Comprehensive mixed reality surgical navigation system for liver surgery
Bowen Xiang, Jon S. Heiselman, Michael I. Miga · Journal of medical imaging · 2025
PurposeIntraoperative liver deformation and the need to glance repeatedly between the operative field and a remote monitor undermine the precision and workflow of image-guided liver surgery. Existing mixed reality (MR) prototypes address only isolated aspects of this challenge and lack quantitative validation in deformable anatomy.ApproachWe introduce a fully self-contained MR navigation system for liver surgery that runs on a MR headset and bridges this clinical gap by (1) stabilizing holographic content with an external retro-reflective reference tool that defines a fixed world origin, (2) tracking instruments and surface points in real time with the headset’s depth camera, and (3) compensating soft-tissue deformation through a weighted ICP + linearized iterative boundary reconstruction pipeline. A lightweight server–client architecture streams deformation-corrected 3D models to the headset and enables hands-free control via voice commands.ResultsValidation on a multistate liver-phantom protocol demonstrated that the reference tool reduced mean hologram drift from 4.0±1.2 mm to 1.1±0.3 mm and improved tracking accuracy from 3.6±1.3 to 2.3±0.8 mm. Across five simulated deformation states, nonrigid registration lowered surface target registration error from 7.4±4.8 to 3.0±2.7 mm—an average 57% error reduction—yielding sub-4 mm guidance accuracy.ConclusionsBy unifying stable MR visualization, tool tracking, and biomechanical deformation correction in a single headset, the proposed platform eliminates monitor-related context switching and restores spatial fidelity lost to liver motion. The device-agnostic framework is extendable to open approaches and potentially laparoscopic workflows and other soft-tissue interventions, marking a significant step toward MR-enabled surgical navigation.