NP-guide: a portable projection-based navigation system for neurosurgery and beyond

Area of Science:

• Neurosurgery
• Medical Technology
• Augmented Reality

Background:

• Existing stereotactic and robot-assisted neurosurgery systems offer high precision but are costly and complex for routine use.
• There is a need for more accessible and practical surgical navigation solutions.
• This study introduces the Navigation and Projection Guide (NP-Guide), an augmented reality (AR) system.

Purpose of the Study:

• To evaluate the accuracy, efficiency, and reproducibility of the NP-Guide system.
• To compare NP-Guide with traditional freehand localization methods.
• To assess the potential of NP-Guide as a portable and accessible surgical navigation tool.

Main Methods:

• A proof-of-concept study involving 52 neurosurgical patients randomized into NP-Guide and freehand groups.
• Localization error and operating time were measured using an optical navigation system (ONS).
• Bland-Altman analysis and learning curves were used to assess inter-operator agreement and proficiency.

Main Results:

• The NP-Guide group demonstrated significantly improved accuracy (mean error 3.4–4.1 mm) and efficiency (mean time 1.1–1.2 min) compared to freehand localization (p < 0.001).
• Good inter-operator agreement was observed (p = 0.25).
• Operating times plateaued around 1 minute after approximately 15 cases.

Conclusions:

• The NP-Guide system provides accurate, efficient, and reproducible projection-based localization.
• Its portability, cost-effectiveness, and ease of use make it a valuable tool, particularly in resource-limited settings.
• Further multicenter studies are needed to validate these preliminary findings for routine clinical adoption.