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This paper introduces an all-in-one augmented reality (AR) system using HoloLens 2 to guide head and neck tumor resections by relocalizing positive margins from resected specimens to the resection bed via markerless surface registration. The system achieved target registration errors comparable to marker-based methods in phantom studies. Critically, AR guidance significantly reduced margin relocalization error compared to verbal guidance, suggesting improved precision for intraoperative re-excision.
Surgeons can now pinpoint tumor margins with millimeter precision using augmented reality, potentially reducing positive margins in head and neck cancer resections.
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.
