluate the feasibility and efficiency of our user interaction method compared to a standard surgical robotic manipulator via two tasks with different levels of required dexterity. The results indicate that with sufficient training our proposed platform can attain similar efficiency while providing added mobility for the operator.

Jie Ying Wu, Nural Yilmaz, Peter Kazanzides et al.

Measurement of environment interaction forces during robotic minimally-invasive surgery would enable haptic feedback to the surgeon, thereby solving one long-standing limitation. Estimating this force from existing sensor data avoids the challenge of retrofitting systems with force sensors, but is difficult due to mechanical effects such as friction and compliance in the robot mechanism. We have previously shown that neural networks can be trained to estimate the internal robot joint torques, thereby enabling estimation of external forces. In this work, we extend the method to estimate external Cartesian forces and torques, and also present a two-step approach to adapt to the specific surgical setup by compensating for forces due to the interactions between the instrument shaft and cannula seal and between the trocar and patient body. Experiments show that this approach provides estimates of external forces and torques within a mean root-mean-square error (RMSE) of 2 N and 0.08 Nm, respectively. Furthermore, the two-step approach can add as little as 5 minutes to the surgery setup time, with about 4 minutes to collect intraoperative training data and 1 minute to train the second-step network.

Balazs P. Vagvolgyi, Mikhail Khrenov, Jonathan Cope et al.

Since the first reports of a novel coronavirus (SARS-CoV-2) in December 2019, over 33 million people have been infected worldwide and approximately 1 million people worldwide have died from the disease caused by this virus, COVID-19. In the US alone, there have been approximately 7 million cases and over 200,000 deaths. This outbreak has placed an enormous strain on healthcare systems and workers. Severe cases require hospital care, and 8.5\% of patients require mechanical ventilation in an intensive care unit (ICU). One major challenge is the necessity for clinical care personnel to don and doff cumbersome personal protective equipment (PPE) in order to enter an ICU unit to make simple adjustments to ventilator settings. Although future ventilators and other ICU equipment may be controllable remotely through computer networks, the enormous installed base of existing ventilators do not have this capability. This paper reports the development of a simple, low cost telerobotic system that permits adjustment of ventilator settings from outside the ICU. The system consists of a small Cartesian robot capable of operating a ventilator touch screen with camera vision control via a wirelessly connected tablet master device located outside the room. Engineering system tests demonstrated that the open-loop mechanical repeatability of the device was 7.5\,mm, and that the average positioning error of the robotic finger under visual servoing control was 5.94\,mm. Successful usability tests in a simulated ICU environment were carried out and are reported. In addition to enabling a significant reduction in PPE consumption, the prototype system has been shown in a preliminary evaluation to significantly reduce the total time required for a respiratory therapist to perform typical setting adjustments on a commercial ventilator, including donning and doffing PPE, from 271 seconds to 109 seconds.

Murilo M. Marinho, Bruno V. Adorno, Kanako Harada et al.

In adult laparoscopy, robot-aided surgery is a reality in thousands of operating rooms worldwide, owing to the increased dexterity provided by the robotic tools. Many robots and robot control techniques have been developed to aid in more challenging scenarios, such as pediatric surgery and microsurgery. However, the prevalence of case-specific solutions, particularly those focused on non-redundant robots, reduces the reproducibility of the initial results in more challenging scenarios. In this paper, we propose a general framework for the control of surgical robotics in constrained workspaces under teleoperation, regardless of the robot geometry. Our technique is divided into a slave-side constrained optimization algorithm, which provides virtual fixtures, and with Cartesian impedance on the master side to provide force feedback. Experiments with two robotic systems, one redundant and one non-redundant, show that smooth teleoperation can be achieved in adult laparoscopy and infant surgery.

Ehsan Azimi, Long Qian, Nassir Navab et al.

With the mounting global interest for optical see-through head-mounted displays (OST-HMDs) across medical, industrial and entertainment settings, many systems with different capabilities are rapidly entering the market. Despite such variety, they all require display calibration to create a proper mixed reality environment. With the aid of tracking systems, it is possible to register rendered graphics with tracked objects in the real world. We propose a calibration procedure to properly align the coordinate system of a 3D virtual scene that the user sees with that of the tracker. Our method takes a blackbox approach towards the HMD calibration, where the tracker's data is its input and the 3D coordinates of a virtual object in the observer's eye is the output; the objective is thus to find the 3D projection that aligns the virtual content with its real counterpart. In addition, a faster and more intuitive version of this calibration is introduced in which the user simultaneously aligns multiple points of a single virtual 3D object with its real counterpart; this reduces the number of required repetitions in the alignment from 20 to only 4, which leads to a much easier calibration task for the user. In this paper, both internal (HMD camera) and external tracking systems are studied. We perform experiments with Microsoft HoloLens, taking advantage of its self localization and spatial mapping capabilities to eliminate the requirement for line of sight from the HMD to the object or external tracker. The experimental results indicate an accuracy of up to 4 mm in the average reprojection error based on two separate evaluation methods. We further perform experiments with the internal tracking on the Epson Moverio BT-300 to demonstrate that the method can provide similar results with other HMDs.