All-in-One Augmented Reality Guided Head and Neck Tumor Resection

TL;DR

This paper introduces an augmented reality system using HoloLens 2 for precise intraoperative margin localization in head and neck tumor resection, improving accuracy over verbal guidance.

Contribution

The authors develop a markerless AR system that relocalizes positive margins from specimens to the surgical site with high accuracy, enhancing surgical precision.

Findings

Markerless registration achieved median error of 1.8 mm.

AR guidance reduced relocalization error from 14.2 mm to 3.2 mm.

All AR localizations were within 5 mm error.

Abstract

Positive margins are common in head and neck squamous cell carcinoma, yet intraoperative re-resection is often imprecise because margin locations are typically communicated verbally from pathology. We present an all-in-one augmented reality (AR) system that relocalizes positive margins from a resected specimen to the resection bed and visualizes them in situ using HoloLens 2 depth sensing and fully automated markerless surface registration. In a silicone phantom study with six medical trainees, markerless registration achieved target registration errors comparable to a marker-based baseline (median 1.8 mm vs. 1.7 mm; maximum < 4 mm). In a margin relocalization task, AR guidance reduced error from verbal guidance (median 14.2 mm) to a few millimeters (median 3.2 mm), with all AR localizations within 5 mm error. These results support the feasibility of markerless AR margin guidance for more precise intraoperative re-excision.