Comprehensive mixed reality surgical navigation system for liver surgery

Area of Science:

• Surgical Navigation
• Mixed Reality (MR)
• Medical Imaging

Background:

• Intraoperative liver deformation and reliance on remote monitors hinder precision in image-guided liver surgery.
• Existing mixed reality (MR) prototypes lack comprehensive solutions and quantitative validation for deformable anatomy.

Purpose of the Study:

• To introduce a self-contained MR navigation system for liver surgery that addresses challenges of intraoperative liver deformation and workflow disruption.
• To quantitatively validate the system's ability to stabilize holographic content, track instruments, and compensate for soft-tissue deformation.

Main Methods:

• Developed a mixed reality (MR) navigation system utilizing a MR headset with a retro-reflective reference tool for hologram stabilization.
• Implemented real-time instrument and surface point tracking via the headset's depth camera.
• Employed a weighted ICP + linearized iterative boundary reconstruction pipeline to compensate for soft-tissue deformation, streamed via a server-client architecture with voice control.

Main Results:

• The reference tool reduced mean hologram drift from 4.0 ± 1.2 mm to 1.1 ± 0.3 mm.
• Tracking accuracy improved from 3.6 ± 1.3 mm to 2.3 ± 0.8 mm.
• Nonrigid registration reduced surface target registration error by an average of 57% (from 7.4 ± 4.8 mm to 3.0 ± 2.7 mm), achieving sub-4 mm guidance accuracy.

Conclusions:

• The unified MR platform enhances surgical precision by stabilizing visualization, tracking instruments, and correcting for liver motion and deformation.
• The device-agnostic framework is adaptable to various surgical approaches, including open and laparoscopic procedures.
• This represents a significant advancement toward MR-enabled surgical navigation systems.