What is the evidence for HoloLens in surgical planning?

“Postoperative statistics indicated that the operation time for the MR group was significantly shorter than that of the control group (102.00(98.00 103.00) minutes vs. 103.50(101.00 106.75) minutes, p = 0.017).”

p = 0.017

“The HoloCare™ MXR system was seamlessly integrated into all five cases and improved tumor localization and understanding of vascular anatomy.”

“Compared with the MR (-) group, intraoperative blood loss and hospital stay were decreased, and the number of lymph nodes harvested around the middle colic artery/vein were increased without prolonging the operative time in the MR (+) group.”

“Although a slight increase in procedure time was observed in a few cases, MR did not significantly prolong SP or H.”

“The additional planning time for segmentation averaged 45 min.”

45 min

“All patients had negative resection margins, indicating equivalent therapeutic outcomes between the two groups.”

“The prototype achieved a mean SUS score of 67.25 (SD 7.95), indicating acceptable usability.”

67.25 (SD 7.95)

“Survey results from 18 faculty members regarding seven questions indicated that AREP was user-friendly and can be effective in presurgical planning moving forward.”

“The AR condition had the highest scores for mental demand (median 75, IQR 70-85), effort (median 55, IQR 30-65), and frustration (median 40, IQR 15-75) compared with the VR and PC conditions.”

“The orientation of adjacent organs was better understood using AR (5 vs. 4, p = 0.004).”

p = 0.004

“All subjects strongly agreed that MR can be used effectively for surgical training, whereas 10 (90.9%) strongly agreed that it can be used effectively for preoperative planning.”

90.9%

“In addition, the intended patient positioning changed in 16.1% of the cases, the surgical approach in 33.9% and osteosynthesis in 39.3%.”

33.9%

“According to experts, the most useful areas are medical education and surgical planning.”

“HoloLens (Microsoft Corp., Redmond, WA, USA) was perceived as the best imaging technology for the surgical planning (50% for prostate and 60% for kidney)”

60%

“Analysis of the Likert-scale questionnaire shows that MR adds significant value to understanding and communication, spatial awareness, learning and effectiveness.”

“The results showed that the MR models were ranked as the best modality amongst the three, and were significantly better than DICOM images in demonstrating complex CHD lesions (mean difference (MD) = 0.76, p = 0.01)”

p = 0.01

“High satisfaction toward the potential role of this technology in surgical planning and understanding of surgical complexity (both scored 9/10) were expressed.”

9/10

“The studies indicated that using a joystick improved the interactive capacity and enabled operator to plan MRgPBx in less time.”

“This preliminary study demonstrates that MR holograms as surgical planning tool for congenital heart disease may have a high diagnostic value and contribute to understanding complex morphology.”

“In this study, the 3-D kidney models were associated with improved anatomical understanding among the surgeons and can be helpful in future preoperative planning of nephron-sparing surgery for Wilms tumors.”

“Using different visualization settings, the spatial relationship of perforators to surrounding anatomical structures-especially the subcutaneous tissue and the Rectus Abdominis Muscle-can be understood more intuitively.”

“An expert study across four common brain tumor locations demonstrated that the MOO model significantly outperformed manual methods in satisfying safety criteria.”

“Expert evaluation showed positive perceived utility for target-anatomy-dose understanding, motion interpretation, and multidisciplinary communication.”

“The HJPHub system enabled three-dimensional assessment of complex anatomy, facilitating optimal transseptal puncture site selection.”

“The application of AR technology facilitated precise tumor localization, reduced the operation time, and prevented damage to vessels and adjacent anatomical structures.”

“Feedback highlighted its comfort, confidence enhancement, and user-friendliness.”

“Furthermore, LS showed that clinicians in the DCU-Net-based MR group had better spatial awareness of tumor preoperative planning.”

“Preoperative MixR allowed a comprehensive understanding of complex anatomical relationships and spatial mapping, using immersive 3-dimensional navigation.”

“No complications were reported during or after the surgery and the dog completely recovered.”

“The incision site marking made using HoloLens® 2 differed by one intercostal space from the marking made using a conventional surgeon's mental reconstructed image from the patient's preoperative imaging and was found to be a more appropriate site of entry”

“Preoperative modeling required 15.3 ± 5.1 min, while AR navigation averaged 12.7 ± 3.2 min.”

15.3 ± 5.1 min

“Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application.”

“This technology allows for efficient and accurate registration of a patient's 3D anatomical model onto their head while positioned in the operating room.”

“However, the recommendation for widespread use awaits validation through clinical trials.”

“The mean projection error is 10.3 ± 9.4 mm.”

10.3 ± 9.4 mm

“Both preoperatively and intraoperatively, the tool augmented spatial orientation and facilitated precise stenosis localization, thereby enhancing the surgeon's operative proficiency.”

“When the surgical team was asked to evaluate whether the 3DAR better prepared the surgeon for planned surgical resection, 10 responses favored the 3DAR, 5 favored the 2D CT scans and 11 showed no difference (p = 0.074).”

p = 0.074

“In these sessions, surgeons discuss perforator anatomy and perforator selection strategies whilst comprehensively assessing the respective models.”

