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212Chapter12EvenwhensurgicalguidescouldbeusedtherelativelyhighcoststheadditionalmanufacturingtimeandtheinflexibilityareseriouslimitationsForasurgicalcraniosynostosisproceduretheproductionofanosteotomyandareconstructionguiderequires eight days and costs around1400 euros (Chapter 4 and Chapter7)Whiletimeandcostarelikelytobereducedinfuturewithnewer3Dprintingtechniques theselimitations are completely absent whenusing AR guidanceEventhoughChapter7concludedthatsurgicalguidesaremoreaccurateatthispointwebelievethatARwillhaveamajorimpactonclinicalpracticebecauseitcanbemadeeasilyandwidelyaccessiblereducecostsandeliminatethemanufacturingtimeofsurgicalguidesTherearetwoimportantphaseswhentheplanningistransferredinOCVRmarkingtheosteotomylinesandperformingthecranialreconstructionChapter7focusedonlyonthefirstphasebecausethisallowedascientificallyfairandstraightforwardcomparisonbetween theARmethodand thesurgicalguidesHowever,inretrospectitwouldhavebeenfarmoreinterestingtoevaluatethereconstructionphasebecausethisissurgicallymorechallengingInadditionwhenbonesegmentsarenotcutpreciselythesesegmentsmightnotfitintotheguidesConsidering this therealadded valueofARcouldbe toprovideassistancetothesurgeonhowtoreconstructthebonesegmentsFollowingthisahybridsolutionthatusessurgicalguidesfordelineationandARforreconstructionmightbea futuredirection thatshouldbeinvestigated Thesimplesmartphone-assistedARapplicationthatwasusedbyAlshomeretalconfirmsthatthisisprobablythemostlogicalfirststeptowardclinicalimplementation25ThereisanotherimportantbenefitofusingARinsteadofsurgicalguidesinfutureapplicationstheAR-trackingsystemcouldanticipatepotentialusererrorsincasethesurgeonhastodeviatefromtheoriginalsurgicalplanningForexampleif(foranyreason)thesurgeondeviatesfromtheplanninginhisfirstcutinthefibulathesegmentsmightnotfittogether(eveniftherestofthecutsaremadeaccurately)AnARguidancesystemcouldcompensateforthiserrorBecausethesawistrackedbytheARsystemandtheplanningisonly ‘virtual’,theARguidancesystemcouldautomaticallyevaluateeveryactionofthesurgeonandadjustthesubsequentosteotomiesoftheplanningInthiswayamoredynamicguidancesystemwillbeavailable26Figure8showsanimpressionofa firstprototypeofsuchadynamicguidancesystem