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Generaldiscussionandfutureperspectives21512indicatesthelandmarks3233 YetbecauseARcanvisualizeapotentialmismatchofeachlandmark directly on thepatient theregistrationlandmarks couldbe adjustedtoimprove theoverallregistration ThisisasubstantialreasonwhyPBRcouldworkbetterinARthaninanimageguidedsurgery(IGS)systemsInfutureresearchtheautomaticdetectionoflandmarkswillbeusedtoimprovethePBRPepeetalpresentedamarkerlessPBRmethodthatautomaticallydetectslandmarksinthefaceandusestheseforregistrationontheHoloLens34EspeciallyforthedetectionofskinmarkersduringDIEP flappreparationanautomaticdetectionalgorithm forabdominalneviwouldimprovetheworkflowofChapter8SURFACE-BASEDREGISTRATIONSimilartoPBRsurface-basedregistration(SBR)usesasurfacetoalignthevirtualdataonapatientandisoftenusedinneurosurgery35SBRrequiresasurfacewithsufficientcurvaturesuchas the face Witha(mobile)3Dsurfacescanner, thesurfaceofapatientintheoperationroomcanbescannedandthevirtualcontentcanbematchedEspeciallyforcraniosynostosissurgery,SBRcouldreallyimprovetheaccuracyandminimize thecomplexityofcurrentregistrationmethodsBecause thebonycraniumhasanevidentanduniquecurvaturematchingtheimagedatawillberelativelyeasyandaccurate WhenSBRisimplementedthecurrentlimitationofPBR(egtoofewclearlandmarks)shouldbesurmounted Varioustestswith(semi-)mobile3Dscannerswereperformedinourgroupandshowedthatthequalitywassufficient(Figure10)However,alongscanningandprocessingtime(around15minutes)makesthisworkflownotsuitableforintra-operativeuseatthismomentNeverthelessSBMisarealisticandpromisingfutureoptiononceitcansatisfysomerequirements Theseinclude a fast setup time(less than fiveminutes) a fast scanningtime(lessthanoneminute)andafastprocessingtime(lessthanafewminutes)Fortunately,thenewestgeneration3DscannerssuchastheArtecEva(Artec3DLuxembourgLuxembourg)andtheEinscanProHD(SHINING3DHangzhouChina)andseveralotherscannersalreadyfulfilstheserequirements36Thereforefutureresearchshouldfocusontheimplementationof3Dscanningduringsurgeryinamannerthatdoesnothamperthesurgicalroutinetoomuch