“Novel techniques, including ultrasonography-guided placement of a guiding marker and strategic port-site placement facilitated by HoloLens2, ensured accurate tumor identification and laparoscopic resection with minimal blood loss and no intraoperative complications.”

“AR for microsurgical planning was performed in two inguinal regions and was 100% correlated with the results of high-frequency ultrasound, in the case of perforant vessels of the peroneal artery”

100%

“Gross total resection and favorable functional outcome were finally achieved.”

“The average time taken to mark each perforator is 7.7 ± 6.5 s, with an average absolute error of 6.8 ± 2.6 mm and an estimated average deviation of 3.6 ± 1.4 mm.”

7.7 ± 6.5 s

“Initial responses indicated that the prototype could be an effective surgical teaching and planning tool for less-experienced neurosurgeons because it could allow neurosurgeons to view physical and image space simultaneously.”

“The graphic performance was also deemed very satisfactory.”

“Although the authors did not use the HoloLens technology to make clinical decisions, they provide evidence of its accuracy and ease of use, offering a proof of concept.”

“For surgical planning, we have used 3D CT and MRI reconstructions to evaluate complex cases, which has made the interpretation of the anatomy more precise and the planning of the technique simpler.”

“The AR method was non-inferior to the 2D desktop planner, with a mean error of 2.1 ± 1.4 mm.”

2.1 ± 1.4 mm

“The qualitative survey of the LS questionnaire suggested that the MR group had superior spatial awareness of tumors and was considered more effective as a preoperative planning tool than the conventional group.”

“From November 2019 until February 2022, 53 3D virtual biomodels were produced for intervention planning (using Virtual/Augmented Reality and/or 3D printing), following a specific segmentation and preprocessing workflow for biomodelling, in patients with advanced heart failure due to structural heart disease or cardiomyopathies.”

“During the operation, we successfully identified the planned relationship between the aneurysm and the fetal PCA.”

“AR technology shows promise in enhancing perforator identification efficiency and deepening understanding of perforator trajectories during preoperative planning.”

“We have successfully created a valuable and easy-to-use neuroimaging data mixed reality app, laying the foundation for more future clinical uses, as more models and data derived from various biomedical images can be imported.”

“The planning time was low and the surgeon's satisfaction was high regarding the practicality of its use and the result obtained.”

“The intraoperative hologram contributed to better presentation of tumor size and locations, more precise setting of needles used to irreversible electroporation and for determining ablation line in case of liver metastases.”

“The 3D visualization of pathological conditions resulted in correct preoperative surgical planning and less invasive surgery in all five cases.”

“Without an HMD, the misidentification rate of the level was at 26.5%, while with it, the rate was reduced to 14.3%.”

14.3%

“Both techniques were used (8 clinical cases) for preoperative planning and intraoperative navigation, which allowed surgeons to verify the radicality of the operation, to have visual control of all anatomical structures near the zone of interest”

“We integrated the MR technique with a 3D surgical template to successfully accomplish the surgery.”

“The solution developed for medical training was considered a useful tool for training in urological anatomy, facilitating the translation of this knowledge to clinical practice.”

“A preliminary qualitative evaluation revealed that holographic visualization of high-resolution 3D MRI data offers an intuitive and interactive perspective of the complex brain vasculature and anatomical structures.”

“Results suggest that the platform is easy and quick to learn and could be used in clinical practice to improve anatomical understanding, to make surgical planning easier than the traditional method, and to strengthen the memorization of surgical planning.”

“Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence.”

“This system was useful for cervical and lumbar decompression for confirming the proper decompression area preoperatively.”

“Feedback from testing the prototype indicated potential for augmented reality to assist an interventionalist in spatial understanding and depth perception of spatially complex anatomy and could increase confidence in pre-procedural planning.”

“The intraoperative hologram contributed to better imagination of tumor locations, and for determining the parenchymal dissection line in the hepatectomy for the patients with more than 20 multiple colo-rectal liver metastases.”

“Mixed-reality visualization during surgical planning may facilitate accurate and rapid identification of small lung lesions during minimally invasive surgeries and reduce the need for additional invasive preoperative localization procedures.”

“Furthermore, our clinical use-cases demonstrate that the surgeons perceived the HoloLens to be useful, recommendable to other surgeons and also provided a definitive answer at a multi-disciplinary team meeting.”

“Holograms provided enhanced visualization of 3-dimensional spatial relationships and depth perception within and between anatomic structures which could not be observed by the conventional 2-dimensional display monitors.”

“Clinicians expressed their satisfaction with the quality of imaging and potential clinical benefits.”

“This method can be quicker than the traditional way and eliminates sizer implants from the process.”

“The application of 3D printed and AR models is safe and feasible and can influence surgical decisions.”

“The exact match with the target organ was performed during the operation via HoloLens glasses leaded by the 3D model.”

“Holograms were successfully created in all cases.”

“There was no significant bias between two methods used and 95% of the values were within the limits of the agreement.”

95%

“The current set-up enables visualization and perception of holograms with a margin tolerance of < 6 mm.”

< 6 mm