2026 Proffered Presentations
S138: APPLICATION OF MIXED REALITY IN ENDOSCOPIC STREAMING DURING SKULL BASE SURGERY
Yujin Choi, BS1; Shovan Bhatia, BS1; Adam C Monek, BS1; Harrison Alexander2; Talha Khan, PhD3; Brendan Szczepkowski4; Griffin Hurt, BPhil2; Anthony Tang, BS5; Michael R Kann, BE1; Regan M Shanahan, BA1; Brock Gjesdal1; Rishi Basdeo, MS6; Kyle Affolter, MS1; David Fernandes Cabral, MD1; Georgios A Zenonos, MD1; Paul A Gardner, MD1; Jacob T Biehl, PhD2; Edward G Andrews, MD1; 1Department of Neurosurgery, University of Pittsburgh Medical Center; 2School of Computing and Information Sciences, University of Pittsburgh; 3College of Computing, Grand Valley State University; 4Dietrich School of Arts and Sciences, University of Pittsburgh; 5Department of Otolaryngology, University of Pittsburgh Medical Center; 6Department of Mechanical Engineering, Carnegie Mellon University
Background: Despite the success of the endoscopic endonasal approach, ergonomic and workflow challenges require surgeons to operate outside their direct line of sight using non-sterile planar displays. Mixed reality (MR) may address these limitations by unifying video feeds and imaging into a heads-up display; however, its role in intraoperative streaming remains unclear.
Objective: To evaluate the performance, usability, and ergonomics of MR endoscopic streaming compared to 2D planar display during skull base surgeries in cadaveric models.
Methods: Four skull base neurosurgeons from a quaternary care institution each conducted four trials of endonasal endoscopic skull base dissections on cadaveric heads, two with a 2D planar display and two with an MR-streaming interface (HoloLens 2, Microsoft, Seattle, WA) (Figure 1). Surgical performance was evaluated through 1) an objective error analysis performed by a neurosurgeon blinded to the display type and 2) a blinded video condition recognition survey distributed to experts and non-experts in skull base surgery. Usability of the MR-streaming interface was evaluated through post-trial Surgical Task Load Index scores. Ergonomics were evaluated by the Simulator Sickness Questionnaire.
Results: An objective error analysis revealed no statistical difference in the total number of errors encountered between MR-streaming and 2D planar display conditions (p=0.73) (Figure 2a). Subgroup analysis per error type further demonstrated no significant differences for all examined errors (Figure 2b). Survey responses showed no significant difference in the experts and non-experts' ability to distinguish between MR-streaming and 2D planar display conditions (p=0.90) (Figure 3). MR-streaming was associated with reduced task load compared to current literature (Table 1a). Lastly, MR-streaming had ergonomic shortcomings such as general discomfort, eyestrain, and difficulty concentrating (Table 1b).
Conclusion: The utilization of endoscopic MR-streaming provides comparable surgical task performance compared to 2D planar display for endoscopic skull base surgeries. With further improvements in the user experience and system performance, this novel method provides a promising pathway towards a digital operating room environment.
