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

2026-03-31

AI Summary

This study addresses the challenge of imprecise intraoperative re-excision in head and neck squamous cell carcinoma surgery, where positive margins are common yet often inaccurately localized due to reliance on verbal communication. The authors propose an integrated augmented reality (AR) system based on HoloLens 2 that enables fully automatic, markerless surface registration and real-time visualization of positive margins without intraoperative labeling. By fusing depth sensing, a novel markerless registration algorithm, and AR rendering, the system accurately maps positive margins identified on excised specimens back onto the surgical site. Experiments using silicone phantoms demonstrated a median registration error of 1.8 mm. Under AR guidance, margin localization error decreased significantly from 14.2 mm to 3.2 mm, with all errors maintained within 5 mm, substantially improving the precision of re-excision.

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.

Problem

• positive margins
• head and neck cancer
• intraoperative resection
• surgical guidance
• margin localization

Innovation

• markerless registration
• augmented reality
• head and neck cancer
• intraoperative guidance
• HoloLens 2