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210Chapter12firstwe(the3DLab)shouldstopproviding2DmeasurestothecliniciansWeshouldstopprovidingtheclinicianswithlengthmeasuresthatexplainhowabonefragmentshouldbemovedWeshouldstopexpressingtherollpitchyawandanteriordisplacementinnumberstodescribehowamaxillashouldberepositionedWeshouldstopcreatingreferencepointsonanorbitalfloorimplanttodeduceitspositionInsteadweshouldstartusingARglassesassoonaspossible Thepotentialof3Dvisualizationmethodsintheoperationtheatrebymeansof3Dcomputerscreens3DholographicprojectorsandvariouskindsofstereoscopicARglassesisdescribedinmanystudies1619–23ThemainconcernofearlierstudiesarethehighcoststhecumbersomenessofusingnewtoolsduringsurgeryandthelackofcomparativestudiesYetthelatestARglasses(egtheHoloLens2)areeasy tousecheapand widelyavailableandcould thereforemake3DvisualizationaccessibleineveryORInadditionfutureresearchshouldalsofocusontheusabilityofARglassesduringsurgeryandeliminatingfactorsthatarecumbersomeReason 2-FromdiagnostictoinstructiveBecausemedicalimagescanbeviewedquicklyandeasilyatdifferentlocationswithARglassesitcanbeexpectedthatmedicalimaginginitiallyacquiredfordiagnosticpurposeswillalsobeconsultedduringinterventionsForexampleCT-angioscansusedinfreeflapsurgeryassessthenumberandaccessibilityofperforators(bloodvessels)Yetthesamescanscouldbeused(afterautomaticsegmentationandreconstruction)tovisualizethecourseandpositionoftheseperforatorsin3DatthecorrectanatomicalpositioninthepatientThiswasillustratedinChapter8wherepre-surgicalinformationwasusedduringabreastreconstructionwithamicrosurgicalDIEPflapAdiagnosticCT-angioscanwassegmentedandtransformedtoa3DvisualizationintheHoloLensIncombinationwithreal-timetrackingandanovelregistrationmethodusingthepatient’sabdominalskinmarks thesurgeon wasable tosee thecomplexanatomydirectlyonandinthepatientInfollow-upresearch(notyetpublished)thisinnovative workflow was testedin tenpatientsin apre-surgicalpreparation settinganddemonstratedthattheHoloLenscanindicateperforatorlocationswithinaclinicalmarginof10mmThisispromisingforclinicalimplementationbecausethisworkflowdoesnotdemandmillimeteraccuracyTheusabilityintuitivenessandtheset-uparethemostimportantfactorsthatwilldecidewhenARwillbe
