All-in-One Augmented Reality Guided Head and Neck Tumor Resection.

Positive margins are common in head and neck squamous cell carcinoma, yet intraoperative re-resection is often imprecise because margin locations are typically communicated verbally from pathology. We present an all-in-one augmented reality (AR) system that relocalizes positive margins from a resected specimen to the resection bed and visualizes them in situ using HoloLens 2 depth sensing and fully automated markerless surface registration. In a silicone phantom study with six medical trainees, markerless registration achieved target registration errors comparable to a marker-based baseline (median 1.8 mm vs. 1.7 mm; maximum < 4 mm). In a margin relocalization task, AR guidance reduced error from verbal guidance (median 14.2 mm) to a few millimeters (median 3.2 mm), with all AR localizations within 5mm error. These results support the feasibility of markerless AR margin guidance for more precise intraoperative re-resection.