Development of augmented-reality applications in otolaryngology-head and neck surgery

Objectives/Hypothesis Augmented reality (AR) allows for the addition of transparent virtual images and video to one's view of a physical environment. Our objective was to develop a head-worn, AR system for accurate, intraoperative localization of pathology and normal anatomic landmarks during open head and neck surgery. Study Design Face validity and case study. Methods A protocol was developed for the creation of three-dimensional (3D) virtual models based on computed tomography scans. Using the HoloLens AR platform, a novel system of registration and tracking was developed. Accuracy was determined in relation to actual physical landmarks. A face validity study was then performed in which otolaryngologists were asked to evaluate the technology and perform a simulated surgical task using AR image guidance. A case study highlighting the potential usefulness of the technology is also presented. Results An AR system was developed for intraoperative 3D visualization and localization. The average error in measurement of accuracy was 2.47 +/- 0.46 millimeters (1.99, 3.30). The face validity study supports the potential of this system to improve safety and efficiency in open head and neck surgical procedures. Conclusions An AR system for accurate localization of pathology and normal anatomic landmarks of the head and neck is feasible with current technology. A face validity study reveals the potential value of the system in intraoperative image guidance. This application of AR, among others in the field of otolaryngology-head and neck surgery, promises to improve surgical efficiency and patient safety in the operating room. Level of Evidence 2b Laryngoscope, 2019