# Augmented reality system for endoscopic pituitary surgery with automatic registration

## TL;DR

This paper introduces an augmented reality system for pituitary surgery that improves accuracy and workflow by automatically registering pre-operative scans onto endoscopic video.

## Contribution

The novel contribution is an AR system with automatic registration and a compact setup that outperforms IR-tracked endoscopes in accuracy.

## Key findings

- The proposed AR system achieved an accuracy of 1.1 (± 0.4) mm.
- It outperformed the IR-tracked endoscope approach, which had an accuracy of 2.4 (± 0.9) mm.
- The system is more compact and transportable, reducing setup time and improving surgical workflow.

## Abstract

Endoscopic pituitary surgery is a minimally invasive technique to remove pituitary tumours through the nose. Currently, image guidance may be used in the form of a tracked pointer to help surgeons navigate the region and avoid damage to critical structures. However, the pointer method is mentally demanding as the pointer location is displayed in a different modality and disrupts the surgical workflow due to the setup time and frequent tool removal.

We propose an Augmented Reality (AR) system where information from the pre-operative scan is displayed directly onto the endoscopic video. Our system features an on-board tracking system, allowing for the registration process to be performed automatically.

We evaluated the accuracy of our system and compared it to an AR system that uses an infrared (IR) camera to track an endoscope with reflective markers. Our system gave an accuracy of 1.1 (± 0.4) mm, compared to 2.4 (± 0.9) mm in the IR-tracked endoscope approach.

Our Augmented Reality system is a more compact and transportable setup which outperformed the IR-tracked endoscope. The automatic registration method can save time in the operating room as well as increase AR overlay accuracy, improving the translation of these technologies.