Optimizing visualization feedback of real-time navigation for orbital reconstructions: A preclinical study

Surgical navigation can improve orbital implant positioning, yet current commercial systems are limited by the feedback interpretation and its timing after implant positioning. This study evaluated how different visualization methods impact the efficiency and interpretability of real-time feedback during orbital reconstruction. A standardized in-vitro setup was used to simulate orbital reconstructions by six surgeons of varying experience levels. Each surgeon performed implant positioning tasks using six different visualization modes, starting from three predefined misaligned positions. Interpretation accuracy and time to correct implant positioning were recorded. Visualization methods varied in the presence of computed tomography (CT) images, visualization of three-dimensional (3D) models, and use of implant-to-target distance visualization (distance mapping). Across a total of 108 reconstructions, no statistically significant differences in positioning time or interpretation accuracy were found between visualization methods. However, surgeon feedback revealed strong preferences: anatomical CT data and additional coronal view at the ledge improved spatial understanding, while views relying solely on 3D models or instrument orientation were seen as less intuitive. Notably, surgeons reported a consistent two-step strategy: initially 3D views were used for initial spatial alignment, followed by two-dimensional slices for precise adjustments. These findings suggest that while performance metrics may not differ across visualization modes, surgeon usability and interpretability are critical for clinical implementation. Future development of a clinically viable navigation workflow should include real-time feedback with both anatomical context and tailored visual support to promote more intuitive navigation in orbital surgery.