From Surface Digitization to Subsurface Guidance: Development and Validation of A Self-contained Mixed Reality Surgical Navigation System for Precision Liver Surgery

Abstract

This research presents the first fully self-contained mixed reality (MR) surgical navigation system for liver surgery, addressing critical limitations in current image-guided surgical approaches. Traditional navigation systems fail to account for intraoperative tissue deformation and require surgeons to repeatedly shift attention between the operative field and remote monitoring displays, creating cognitive burden and compromising precision. Our comprehensive MR platform integrates three essential components within a Microsoft HoloLens 2 headset: precision tool tracking using the device's depth camera, biomechanical deformation correction through advanced registration algorithms, and real-time mixed reality visualization with voice-controlled interfaces. A key innovation introduces an external retro-reflective reference tool that dramatically improves hologram stability, achieving substantial drift reduction. Through rigorous validation including clinical comparison of surface acquisition methods and comprehensive phantom experiments, our system demonstrates remarkable performance improvements with significant reductions in target registration error and enhanced tracking accuracy. The platform successfully enables surgeons to visualize subsurface tumors and vascular structures with superior stability and intuitive interaction. This work fundamentally transforms surgeon-technology interaction, creating more intuitive surgical workflows that enhance accuracy while reducing complications. The comprehensive validation framework provides standardized protocols for evaluating future MR surgical technologies, positioning this technology as a significant advancement toward routine clinical adoption in liver surgery and other soft tissue interventions requiring precise intraoperative guidance.