Augmented Reality-Assisted Placement of Surgical Guides and Osteotomy Execution for Pelvic Tumour Resections: A...

Objectives: This pre-clinical feasibility study evaluates the accuracy of a novel augmented reality-based (AR-based) guidance technology using head-mounted displays (HMDs) for the placement of patient-specific instruments (PSIs)-also referred to as surgical guides-and osteotomy performance in pelvic tumour resections. The goal is to improve PSI placement accuracy and osteotomy execution while assessing user perception and workflow efficiency. Methods: The study was conducted on ten 3D-printed pelvic phantoms derived from CT scans of cadaveric specimens. Custom PSIs were designed and printed to guide osteotomies at the supraacetabular, symphysial, and ischial regions. An AR application was developed for the HoloLens 2 HMD to display PSI location and cutting planes. The workflow included manual supraacetabular PSI placement, AR-guided placement of the other PSIs and osteotomy execution. Postoperative CT scans were analysed to measure angular and distance errors in PSI placement and osteotomies. Task times and user feedback were also recorded. Results: The mean angular deviation for PSI placement was 2.20°, with a mean distance error of 1.19 mm (95% CI: 0.86 to 1.52 mm). Osteotomies showed an overall mean angular deviation of 3.73° compared to planned cuts, all within the predefined threshold of less than 5°. AR-assisted guidance added less than two minutes per procedure. User feedback highlighted the intuitive interface and high usability, especially for visualising cutting planes. Conclusions: Integrating AR through HMDs is a feasible and accurate method for enhancing PSI placement and osteotomy performance in pelvic tumour resections. The system provides reliable guidance even in cases of PSI failure and adds minimal time to the surgical workflow while significantly improving accuracy. Further validation in cadaveric models is needed to ensure its clinical applicability.