Patient-specific Anatomical Registration Marker-guided Surgical Navigation Using a Wearable Mixed-reality Head-mounted Display in Transvaginal Surgery.

Abstract

<h4>Objective</h4>To evaluate the feasibility and perceived utility of mixed-reality-assisted navigation using patient-specific 3-dimensional holographic models derived from computed tomography in transvaginal surgery for stress urinary incontinence and pelvic organ prolapse.<h4>Methods</h4>Patient-specific computed tomography imaging data were converted into 3-dimensional holographic models using the HoloEyes MD system. The holograms were projected using HoloLens 2 for intraoperative guidance. The study included 24 transvaginal surgeries (tension-free vaginal tape, transobturator tape, transvaginal mesh, and sacrospinous ligament suspension), involving 46 surgeons and assistants. Surgical tools were modeled as spatial reference markers using kneadable erasers and integrated into the mixed-reality visualization system.<h4>Results</h4>The mixed-reality system was perceived to improve surgeons' spatial understanding of pelvic anatomy and surgical workflow, particularly in anatomically complex regions such as the sacrospinous ligament and obturator foramen. Most participants reported enhanced anatomical comprehension and perceived usefulness of the system during preoperative planning and intraoperative confirmation. Familiarity with the technology improved with repeated use.<h4>Conclusion</h4>Mixed-reality-assisted navigation using patient-specific holographic models is feasible in transvaginal procedures and may support surgeons' spatial understanding and confidence during surgery. This technology shows potential as a useful educational and intraoperative support tool in urology and gynecology.