Application of Mixed Reality in Endoscopic Streaming During Skull Base Surgery.

Area of Science:

• Neurosurgery
• Surgical Technology
• Medical Imaging

Background:

• Endoscopic endonasal approach presents ergonomic and workflow challenges.
• Surgeons often operate without direct line of sight using 2D displays.
• Mixed reality (MR) may enhance visualization by integrating feeds into a heads-up display.

Purpose of the Study:

• Evaluate MR performance, usability, and ergonomics versus 2D displays.
• Assess MR's role in intraoperative streaming for endoscopic skull base surgeries.
• Compare surgical outcomes and surgeon experience between MR and 2D interfaces.

Main Methods:

• Four neurosurgeons performed cadaveric dissections using both 2D and MR (HoloLens 2) interfaces.
• Surgical performance assessed via objective error analysis and blinded surveys.
• Usability and ergonomics evaluated using Surgical Task Load Index and Simulator Sickness Questionnaire.

Main Results:

• No significant difference in overall surgical errors between MR and 2D displays (P = .73).
• Experts and nonexperts showed no difference in distinguishing display types (P = .90).
• MR-streaming demonstrated reduced task load but reported ergonomic issues like discomfort and eyestrain.

Conclusions:

• MR-streaming provides comparable surgical performance to 2D displays in cadaveric models.
• Further development is needed to address ergonomic shortcomings and latency.
• MR presents a promising avenue for advancing the digital operating room concept.