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Towardholographic-guidedsurgery1136intuitivevisualizationofthetrackingdataintraoperativelytailoredtothesurgicalinterventionarewanted8InthisstudyacombinationofIGSandARvisualizationispresentedTheimplementationofARinIGSmakesitpossibletoprojectthevirtualplanningdirectlyonthepatient ThemostimportantadvantageisthatthissolvestheswitchingfocusproblemallowingthesurgeontolookcontinuouslyatthesurgicalsiteinsteadofswitchingtoamonitorwhenconsultingthevirtualplanningIfaHMDwithastereoscopicviewisusedtoaccomplishARcomplexstructuresand virtualplanningcanbe visualizedin3Dat theiranatomicalpositionresultinginmoreintuitivevisualizationTheproposedsystemcanbeusedforawidevarietyofinterventionsinwhichthepositionsofcritical(anatomical)structures(bonepiecesblood vesselsnervesforeignbodiestumorsetc)tobevisualizedduringsurgeryarecrucialAnARbasedIGSsystemcouldalsobeusedinkeyholesurgeryandminimallyinvasiveproceduresprovidingthesurgeonwithavirtualviewofthepatient’sanatomyandavirtualviewofthepositionoftheinstrumentsdirectlyonthepatientARcancompensateforthelossofdirectvisionandthiscouldimprovehand-eyecoordination whichmayincrease focus and efficiency313536 AR can serve as a visualguideduringdelicatesurgicalprocedureswhendissectingandexploringthepatient’s anatomy10Pratt et alused AR duringreconstructive surgery and amanualalignment to visualizerelevantanatomyand thelocalizationofperforating vesselsdirectlyonthepatientintheviewofthesurgeon5Byresolvingtheswitchingfocusproblemandwithreal3DvisualizationARmightreducethecognitiveloadofthesurgeon ThissetupallowstheuseofmoreadvancedandcomplexvirtualplanningduringsurgeryHARDWARESELECTIONAwidevarietyofopticaltrackingsystemsareavailableforclinicalapplicationsInthisstudythePSTBasetrackerwasusedbecauseofitshighaccuracythepossibilitytodevelopuniquetrackableobjectsandbecausethecommunicationprotocolcanconnectthetrackertoothersoftwareplatformsTheHoloLenswasusedfortheARvisualizationAlthoughmultipleARglassesareavailabletodaycommerciallyandnoncommerciallymanydonotprovidereal3Dvisualizationbystereosee-throughdisplaysTheMetaGlasses1andMetaGlasses2(MetaCompanySanMateoCAUSA)provide3Dvisualizationwithalargefieldofviewbut a cable connected to a computerisusedIn our experience the wireless design
